Abstract
Purpose :
Atropine's dose-dependent nature heightens the risk of amblyogenic factors, particularly with higher doses. This risk stems from reduced accommodation and systemic side effects, especially in those with lower body weight. This study examines the effectiveness of atropine in slowing myopia progression in children younger than 6 years old.
Methods :
A total of 65 young children (mean age 3.8yrs ±1.01) with progressive myopia were treated according to myopia severity: untreated (n=11: 3,9 yrs±0.9; mean SER of -3.7D (±3.4)), low-dose atropine (0.01, 0.05, and 0.1%, n=22; 4 yrs±1.0; mean SER -6.2D (±3.4)), and high-dose atropine (0.5 and 1%, n=32; 3.6 yrs±1.0; mean SER -8.1D (±2.7)). Baseline and 12-month follow-up assessments were conducted including cycloplegic refraction and axial length measurements. Progression of spherical equivalent (SER) and of axial length (AL) at 12-month were considered outcomes. Near visual acuity was measured with LogMAR based LEA chart. Children with amblyopia, strabismus, systemic disorders, and retinal dystrophies were excluded.
Results :
The progression of SER in the year preceding treatment was -0.38D (±0.4) for the untreated children (UC), -0.71D (±0.9) for low dose children (LD), and -1.4D (±1.3) for high dose children (HD). This correlated significantly with baseline refractive error (Pearson's R=0.315, p=0.03). Forty-four (68%) children completed one year of therapy. First-year mean progression of SER per group was -0.63D (±0.7, 67% increase) for UC, -0.38D (±0.9, 46% reduction) for LD, and -1.0D (±1.1, 29% reduction) for HD. Progression of AL was 0.48mm (±0.5) for UC, 0.36mm (±0.3) for LD, and 0.51mm (±0.2) for HD. Median near visual acuity for UC (1.0 IQR 0.19) did not differ from HD (1.0 IQR 0.3).
Conclusions :
The study indicates that, despite the young age of the subjects, atropine therapy was associated with a slower rate of myopia progression than before therapy. High dose atropine did not interfere with their reading abilities. However, higher doses did not prevent continued progression at a high rate. The findings underscore the need for tailored strategies or combination therapies, especially for very young children showing rapid progression.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.