Final refractive errors in children not associated with topical atropine eye drops Key points What long-term outcomes were seen in adulthood among people who received atropine during childhood for myopia? Findings Among approximately one-quarter of the original cohort who received childhood atropine treatment (0.01% to 1.0%) for myopia control (2 to 4 years duration), no differences in refractive errors were identified finals. There was no association with a higher incidence of treatment or myopia-related ocular complications in the 1% atropine-treated groups versus placebo. Meaning Long-term follow-up of a minority of participants who received atropine for a limited period during childhood did not affect final refractive errors or the incidence of ocular complications in adulthood. |
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Children who received short-term topical atropine eye drops , 0.01% to 1.0%, had no difference in final refractive errors 10 to 20 years after treatment.
Short-term topical atropine eye drops, at doses of 0.01% to 1.0%, for 2 to 4 years during childhood had no effect on final refractive errors approximately 10 to 20 years after treatment, according to a study. study published in JAMA Ophthalmology . No higher incidence of treatment or ocular complications related to myopia was found in the patients.
Myopia affects approximately one-third of the world’s population and is estimated to increase to approximately 5 billion people by 2050. Slowing the onset of myopia or reducing its progression can be achieved when using atropine eye drops, but results are inconsistent depending on dose and difference in adverse events. This study aimed to evaluate 20-year outcomes and safety in patients participating in the study called Atropine for the Treatment of Myopia (ATOM) 1 and 10-year outcomes in patients in ATOM2.
The Atropine Treatment Long-Term Evaluation Study (ATLAS) included participants who had been evaluated 10 and 20 years after their final trial visit in the ATOM1 and ATOM2 trials, respectively. ATOM1 took place in 1999, while ATOM2 took place in 2006, but both involved 400 children aged 6 to 12 years with myopia; ATOM2 included children with myopia of at least –2.0 D.
All children were assigned to receive 0.5%, 0.1%, or 0.01% atropine eye drops for 2 years in a 2:2:1 ratio. If children had myopia progression of –0.5% D or more during the 1-year washout phase, they restarted treatment with 0.01% atropine.
A medical history was taken for all participants, including medical and ocular conditions, surgical history, ocular complaints, and whether they had received treatment for myopia after their final testing visit. An examination of the anterior and posterior sections of the eye, as well as optical coherence tomography and fundus photography, were also performed.
ATLAS included 63 of the ATOM1 studies and 148 of the ATOM2 studies for statistical analysis. The researchers found that the 63 children who received 2 years of atropine treatment had no differences in final spherical equivalent (SE) and axial length (AL) between eyes that had been treated with 1% atropine compared to eyes untreated and eyes treated with 1%. % atropine compared to placebo. Myopic refractive error and axial lengthening were found in both groups 20 years after their last testing visit.
The 148 participants in the ATOM2 study showed no differences in SE or AL. Progression of SE and axial elongation was found in all groups within 10 years of the final trial visit. Progression was greater in those of younger age (mean difference, 0.6 years; 95% CI, 0.2-0.9 years), those who were randomly assigned to higher concentrations of atropine (0.1 % and 0.5%, 88.3% versus 0.01%, 77.7%), and in those who needed more treatment (68.1% versus 54.5%).
Greater progression of SE and axial elongation was found during the clinical trial period and after stopping treatment in patients whose eyes progressed 1.0 D or more, which also led to longer AL and greater SE in the last trial visit and in ATLAS.
Patients with a younger age (OR, 0.82; 95% CI, 0.67-0.99) and a higher atropine concentration (0.1% vs 0.01%, OR, 2.57; 95% CI %, 1.16-5.69. 0.5% vs 0.01%, OR, 2.48; 95% CI, 1.09-5.62) had myopia progression 10 years after discontinue atropine treatment.
Although there was no increased incidence of cataracts/lens opacity, glaucoma, parapapillary atrophy, and optic disc tilt when comparing those using atropine 1% to the placebo group in ATOM1, there were some differences in ATOM2. The incidence of myopic macular degeneration was 19.6%, 28.7% and 38.1% in the atropine 0.01%, 0.1% and 0.5% groups respectively. Female participants (OR, 0.52; 95% CI, 0.29-0.92), those with higher atropine treatment concentration (0.5% vs. 0.01%, OR, 2.60; CI of 95%, 1.15-5.89).
There were some limitations to this study. Many of the participants from the original ATOM1 and ATOM2 studies were not included in this study, which could have led to selection bias. Differences in instruments used and measurements between studies could have affected comparisons. Peripheral retinal changes could have been overlooked.
The final refractive errors of children who had taken 0.01% to 1.0% atropine drops for 2 to 4 years were not associated with this treatment 10 to 20 years later. No increased incidence of treatment or ocular complications related to myopia was found. More research is needed on the duration and concentration of atropine treatment that is safe and effective for children.
Conclusions and relevance Among approximately a quarter of the original participants, use of short-term topical atropine eye drops between 0.01% and 1.0% over a period of 2 to 4 years during childhood was not associated with differences in errors. final refractives of 10 to 10 years. 20 years after treatment. There was no increased incidence of treatment or myopia-related ocular complications in the 1% atropine group versus the placebo group. These findings may affect the design of future clinical trials, as further studies are required to investigate the duration and concentration of atropine for the control of childhood myopia. |
