Comment on: Efficacy of low-concentration atropine (0.01%) eye drops for prevention of axial myopic progression in premyopes.

Dear Editor,

We read the article “Efficacy of low concentration atropine (0.01%) eye drops for prevention of axial myopic progression in premyopes”[1] published in January 2022 issue.

We would like to congratulate the author for the successful randomized case control study. We have a few queries regarding the study, which are as follows:

The inclusion Criteria states that patients with Spherical Equivalent < +1.00 were included. Would be interesting to note how many with and without Low concentration Atropine (LCA) needed glass prescription at the end of the study period?

As age included is 4–12 years, was topography reliable/possible in all patients?

Since only family history of pathological or high myopia was excluded, significant risk factor in terms of myopia from an early age in parents can induce bias and needs to be addressed.[2]

LCA is well established in treating the progression of myopia, and 0.01% was chosen based on less rebound effects.[3] The article concludes with results at the end of 2 years, without mentioning if this is the phase 1 of the study. It would be interesting to note how long the effects last and the rebound effects if any.

We were also curious to understand how the other risk factors in terms of outdoor activity, sunlight exposure, near activities, and vitamin D deficiency were standardized in both groups.[4]

With online classes being the norm in post-COVID-19 era, children in age group of 9–12 years were at a risk of more hours of near activities versus younger children. Although the study has a small sample size, would be interesting to know the outcomes in these subgroups.

While the above comments do not undermine the significance of LCA in preventing the onset of myopia in children at high risk for the same, addressing the impact of above-mentioned factors is imperative to establish the role of LCA in premyopes.

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Conflicts of interest

There are no conflicts of interest.