ATROPINE EYE DROPS
Eye drops to help prevent your child's eyes from getting worse. Sounds too good to be true?
HOW DOES ATROPINE SLOW MYOPIA?
The exact biochemical mechanism in how atropine slows myopia progression is not yet fully understood. Atropine has effect on various stuctures with the eye, including the iris and the ciliary muscles that control focusing, but current research suggests atropine also acts to thicken the choroid, the middle layers of the eye's structure, thereby helping to resist stretching and elongation that occurs with myopic eye growth.
HOW EFFECTIVE IS ATROPINE TREATMENT?
Atropine as a pharmaceutical drug has been known for many years to reduce myopia progression, but due to its potential ocular and systemic side effects it wasn't a commonly prescribed treatment outside of hospitals and ophthalmology. In more recent times, researchers found that even much lower concentrations of atropine — hence much safer and better tolerated in children — were almost as effective in slowing progression as the regular-dose 1% atropine.
The ATOM 1 myopia study in Singapore found a 77% reduction in myopia progression over a 2 year period with 1% atropine treatment. With the low-dose form of atropine, around 50% reduction in rate of progression is suggested in clinical research, but with lower rebound effect than 1% atropine when treatment stopped. The effectiveness of all myopia control treatments will vary from child to child, as every eye's biology and structure is different.
HOW IS THE TREATMENT ADMINISTERED?
Atropine eye drops are placed in the child’s eyes once a day, at night time before sleep. A one-week trial is recommended to ensure of no unexpected adverse effects. The child's usual form of vision correction — glasses and/or contact lenses — are worn as usual to see. Sunglasses or photochromatic Transitions lenses may be needed if the child becomes more sensitive to glare. Treatment effect is monitored every 6 months. Length of treatment is typically 2 years but can vary after evaluation of its myopia control effect on the child.
WHAT ARE THE RISKS OF USING ATROPINE?
The atropine eye drops used for myopia control are a specially formulated low-concentration version. 0.01% atropine is the typical dosage prescribed, occasionally 0.02% and 0.05% are used when more treatment effect is required. Low-dose atropine treatment has been clinically tested over 5 years and found to be safe for long-term use in children. Side effects and adverse reactions are very minimal. Some children may experience increased glare from slight pupil dilation, mild changes in their close-up focusing and very occasionally some sensitivity to the eye drops and preservatives. Any potential risks in the longer term (>10 years) are however not yet known. The landmark 2012 ATOM 2 myopia study can be found in the link below.
WHICH KIDS ARE SUITABLE FOR ATROPINE TREATMENT?
At our clinic we have prescribed low-dose atropine for children as young as 3 with myopia and high risk of progression. We would suggest atropine is better suited for younger kids (age 8 or under) than adolescents. It is easy to administer to young children who may not be ready for overnight or daytime contact lenses.
For older kids and teenagers, atropine treatment is also possible but the optical treatment options — Ortho-K and myopia control soft contact lenses — which also correct vision at the same time and frees them from wearing glasses for school and sports, are usually preferred.
WHO CAN PRESCRIBE ATROPINE FOR MY CHILD?
An optometrist who is therapeutically endorsed to prescribe prescription-only medicines and has an interest in myopia management can prescribe low-dose atropine eye drops for your child. Ophthalmologists (eye specialists) can also prescribe this treatment. Low-dose atropine for myopia control is a treatment endorsed by some of Melbourne's leading paediatric ophthalmologists, including Dr Elaine Wong (Box Hill Eye Surgeons) and Dr Joanne Dondey (Glen Iris Eye Specialists). If your child sees an ophthalmologist we can certainly work with them to co-manage your child's myopia.
WHERE TO BUY 0.01% ATROPINE EYE DROPS
One difficulty with atropine treatment is the availability of low-dose atropine eye drops. Such low concentration of atropine is not commercially available in Australia and needs to be individually formulated by a compounding chemist. This increases the ongoing cost of treatment. Expect treatment cost to be $30-40 per month. Please see our blog post for further information about obtaining compounded atropine eye drops in Melbourne.
See below for other myopia control treatments.
© 2019 The Myopia Clinic | Eyecare Concepts | Kew East Melbourne