Atropine eye drops for myopia in children

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Once a child becomes short-sighted (also called near-sighted or myopic), their blurred long-distance vision tends to get worse over time. However there are ways to slow down this worsening, called myopia control or myopia management.

When your child is myopic, we have to firstly think about correcting their blurred distance vision, which we can do with spectacles or contact lenses. You can read more about spectacle lens options, contact lens options and the safety of contact lenses in children via the links. So far, the vast amount of myopia control research indicates that myopia controlling contact lenses offer better effectiveness for slowing down the worsening of childhood myopia than spectacles. However your child may not be ready or suitable for contact lenses, or special contact lens designs may not be available in your country or from your eye care practitioner. There is a special type myopia control spectacle design which seems to be just as good as contact lenses to slow myopia progression, but it’s only available in some Asian countries.

Your eye care practitioner may instead recommend atropine eye drops, which are used in combination with either spectacles or contact lenses. Atropine eye drops are especially favoured by ophthalmologists (medical doctor eye surgeons) around the world. Optometrists (non-medical eye care practitioners) in Australia, New Zealand and the USA can also prescribe atropine eye drops.

Here’s some information about atropine eye drops, so you can ensure the right choice is made for your child between yourself and their optometrist and/or ophthalmologist.

Atropine concentration

The concentration of atropine eye drops which have been researched for myopia control vary from 0.01% right up to 1%. The stronger the concentration, the more likelihood of side effects.

Side effects of stronger atropine concentrations (0.1% up to 1%) include sensitivity to light due to enlarged (dilated) pupils, and problems with close up reading vision due to reducing the eye’s inherent focussing mechanism. These side effects can be managed with spectacle lenses which darken when outside (called photochromatic) and that also incorporate a stronger power in the lens to support reading (a bifocal or progressive addition spectacle lens).

Lower dosages of atropine – 0.01% to 0.05% – have been shown to have minimal effects on pupil size and close up reading vision, making them more attractive options to prescribe for myopia control. The well known ATOM2 atropine study seemed to indicate that 0.01% had the least side effects and the best effectiveness for myopia control, however the newer LAMP atropine study has shown that there is a dose dependent effect and that 0.01% actually has minimal influence on slowing down the speedy eye growth which is a feature of childhood myopia. Slowing down eye growth is important as longer eyes have been shown to have higher risks of myopia-associated eye diseases and vision impairment in adulthood. (research link) Low dose atropine of 0.025% slowed eye growth by about 30% and 0.05% by about 50% in the LAMP study.

Newer studies are underway investigating low dose atropine in various formulations – it may be that more stable chemical formulations of 0.01% atropine show better research results for myopia control.

Currently, in most countries low dose atropine has to be compounded – specially made by a pharmacist – and in this form it appears that 0.01% shouldn’t be the first choice for your child’s myopia management, until research shows us stronger data. Concentrations of at least 0.025% are more evidence based.

Side effects can also include stinging of the eye drop on instillation, and sensitivity reactions. It is important to ensure that your child tolerates the eye drops – and in fact any myopia control treatment – so make sure to ask about side effects and report any concerns you may have. Atropine eye drops are usually used once daily, at night time.

Atropine combinations

While atropine 0.01% may not be the first choice for a front-line myopia management option, it is showing promise as a combination with Orthokeratology (OrthoK), special overnight wear contact lenses. Atropine 0.01% plus OrthoK appears to work better than just OrthoK alone, however this research is very early so more information is needed. If your child’s vision continues to progress in OrthoK wear or your eye care practitioner feels they’re at higher risk of fast progression, this may be prescribed.

New research is also combining atropine 0.01% with multifocal soft contact lenses, but this research is yet to be published.

Which is best?

Your eye care practitioner will be the best guide of which myopia control option is most suitable for your child, as it can depend on their level of myopia, age and other factors. Not all options are available in all countries – your eye care practitioner may recommend contact lens options or spectacle lens optionss for myopia in children. It’s important for you to also understand the influence of your child’s visual environment – outdoor time and screen time – on successfully managing their myopia.

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