Abstract
Purpose :
Since 2015, five studies have published promising results on the use of low-dose atropine for the treatment of myopia. However, these results represent a majority Asian (82%) and Spanish (14%) cohort with <2% Caucasian participants. We investigated the effects of low-dose atropine on myopia progression in Australian school children.
Methods :
Retrospective data recording patient cycloplegic refraction, axial length (using a Carl Zeiss IOLMaster), height, eye colour and adverse treatment effects were collected with consent from 12 myopic patients ranging from 2-16 years of age, prescribed low-dose (0.005% - 0.01%) atropine eye drops. Half (6/12) were male and half (6/12) had at least one parent with myopia. The mean (and range) of observation durations before and during treatment were 2.44 (0-6.8) years and 2.37 (1.3–4.2) years respectively.
Results :
A clear division between fast (-0.67D/year) and slow (-0.22D/year) progression in refractive errors (spherical equivalent normalised to age) was observed. Within both groups, half were male (3/6 within each group) and half had at least one parent with myopia (3/6 within each group). Segregating data points within these groups into pre and post-atropine treatment, revealed a decrease in the slope of refractive progression after receiving atropine, which aligned well with published data on 0.01% atropine. Relative to rates before treatment, the slope of refractive error progression post-atropine treatment was reduced more for fast (-0.26D/year; 38%) than slow (-0.14D/year; 64%) progressing groups. Three patients who stopped treatment (two intermittently, one permanently) all experienced an accelerated refractive decline in at least one eye after cessation. The most common adverse effect was dilated pupils (5/12 subjects) however some patients also experienced dry or irritated eyes (2/12), headaches (1/12) or photophobia (1/12). 5/6 children with blue eyes experienced some adverse effect, compared to only 1/4 with brown eyes and 1 patient with hazel eyes.
Conclusions :
In our small sample, there were two distinct rates of myopia progression. Low-dose atropine slowed the progression of myopia in both fast and slow progressing myopes. However, accelerated ‘rebound’ growth may still occur upon cessation of treatment despite using a low dose. Additionally, children with blue eyes may be more susceptible to the negative effects of atropine treatment.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.