Atropine for the Prevention of Myopia Progression in Children

Pineles, Stacy L.; Kraker, Raymond T.; VanderVeen, Deborah K.; Hutchinson, Amy K.; Galvin, Jennifer A.; Wilson, Lorri B.; Lambert, Scott R.

doi:10.1016/j.ophtha.2017.05.032

Cited by 128 publications

(115 citation statements)

References 28 publications

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“…During the years, atropine for decreasing progression of myopia was utilized in different dosages (1, 0.5, 0.3, 0.1, and 0.01%). Higher dosages had a stronger initial effect but caused more side effects such as light sensitivity and accommodative insufficiency and furthermore caused a rebound effect [12]. Atropine 0.01% was found to have the same efficacy after 5 years with few side effects without a rebound effect after cessation [12,26].…”

Section: Discussionmentioning

confidence: 85%

“…In this survey, only 16.64% were of Far East Asia decent, sharing the same ethnic background as the subjects treated in the ATOM studies [12]. Further studies of subjects from other ethnic groups are needed to verify the applicability of these studies to other parts in the world.…”

Section: Discussionmentioning

confidence: 98%

“…The treatment to decrease the rate of myopia progression spans three modalities: pharmacological, optical, and behavioral. Each of these modalities includes numerous possibilities with different impact on myopia progression [12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Current trends among pediatric ophthalmologists to decrease myopia progression—an international perspective

Zloto

Wygnanski–Jaffe

Farzavandi

et al. 2018

Graefes Arch Clin Exp Ophthalmol

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Most pediatric ophthalmologists treat to decrease myopia. They employ a wide variety of means to decrease myopia progression. Atropine 0.01% is the most popular and safe modality used similarly to recent reports. However, there is no consensus when treatment should be initiated. Further prospective studies are needed to elucidate the best timing to start treatment and the applicability of recent studies in the Asian population to other ethnic groups. This will improve the ability to update pediatric ophthalmologist with evidenced-based treatment options to counter the myopia epidemic.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

Current trends among pediatric ophthalmologists to decrease myopia progression—an international perspective

Zloto

Wygnanski–Jaffe

Farzavandi

et al. 2018

Graefes Arch Clin Exp Ophthalmol

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“…Pharmacologic interventions, namely atropine, have been employed with some success to slow the progression of myopia 18–21. Prior studies have demonstrated an inverse relationship between myopia rates and physical activity22 and sports participation16,23,24 where myopia was defined as ≤−0.5 diopters (D),23,24 ≤−0.75 D,16 or ≤−1 D 22.…”

Section: Introductionmentioning

confidence: 99%

Myopia prevalence and risk factors in children

Theophanous¹,

Modjtahedi²,

Batech³

et al. 2018

OPTH

100

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PurposeTo evaluate the prevalence and risk factors for pediatric myopia in a contemporary American cohort.MethodsA cross-sectional study of pediatric patients enrolled in the Kaiser Permanente Southern California health plan was done. Eligible patients were 5- to 19-years old between January 1, 2008, through December 31, 2013, and received an ophthalmologic or optometric refraction. Electronic medical records were reviewed for demographic data, refraction results, and exercise data. Prevalence and relative risks of myopia (defined as ≤−1.0 diopter) were characterized. Age, sex, race/ethnicity, median neighborhood income, and minutes of exercise per day were examined as risk factors.ResultsThere were 60,789 patients who met the inclusion criteria, of which 41.9% had myopia. Myopia was more common in older children (14.8% in 5- to 7-year olds, 59.0% in 17- to 19-year olds). Asian/Pacific Islander patients (OR 1.64, CI 1.58–1.70) had an increased rate of myopia compared to White patients as did African Americans to a lesser extent (OR 1.08, CI 1.03–1.13). Median neighborhood household income of $25,000–40,000 was associated with lower rates of myopia (OR 0.90, CI 0.83–0.97) compared to median neighborhood household incomes less than $25,000. Having at least 60 min of daily exercise was associated with lower prevalence of myopia (OR 0.87, CI 0.85–0.89).DiscussionMyopia was common in this large and diverse Southern Californian pediatric cohort. The prevalence of myopia increases with age. Asian children are at highest risk for myopia. Exercise is associated with a lower rate of myopia and represents an important potentially modifiable risk factor that may be a target for future public health efforts.

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“…Therefore, 0.01% atropine is currently the most favored concentration prescribed by clinicians both in Southeast Asia and North America. [9][10][11][12] Atropine is a potent nonselective mAChR antagonist. Thus, it has been widely assumed to inhibit myopia via blockade of mAChRs.…”

mentioning

confidence: 99%

Myopia-Inhibiting Concentrations of Muscarinic Receptor Antagonists Block Activation of Alpha_2A-Adrenoceptors In Vitro

Carr

Mihara

Ramachandran

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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Citation: Carr BJ, Mihara K, Ramachandran R, et al. Myopia-inhibiting concentrations of muscarinic receptor antagonists block activation of alpha 2A -adrenoceptors in vitro. Invest Ophthalmol Vis Sci. 2018;59:2778-2791. https://doi.org/10.1167 PURPOSE. Myopia is a refractive disorder that degrades vision. It can be treated with atropine, a muscarinic acetylcholine receptor (mAChR) antagonist, but the mechanism is unknown. Atropine may block a-adrenoceptors at concentrations ‡0.1 mM, and another potent myopiainhibiting ligand, mamba toxin-3 (MT3), binds equally well to human mAChR M 4 and a 1A -and a 2A -adrenoceptors. We hypothesized that mAChR antagonists could inhibit myopia via a 2A -adrenoceptors, rather than mAChR M 4 . METHODS.Human mAChR M 4 (M 4 ), chicken mAChR M 4 (cM 4 ), or human a 2A -adrenergic receptor (hADRA2A) clones were cotransfected with CRE/promoter-luciferase (CRE-Luc; agonist-induced luminescence) and Renilla luciferase (RLuc; normalizing control) into human cells. Inhibition of normalized agonist-induced luminescence by antagonists (ATR: atropine; MT3; HIM: himbacine; PRZ: pirenzepine; TRP: tropicamide; OXY: oxyphenonium; QNB: 3-quinuclidinyl benzilate; DIC: dicyclomine; MEP: mepenzolate) was measured using the DualGlo Luciferase Assay System. RESULTS.Relative inhibitory potencies of mAChR antagonists at mAChR M 4 /cM 4 , from most to least potent, were QNB > OXY ‡ ATR > MEP > HIM > DIC > PRZ > TRP. MT3 was 563 less potent at cM 4 than at M 4 . Relative potencies of mAChR antagonists at hADRA2A, from most to least potent, were MT3 > HIM > ATR > OXY > PRZ > TRP > QNB > MEP; DIC did not antagonize.CONCLUSIONS. Muscarinic antagonists block hADRA2A signaling at concentrations comparable to those used to inhibit chick myopia ( ‡0.1 mM) in vivo. Relative potencies at hADRA2A, but not M 4 /cM 4 , correlate with reported abilities to inhibit chick form-deprivation myopia. mAChR antagonists might inhibit myopia via a 2 -adrenoceptors, instead of through the mAChR M 4 /cM 4 receptor subtype.

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Atropine for the Prevention of Myopia Progression in Children

Cited by 128 publications

References 28 publications

Current trends among pediatric ophthalmologists to decrease myopia progression—an international perspective

Current trends among pediatric ophthalmologists to decrease myopia progression—an international perspective

Myopia prevalence and risk factors in children

Myopia-Inhibiting Concentrations of Muscarinic Receptor Antagonists Block Activation of Alpha_2A-Adrenoceptors In Vitro

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Atropine for the Prevention of Myopia Progression in Children

Cited by 128 publications

References 28 publications

Current trends among pediatric ophthalmologists to decrease myopia progression—an international perspective

Current trends among pediatric ophthalmologists to decrease myopia progression—an international perspective

Myopia prevalence and risk factors in children

Myopia-Inhibiting Concentrations of Muscarinic Receptor Antagonists Block Activation of Alpha2A-Adrenoceptors In Vitro

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Myopia-Inhibiting Concentrations of Muscarinic Receptor Antagonists Block Activation of Alpha_2A-Adrenoceptors In Vitro