Study: 0.01% atropine drops slow myopia progression, do not interfere with exotropia
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Key takeaways:
- Atropine eye drops showed efficacy in slowing myopia progression.
- The use of atropine did not aggravate intermittent exotropia.
Low-dose 0.01% atropine eye drops safely slowed myopia progression in children with myopia and intermittent exotropia, with some compromise on accommodative amplitude.
Exotropia often coexists with myopia, but previous clinical trials on atropine for myopia have excluded children with strabismus. Investigating the use of atropine for myopia control in this population was the objective of the AMIXT randomized clinical trial at Nanjing Medical University in China.
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Three hundred children aged 6 to 12 years with basic-type intermittent exotropia and myopia of –0.5 D to –6 D were included and randomly assigned 2:1 to receive 0.01% atropine or placebo in both eyes once a night for 12 months.
Atropine had a significant effect on the rate of myopia progression, with a mean change of –0.51 D in cycloplegic spherical equivalent at 1 year vs. –0.75 D in the group treated with placebo. The mean difference between the groups gradually increased with time. The proportion of eyes with myopia progression of less than 0.5 D at 1 year was 49.4% with atropine and 30.3% with placebo. The proportion of eyes with spherical equivalent progression of 1 D or more was 19.3% with atropine and 36.2% with placebo.
Axial length increased by a mean of 0.31 mm in the atropine group and 0.42 mm in the placebo group, and the difference gradually increased with time.
In the atropine group, a decrease in accommodative amplitude of –3.06 D was reported, as compared with 0.12 D in the placebo group, as well as a larger increase in photopic and mesopic pupil size. These changes began at month 2 and remained stable over time. The use of atropine did not aggravate intermittent exotropia and did not interfere with stereoacuity, distance and near vision, IOP and corneal endothelial cell density.
“These results suggest that 0.01% atropine eye drops are effective and safe in slowing myopia progression without interfering with exotropia conditions or binocular vision in children with myopia and intermittent exotropia,” the authors wrote.
Perspective
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Myopia and intermittent exotropia, a form of strabismus, often occur together. This is especially true in Asia where myopia increases the risk for intermittent exotropia fivefold. This placebo-controlled randomized trial compared 0.01% atropine with placebo drops in patients with intermittent exotropia. The take-home message is that 0.01% atropine drops reduce myopia progression, as in other studies, but without worsening the magnitude or control of the intermittent exotropia.
This study will give ophthalmologists confidence that children with controlled intermittent exotropia and myopia can be treated with dilute atropine without causing the intermittent exotropia to worsen or become more constant. In larger cohorts, it would be useful to know if early vs. late surgical correction of intermittent exotropia has any effect on the success of myopia prevention treatments.
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