Abstract
Purpose :
Choroidal thickness (CT) has been shown to respond to low-dose atropine eye drop during myopia treatment. Choroidal thinning appears to be associated with myopic macular degeneration (MMD); however, it is unclear how macular CT changes in response to 0.01% atropine eye drop relate to myopia control in European children. We investigated long-term macular CT changes in children receiving 0.01% atropine eye drop and its relationship with spherical equivalent (SE) progression and axial length (AL) elongation.
Methods :
250 myopic children (167 – 0.01% atropine, 83 – placebo) were enrolled in the MOSAIC (ISRCTN36732601) clinical trial. Participants with complete 2-year CT (Topcon Triton Swept Source OCT), SE, and AL data were included in this study. Changes in macular CT (subfoveal, parafoveal, and perifoveal regions) at 2 years and associations with changes in SE and AL elongation were analyzed using linear mixed models with eyes nested in participants as random intercept.
Results :
190 children (125 – 0.01% atropine, 65 – placebo) with valid CT were included in the analysis. There were no significant differences in baseline characteristics (including CT, SE, and AL) between atropine and placebo groups (P>0.05 for all). CT thinning over the 2-year period was significantly lower in the 0.01% atropine compared to placebo group across the subfoveal [-1.44±25.69 and -7.86±24.51 (P=0.019)], parafoveal [-0.73±22.88 and -7.71±21.50 (P=0.003)], and perifoveal [-0.45±18.74 and -7.44±17.36 (P=0.0004)] regions. Subfoveal (β=0.058, P=0.006), parafoveal (β=-0.079, P=0.009), and perifoveal (β=0.092, P<0.0001) CT changes were significantly associated with SE change over 2 years. AL change was significantly associated with changes in subfoveal (β=-0.019, P=0.014) and perifoveal (β=-0.038, P<0.0001) regions, but not with changes in the parafoveal region (β=0.002, P=0.055).
Conclusions :
Myopic children treated with 0.01% atropine had significantly less macular CT thinning relative to untreated children over the 2-year study period. The degree of CT change related to the magnitude of SE and AL change. As choroidal thinning is associated with MMD, these findings suggest that 0.01% atropine could potentially mitigate risk of developing MMD or limit disease severity in affected eyes by restricting CT thinning during the active stages of myopia progression and AL growth.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.