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Childhood myopia and the use of atropine 0.01% eye drops

Childhood myopia and the use of atropine 0.01% eye drops

Childhood myopia, also known as short-sightedness or near-sightedness, is the condition of the eye when distance vision is more blurred compared with near vision. It tends to increase rapidly between 5 and 15 years old, and usually stabilizes by the early twenties.

Risk factors of Myopia:

The exact cause of myopia is not known, but certain risk factors increase the likelihood of myopia, such as:

Genetics.

The risk of developing myopia is higher if one (2 times more) or both (8 times more) parents are myopic. In addition, increasing severity of parental myopia leads to a greater risk of myopia.

Environmental

Lack of outdoor activities and excessive near work like reading, playing games on handheld electronic devices or computers, and watching television expose one to the risk of developing myopia

Role of Atropine in Myopia

Atropine Eye Drops:

Anti-myopic activity of atropine is entirely related to nonaccomodative mechanisms. There are three possible mechanisms in action:

  1. Binding of atropine to the muscarinic receptors of amacrine cells in retina increases the release of dopamine, which is an inhibitory chemical mediator for eye growth
  2. Reduction of γ-aminobutyric acid levels was shown to be downregulated following the atropine treatment in myopia-induced mice
  3. Scleral fibroblast cells carry all five muscarinic receptors on their cell membrane and binding to atropine may interfere with scleral remodeling. 

More recently, low-dose 0.01% atropine eye drops have been shown to be effective in slowing down myopia by 50% to 60% over two years .

At five years, it has been shown to be more effective in slowing down myopia progression with less visual side effects compared to the higher doses of atropine eye drops.As it causes minimal increase in pupil size, children do not require tinted or reading add in their glasses. They are also less likely to have the other side effects associated with the higher-dose atropine.

 Based on 5 years ATOM Study:

  • Atropin slows down myopia progression, however, as the dose was increased rebound increased Side effects also increased with the increase of dose.
  • No significant side effects were observed in low doses
  • Best therapeutic index with atropine was 0.01%
  • 0.01% atropine slowed down myopia progression by 50%
  • 0.01 % atropine treatment proved to be as effective even after the cessation and restart of the

Recently American Academy Of Ophthalmology has also published Atropine drops effectively control myopia progression on their editor’s choice articles.

Atropine 0.01% Therapy in Nepal

In Nepal Tilganga Institute of Ophthalmology, and some major eye hospitals are providing atropine 0.01% therapy in children, which aims to help in decreasing myopia progression and hence prevent it to progress into pathological myopia with complications. 

Reference:

  1. https://www.singhealth.com.sg/news/patient-care/childhood-myopia-use-of-atropine-eye-drops
  2. https://clinicaltrials.gov/ct2/show/study/NCT03508817?show_desc=Y#desc

Myopia Control: How Can We Stop Myopia Progression? 

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