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Low-dose atropine effective in slowing myopia progression
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CHICAGO — Low doses of atropine are the most effective in slowing myopia progression, according to a speaker here.
Multiple studies comparing different doses of atropine have shown a 0.01% dose has slowed myopia progression more so than doses of 0.05% or 0.1%, Donald Tan, MD, FRCS, FRCOphth, said at the American Academy of Ophthalmology meeting.
The ATOM1 trial, which was started in 1999, dosed 400 myopic children with 0.1% atropine for 2 years, with the third year being a washout year.
“After 2 years, we definitively showed a 77% reduction in the mean progression of myopia,” Tan said. “In year 3, however, there was a significant rebound in the eye with atropine both in refractive error and axial length.”
A second ATOM trial looked at atropine at three doses, 0.1%, 0.05% and 0.01%, and was extended over a 5-year period.
After the first 2 years of treatment and a washout year, it was determined that the 0.01% dose was the most effective, and all of the subjects were given 0.01% in the subsequent 2 years.
“There was not a statistically significant difference between these three doses, so we can reduce the atropine from 0.1% to 0.01% and still have reasonable efficacy,” Tan said. “The next year, the washout year ... the higher doses had greater rebound. In fact, the lowest dose was the best.”
Subjects treated with placebo had a 1.5 D increase at 30 months, whereas those treated with 0.01% reached a 1.5 D increase at 60 months.
“Low-dose atropine seems to herald a new therapeutic scenario that decreases the adverse effects and seems to decrease rebounding,” Tan said. – by Rebecca L. Forand
Reference:
Tan D. Atropine for myopia. Presented at American Academy of Ophthalmology meeting; Oct. 27-30, 2018; Chicago.
Disclosure: Tan reports he is a company that makes atropine for some Asian countries.