Reducing myopia progression
Leigh Spielberg
Published: Sunday, September 23, 2018
“WHAT really works to slow myopic progression is atropine 0.01 per cent,” said Donald Tan, Singapore National Eye Centre, Singapore.
Dr Tan’s presentation, Pharmacological Prophylaxis of Myopia, was given during an ESCRS clinical research symposium on Saturday morning in Vienna.
“Although there are many interventional approaches to reducing myopia progression, with over 180 studies in the literature, the largest positive effects are exhibited by antimuscarinic medications,” he said.
But how does atropine work to slow progression? “Basically, we don’t know. Atropine’s original use to affect accommodation paralysis led to the idea that it could reduce myopia,” said Dr Tan. However, it also works in the chick model, where accommodation is nicotine-pathway driven.
“Instead, it probably occurs via a neurochemical cascade which begins with receptors at the retinal level,” he said, and directly on scleral fibroblasts.
Dr Tan then discussed the very positive results of his group’s three large studies of atropine for the treatment of childhood myopia (ATOM).
“ATOM 1 demonstrated a 77 per cent reduction in the mean progression of myopia, with a strong correlation with axial length,” he explained. ATOM 2 addressed the side effects of atropine by lowering the concentration to 0.01 per cent, which was shown to be equally effective.
The study hypothesis of ATOM 3 is that 0.01 per cent atropine eye drops, given to children just prior to developing myopia, may either prevent or delay the onset of myopia. This study is currently ongoing.