Consider combining atropine with optical solutions for myopia management
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As the number of myopia cases increases globally, implementing effective therapies to slow the progression and provide optimal vision correction is critical.
It is imperative to regularly examine pre-myopic children and those at high genetic risk to record baseline axial growth measurements. This will enable the detection of myopic onset as early as possible.
The age at which myopia is diagnosed serves as a reliable indicator of how rapidly it will progress. Employing interventions such as orthokeratology can provide the most significant benefit as early as ages 7 and 8 years, when axial elongation tends to advance rapidly. It is essential to prevent high myopia in rapidly progressing cases with early interventions.
Atropine and ortho-K
Ortho-K effectively helps slow the progression of myopia as a monotherapy. Atropine is also a first line of treatment for myopia control, with evidence from the LAMP study (Yam et al.) demonstrating that 0.05%, 0.025% and 0.01% atropine drops reduced myopia progression along a concentration-dependent response. All concentrations in this study were well tolerated without adversely affecting quality of vision.
However, when ortho-K lenses are used in combination with low-concentration atropine, evidence indicates that even greater control of myopic progression can be achieved. Researchers conducted a meta-analysis (Gao et al.) to examine data from 341 children who participated in five studies. The analysis confirmed that atropine combined with ortho-K is an effective treatment to slow axial elongation in myopic children; this combination therapy may be superior to using ortho-K alone during the first 6 to 12 months of treatment.
Evidence supports the best concentration of atropine for this combination therapy as 0.01% atropine with ortho-K over 1 year (Tan et al.). This method resulted in 0.09 mm less axial elongation than ortho-K therapy as monotherapy. Combining atropine at this dosage with ortho-K appears to increase efficacy of myopia control with reduced pupil size and acuity side effects. Still, more long-term randomized clinical trials and research are needed to investigate the use of atropine in myopia control and confirm its efficacy at varying dosages in conjunction with ortho-K.
Atropine and multifocal contacts
Independently, soft multifocal contact lenses (SMCLs) are effective in slowing the progression of myopia as a monotherapy. SMCLs and atropine achieve similar results when used separately.
However, a study from the Ohio State University College of Optometry (Jones et al.) revealed no evidence to indicate that adding 0.01% atropine to soft, multifocal contact lenses controlled myopia any better than using SMCLs alone.
While myopia treatment should be based on the needs of each patient, several factors, including age, family history and ethnicity, should be considered. For younger children with rapid myopia progression and a strong family history, aggressive strategies are needed. Patients may have success by combining SMCLs and 0.01% atropine when weaning off atropine is warranted.
Additionally, further investigation and studies are necessary before rejecting the combination treatment of 0.01% atropine with CooperVision MiSight 1-day contact lenses. This combination therapy would most likely demonstrate efficacy in myopia control, as baseline data suggest that combining the two treatments is well tolerated with good compliance (Erdinest et al.).
Aggressive strategies needed
Starting myopia management early and aggressively is paramount to gaining adequate control over this disorder. For pediatric patients demonstrating rapid progression or those with risk factors that include long baseline axial length and parents with high myopia, finding the correct dose is essential.
Be willing to change interventions if patient compliance is poor or one does not demonstrate sufficient effects. Consider using a combination strategy when seeking the best outcome for your patient, as their future visual health depends on treatments employed during this critical period.
References:
- Erdinest N, et al. Case Rep Ophthalmol. 2021;doi:10.1159/000515568.
- Gao C, et al. Eye Contact Lens. 2021;doi:10.1097/ICL.0000000000000746.
- Jones JH, et al. Optom Vis Sci. 2022:doi:10.1097/OPX.0000000000001884.
- Tan Q, et al. Ophthalmic Physiol Opt. 2020;doi:10.1111/opo.12722.
- Yam JC, et al. Ophthalmology. 2019;doi:org/10.1016/j.ophtha.2018.05.029.
For more information:
Elise Kramer, OD, FAAO, FSLS, is residency-trained and practices at Weston Contact Lens Institute in Weston, Fla.
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