Abstract:Background-Nearsightedness (myopia) causes blurry vision when looking at distant objects. Highly nearsighted people are at greater risk of several vision-threatening problems such as retinal detachments, choroidal atrophy, cataracts and glaucoma. Interventions that have been explored to slow the progression of myopia include bifocal spectacles, cycloplegic drops, intraocular pressurelowering drugs, muscarinic receptor antagonists and contact lenses. The purpose of this review was to systematically assess the e… Show more
“…Here, we review some of the key studies, nearly all of which have been published in the past 20 years, with many in the last decade. The rapid pace with which this field is moving is demonstrated by the 2011 systematic review 21 sponsored by Cochrane that concludes:The most likely effective treatment to slow myopia progression thus far is anti‐muscarinic topical medication……Further information is required for other methods of myopia control, such as the use of corneal reshaping contact lenses or bifocal soft contact lenses with a distance center are promising, but currently no published randomized clinical trials exist.This statement was based on evidence available in the literature as of October 2011, and as we discuss below, much has happened since then. Although an update was published in 2020, 22 it only includes publications through February 2018 and thus does not include several important recent clinical trials 18,23–27 …”
Section: How Effective Are Various Methods Of Myopia Control?mentioning
Purpose: This review arms practitioners with the evidence-based information they need to fully manage myopia. Recent findings: The recent peer-reviewed literature is critically evaluated to provide a comprehensive analysis of the safety and efficacy of behavioural, optical and pharmaceutical myopia management. Importantly, the paper addresses not only who to treat, but how to treat them, and when to stop or modify treatments. Finally, the paper discusses expectations for treatment and why slowing myopia by even 1 dioptre improves long term health outcomes. Summary: The management of an individual child should be underpinned by the evidence-based literature and clinicians must stay alert to ongoing myopia research that will undoubtedly result in an evolution of the standard of care for the myopic and pre-myopic child.
“…Here, we review some of the key studies, nearly all of which have been published in the past 20 years, with many in the last decade. The rapid pace with which this field is moving is demonstrated by the 2011 systematic review 21 sponsored by Cochrane that concludes:The most likely effective treatment to slow myopia progression thus far is anti‐muscarinic topical medication……Further information is required for other methods of myopia control, such as the use of corneal reshaping contact lenses or bifocal soft contact lenses with a distance center are promising, but currently no published randomized clinical trials exist.This statement was based on evidence available in the literature as of October 2011, and as we discuss below, much has happened since then. Although an update was published in 2020, 22 it only includes publications through February 2018 and thus does not include several important recent clinical trials 18,23–27 …”
Section: How Effective Are Various Methods Of Myopia Control?mentioning
Purpose: This review arms practitioners with the evidence-based information they need to fully manage myopia. Recent findings: The recent peer-reviewed literature is critically evaluated to provide a comprehensive analysis of the safety and efficacy of behavioural, optical and pharmaceutical myopia management. Importantly, the paper addresses not only who to treat, but how to treat them, and when to stop or modify treatments. Finally, the paper discusses expectations for treatment and why slowing myopia by even 1 dioptre improves long term health outcomes. Summary: The management of an individual child should be underpinned by the evidence-based literature and clinicians must stay alert to ongoing myopia research that will undoubtedly result in an evolution of the standard of care for the myopic and pre-myopic child.
“…A Cochrane review of the interventions to control myopia progression in children concluded that atropine was the only treatment showing a significant efficacy compared with placebo (Walline et al. ).…”
Purpose: To evaluate the efficacy and safety of atropine 0.01% in slowing myopia progression in European paediatric patients. Methods: Retrospective, medical records review study. Medical charts of paediatric patients with a myopia progression > 0.5 D/year treated with atropine 0.01% for at least 1 year were included. Patients receive a complete ophthalmic examination before and 12 months after initiation of atropine treatment. A group of myopic untreated children serves as a control group. The rate of myopia progression at baseline and 12 months after treatment with atropine was evaluated. The rate of myopia progression in treated and untreated patients was also compared. Adverse events were recorded. Results: Medical records of 52 treated and 50 control subjects were analysed. In the atropine group, the mean rate of myopia progression after 12 months of treatment (À0.54 AE 0.61 D) was significantly slower compared with the baseline progression (À1.20 AE 0.64 D; p < 0.0001) and to the progression in the control group (À1.09 AE 0.64; p < 0.0001). The responders patients were 41/52 (79%), whereas 11/52 patients (21%) showed a progression > 0.50 D despite treatment. The only adverse event was temporary photophobia in five patients (9.6%), severe adverse events were not reported, and none of the patients discontinued the treatment. Conclusion: Low-dose atropine significantly slowed the rate of myopia progression in European paediatric patients with a favourable safety profile.
“…To date, multiple randomized controlled trials have provided a good evidence base for the use of atropine as a promising solution in slowing down myopic deterioration in children (Walline et al. ; Wu et al. ; Fang et al.…”
Purpose: To conduct a multi-tissue investigation on the penetration and distribution of topical atropine in myopia treatment, and determine if atropine is detectable in the untreated contralateral eye after uniocular instillation. Methods: Nine mature New Zealand white rabbits were evenly divided into three groups. Each group was killed at 5, 24 and 72 hr, respectively, following uniocular instillation of 0.05 ml of 1% atropine. Tissues were sampled after enucleation: conjunctiva, sclera, cornea, iris, ciliary body, lens, retina, aqueous, and vitreous humors. The assay for atropine was performed using liquid chromatography-mass spectrometry (LC-MS), and molecular tissue distribution was illustrated using matrix-assisted laser desorption ionization-imaging mass spectrometry (MALDI-IMS) via an independent experiment on murine eyes. Results: At 5 hr, the highest (mean AE SEM) concentration of atropine was detected in the conjunctiva (19.05 AE 5.57 ng/mg, p < 0.05) with a concentration gradient established anteriorly to posteriorly, as supported by MALDI-IMS. At 24 hr, preferential binding of atropine to posterior ocular tissues occurred, demonstrating a reversal of the initial concentration gradient. Atropine has good ocular bioavailability with concentrations of two magnitudes higher than its binding affinity in most tissues at 3 days. Crossing-over of atropine to the untreated eye occurred within 5 hr post-administration. Conclusion: Both transcorneal and transconjunctival-scleral routes are key in atropine absorption. Posterior ocular tissues could be important sites of action by atropine in myopic reduction. In uniocular atropine trials, cross-over effects on the placebo eye should be adjusted to enhance results reliability. Combining the use of LC-MS and MALDI-IMS can be a viable approach in the study of the ocular pharmacokinetics of atropine.
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