Improving Future Refractive Outcomes In Children - Use Of Atropine 0.025% In The Treatment Of Childhood Myopia
Published 2023 - 41st Congress of the ESCRS
Reference: PP15.03 | DOI: 10.82333/d70g-3s05
Authors: Bryan Sim* 1 , Cataract and Comprehensive Ophthalmology,Singapore National Eye Centre,Singapore,Singapore, Audrey Chia 2
1Myopia, 2Paediatric Ophthalmology and Adult Strabismus,Singapore National Eye Centre,Singapore,Singapore
Purpose: Rising rates of childhood myopia has long term implications on refractive outcomes in children in the future. The purpose of this study is to determine the efficacy of Atropine 0.025% (A0.025%) in clinical practice in slowing down the rate of childhood myopia progression.
Methods: 201 children were started on A0.025% between July 2021 and March 2022 at the Singapore National Eye Centre.
Information collected included demographics (age, gender, ethnicity), refractive error and axial lengths (AL) done 6-12 months prior, at baseline, and 6-12 months after initiating A0.025%. Subjects were divided into 3 groups: (A) Children previously on Atropine 0.01% ON (A0.01 ON), who were changed to A0.025% ON; (B) Children previously on A0.01% BD, who were changed to A0.025% ON; and (C) Children started on A0.025% as first-line therapy. The rate of change in Spherical Equivalent (SE) and AL per year was calculated pre- and post- start of treatment.
A total of 166 children were included in the study (68, 34 and 64 in Groups A, B, and C respectively).
Children previously on A0.01% (Group A) had significantly less increase in SE (-0.98 ± 0.71 versus -0.15 ± 0.79 D/year, p <0.001), and AL (0.41 ± 0.27 vs 0.27 ± 0.27 mm/y, p=0.004) after starting A0.025%. Children who were converted from A0.01% twice a day to A0.025% daily (Group B) also demonstrated significantly less progression in SE and AL (-0.63 ± 0.54 vs -0.31 ± 0.74 D/year, p <0.001), and AL (0.27 ± 0.16 vs 0.13 ± 0.19 mm/year, p < 0.001). Children who were started on A0.025% without prior treatment (Group C) progressed at a rate of -0.22 ± 0.80 D/y or 0.22 ± 0.28 mm/y.
The majority of subjects in our study tolerated A0.025% with minimal side effects. Side effects were reported in 9 patients (5.4%). Blurring of vision was the most common side effect (n=4; 2.4%) followed by stinging/discomfort (n=2; 1.2%), itch (n=2; 1.2%), and glare (n=1; 0.60%). No serious or severe side effects were reported during the follow up period.
The Atropine 0.025% dose was clinically well-tolerated and quite effective, with a low side effect profile. This will help ameliorate the myopia pandemic in our paediatric population and curb the rising rates of refractive error which is the leading cause of blindness in the world.