A Pilot Study on the Efficacy and Safety of 0.01% Atropine in German Schoolchildren with Progressive Myopia

Joachimsen, Lutz; Böhringer, Daniel; Gross, Nikolai; Reich, Michael; Stifter, Julia; Reinhard, Thomas; Lagrèze, Wolf A.

doi:10.1007/s40123-019-0194-6

Cited by 42 publications

(44 citation statements)

References 17 publications

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“…[55,56], but study outcomes are not conclusive and often contradictory [57,58,59]. Although several interventions, including orthokeratology [60], atropine therapy [61] and mixed defocused lenses [62] can slow down axial growth significantly, clinically effective therapies to fully normalize eye growth are not available. Understanding the etiology of myopia remains a major goal of the National Eye Institute strategic plan and Asian countries.…”

Section: Discussionmentioning

confidence: 99%

Defocused Image Changes Signaling of Ganglion Cells in the Mouse Retina

Pan

2019

Cells

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Myopia is a substantial public health problem worldwide. Although it is known that defocused images alter eye growth and refraction, their effects on retinal ganglion cell (RGC) signaling that lead to either emmetropization or refractive errors have remained elusive. This study aimed to determine if defocused images had an effect on signaling of RGCs in the mouse retina. ON and OFF alpha RGCs and ON–OFF RGCs were recorded from adult C57BL/6J wild-type mice. A mono green organic light-emitting display presented images generated by PsychoPy. The defocused images were projected on the retina under a microscope. Dark-adapted mouse RGCs were recorded under different powers of projected defocused images on the retina. Compared with focused images, defocused images showed a significantly decreased probability of spikes. More than half of OFF transient RGCs and ON sustained RGCs showed disparity in responses to the magnitude of plus and minus optical defocus (although remained RGCs we tested exhibited similar response to both types of defocus). ON and OFF units of ON–OFF RGCs also responded differently in the probability of spikes to defocused images and spatial frequency images. After application of a gap junction blocker, the probability of spikes of RGCs decreased with the presence of optical defocused image. At the same time, the RGCs also showed increased background noise. Therefore, defocused images changed the signaling of some ON and OFF alpha RGCs and ON–OFF RGCs in the mouse retina. The process may be the first step in the induction of myopia development. It appears that gap junctions also play a key role in this process.

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Section: Discussionmentioning

confidence: 99%

Defocused Image Changes Signaling of Ganglion Cells in the Mouse Retina

Pan

2019

Cells

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“…One small, 32-subject, case–control study in a single US pediatric ophthalmologic practice suggested that atropine 0.01% significantly reduced the rate of myopic progression over 1 year with minimal side effects [11]. Another small, uncontrolled study in Germany detected minimal pupillary dilation and an insignificant reduction in accommodation 24 h after initiating treatment [12]. The current study was designed to amplify these prior data and to assess myopia progression in a much larger, multicenter, multiethnic group of children in the USA given nightly atropine 0.01% eye drops.…”

Section: Introductionmentioning

confidence: 99%

Atropine 0.01% Eye Drops for Myopia Control in American Children: A Multiethnic Sample Across Three US Sites

et al. 2019

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IntroductionTopical atropine eye drops at low concentrations have been shown to slow myopia progression in East Asian studies. This study explored the effect of atropine 0.01% eye drops on controlling myopia progression in a multiethnic cohort of children in the USA.MethodsA multicenter retrospective case–control study (n = 198) quantified the effect of adding nightly atropine 0.01% eye drops to treatment as usual on the progression of childhood (ages 6–15 years) myopia. Cases included all children treated with atropine for at least 1 year. Controls were matched to cases on both age (± 6 months) and baseline spherical equivalent refraction (SER) (± 0.50 diopters, D) at treatment initiation. The primary endpoint was the average SER myopia progression after 1, 1.5, and 2 years of therapy. A secondary outcome was the percentage of subjects with a clinically significant worsening of myopia, defined as a greater than − 0.75 D SER increase in myopia.ResultsThe average baseline SERs for the atropine (n = 100) and control (n = 98) groups were similar (− 3.1 ± 1.9 D and − 2.8 ± 1.6 D, respectively) (p = 0.23). The average SER increase from baseline was significantly less for the atropine group than the control group at year 1 (− 0.2 ± 0.8 D compared with − 0.6 ± 0.4 D, p < 0.001) and at year 2 (− 0.3 ± 1.1 D compared with − 1.2 ± 0.7 D, p < 0.001). Secondary analysis at year 2 revealed that 80% of the control group vs. 37% of the atropine group experienced clinically significant worsening myopia of at least − 0.75 D (p < 0.001). There were no major safety issues reported in either group.ConclusionSimilar to results reported in Asia, atropine 0.01% eye drops significantly reduced myopia progression in a cohort of US children over 2 years of treatment.FundingNevakar, Inc.Plain Language SummaryPlain language summary available for this article.

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“…They defined myopia progression of more than 0.50D or 1.0D at 1 year as rapid myopic progression. Again rates of refractive progression varied considerably between studies, risk factors for faster myopic progression in low concentration atropine studies include younger age at baseline 11,18 , higher initial myopia appropriately controlled studies to explore independent risk factors associated with rapid AL elongation in myopic children in mainland China treated with low concentration atropine.…”

Section: Discussionmentioning

confidence: 99%

“…This was consistent with three other studies which explored the same relationship between baseline age and AL increase in myopic children using atropine and whose baseline profiles were similar to the current study. Joachimsen et al 11 , Wei et al 14 and Lee et al 18 found that younger children in German, mainland China and Taiwan may still progress quickly while using 0.01%, 0.01% and 0.05% atropine, respectively. It is well established that there is slowing of physiological change in AL in older children 19 We also found that the children with 0.01% atropine had a more rapid AL elongation and a worse myopic control effect than 0.02% atropine 13 .…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have shown that low concentrations of atropine can control the progression of myopia in children with good efficacy, minimal side effects, convenient use, and slight rebound effects after discontinuation [5][6][7] . Conversely, it has been observed that low concentration atropine has not effectively controlled myopia in all children [5][6][7][8][9][10][11][12][13][14][15] .…”

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confidence: 99%

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Risk factors for rapid axial length elongation with low concentration atropine for myopia control

Stapleton²,

et al. 2020

Preprint

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Three hundred and twenty-eight myopic children, randomized to use either 0.01% (N=166) or 0.02% (N=162) atropine were enrolled in this study. Gender, age, body mass index(BMI), parental myopia status, atropine concentration used, pupil diameter, amplitude of accommodation, spherical equivalent refractive error (SER), anterior chamber depth (ACD) and axial length (AL) were collected at baseline and 1 year after using atropine. Rapid AL elongation was defined as >0.36 mm growth per year. Univariate analyses showed that children with rapid AL elongation tend to be younger, have a smaller BMI, use of 0.01% atropine, narrow ACD, lower SER, shorter AL, smaller change in pupil diameter between 1 year and baseline (all P < 0.05). Multivariate regression analyses confirmed that rapid AL elongation was associated with children that were younger at baseline (P < 0.0001), use of 0.01% atropine (P = 0.04), a shorter baseline AL (P = 0.03) and a smaller change in pupil diameter between 1 year and baseline (P = 0.04). Younger children with shorter AL at baseline, less change in their pupil diameter with atropine treatment and using the lower of the two atropine concentrations may undergo rapid AL elongation over a 12 months myopia control treatment period.

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A Pilot Study on the Efficacy and Safety of 0.01% Atropine in German Schoolchildren with Progressive Myopia

Cited by 42 publications

References 17 publications

Defocused Image Changes Signaling of Ganglion Cells in the Mouse Retina

Defocused Image Changes Signaling of Ganglion Cells in the Mouse Retina

Atropine 0.01% Eye Drops for Myopia Control in American Children: A Multiethnic Sample Across Three US Sites

Risk factors for rapid axial length elongation with low concentration atropine for myopia control

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