Abstract
Purpose :
Atropine has become standard of care for myopia control in the Netherlands; high dose is recommended for those at risk of high myopia. A risk factor for progression of myopia despite therapy is a young age. In our 3 year follow up study, we evaluated the effect of age on spherical equivalent of refraction (SER) and axial length (AL) change in myopic children receiving atropine 0.5%.
Methods :
Children aged 4-16 years with progressive myopia ≥ 1D/year or myopia ≤ -2.5D were prescribed atropine 0.5% at baseline. Children with additional ocular pathology were excluded. Examination including cycloplegic refraction and AL measurement was performed at baseline and follow-up. Outcome measures were AL and SER; annual progression of Al and SER were compared between age groups 4-6, 7-9, and 10-16 years. Differences in progression of AL and SER between age groups were calculated with linear regression adjusted for gender. Correlation of progression rates between first year and second or third year was calculated with the Pearson’s correlation.
Results :
A total of 116 patients were enrolled in the study (mean age: 9.26 ±2.2 years). At baseline, mean SER was -3.47 ±1.73D; mean AL was 24.92 ±0.90mm. 90 (78%) children continued therapy throughout the 3-year follow-up. Mean AL annual progression was 0.41mm ±0.23 (SER -0.75D ±0.08) for 4-6 year-olds; 0.15mm ±0.12 (-0.22D ±0.35) and for 7-9 year-olds and 0.08 mm ±0.08 (-0.14D±0.23) for 10-16 year-olds. Children aged 4-6 years progressed faster in AL than those aged 7-9 years (P=0.001) or 10-16 years (P<0.001), for SER faster progression was found between 4-6 and 10-16 year old’s (P=0.04). Children with higher AL progression in the first year of therapy were also the faster progressors in the second and third year of therapy (r=0.40 and r=0.40 1st vs 3rd). Due to the hyperopic shift of SER in the first year of therapy only the 2nd and 3rd year of therapy was a predictor of response to therapy (r=0.14 and r=0.24 1st vs 3rd).
Conclusions :
Despite 0.5% atropine, children younger than 7 years of age for progressive myopia progressed up to three times faster in both SER and AL than older children. The latter also had a more consistent protection by this concentration of atropine during the 3 year regimen. Myopia progression in young children may need more stringent control, such as atropine 1% or combination therapy, in particular since they are at risk for the more extreme values of myopia.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.