Abstract
Purpose :
Low-concentration atropine eye drops can delay myopia onset. Identifying whom to consider for treatment is important. This study aimed to evaluate the associated factors affecting the effectiveness of low-concentration atropine eyedrops for delaying the onset of myopia.
Methods :
Secondary analysis from a randomized, placebo-controlled, double-masked trial. (LAMP 2 study). A total of 353 non-myopic children aged 4–9 years with cycloplegic spherical equivalent between +1.00 D to 0.00 D and astigmatism less than -1.00 D, were randomly assigned to the 0.05% atropine (n=116), 0.01% atropine (n=122), and placebo (n=125) groups who completed 2 years of LAMP 2 trial. Factors associated with myopia onset, fast myopic shift, spherical equivalent and axial length changes over 2 years, and the interactions of these factors with atropine treatment concentration were assessed.
Results :
Less baseline hyperopic reserve and higher level of parental myopia were the risk factors for myopia onset (OR=0.02, P<0.001 and OR=2.29, P=0.003 respectively), fast myopic shift (OR=0.16, P<0.001 and OR=1.87, P=0.01 respectively), spherical equivalent myopic shift (β=0.45, P<0.001 and β=-0.22, P=0.003 respectively) and AL elongation (β=-0.22, P<0.001 and β= 0.08, P=0.01 respectively). There was positive interaction between treatment of 0.05% and baseline hyperopic reserve (P=0.02), but not parental myopia (P=0.94). In the placebo group, the myopic shift over 2 years was highly influenced by the hyperopic reserve, the lesser hyperopic reserve the faster progression (-0.74D for the subgroup between +1.0D and 0.75D, increased to -1.42D for the subgroup between +0.00 to +0.25D, P-trend <0.001). The same trends were observed in 0.01% group (P<0.001). In contrast, in 0.05% atropine group, myopic shift was stable, from 0.44 to 0.48D, in various hyperopic reserve groups (P=0.99). Similar trends were observed in AL elongation in various hyperopic reserve groups over 2 years.
Conclusions :
Reduced baseline hyperopic reserve and higher level of parental myopia were two significant risk factors for both myopia onset and myopic shift in non-myopic children, and therefore should be considered for preventive treatment. Hyperopic reserve could be an indicator for treatment, implying that children may benefit more from early intervention with 0.05% atropine when their hyperopic reserve remains relatively preserved.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.