People with myopia, also known as short-sightedness, have difficulty seeing objects that are far away but can see near objects with relative ease. Over 2 billion people worldwide are estimated to have myopia, as defined as ≤ −0.5 diopters (Holden, 2016). Diopters are the strength of the corrective lens that is used to enable the eye to focus a distant image onto the retina. Of the estimated 2 billion global myopic people, around 10% have high myopia, defined as ≤ −5 diopters. People with high myopia are at an increased risk of potentially blinding eye conditions such as macular degeneration, retinal detachment, open-angle glaucoma and cataract (Holden, 2016). It is estimated that by 2050, roughly half of the world’s population will be myopic (Joachimsen, 2019). All of these statistics look grim and clearly show this issue will worsen as time goes on, the real question is what can we do about it?
One mechanism that has been explored for the reason behind this phenomenon is related to the increased use of electronic devices and their detrimental effect on short-sightedness. As computers become more prevalent in the workplace, school and at home, scientists believe this could be contributing to the increased incidence of shortsightedness that is being seen in our younger generation. We are a product of our environment so the vast majority of these children are utilizing electronic devices for access to information, entertainment or an escape similar to their parents. Childhood myopia is usually diagnosed when kids are around the age of 5 to 7 years old. During this phase of life, the eyes are growing very quickly. It is common to see the child’s vision worsen during these years, but vision normally levels off at about age 12. But what else can be done aside from pulling the plug on the electronics? This age range would be the target for low dose atropine therapy and myopia diagnosis.
Until recently, the only option for nearsightedness was frequent optometrist visits with prescription glasses adjustments. There is another way to slow down the progression of nearsightedness in children, however. Topical atropine eye drops has been found to have great results slowing the progression of myopia with very minimal side effects. Atropine was initially FDA approved for use for pupil dilation or mydriasis, to allow observation of the health of the eyes. By dilating the pupil, the optometrist could observe the inner workings of the eye. Photosensitivity is the most common side effect, as more light is allowed into the eye when the pupil is dilated. This side effect has been noted to be more prevalent with higher concentrations of atropine. When large studies like ATOM2 began examining atropine and myopic children in 2012, they were trying to evaluate different doses. The authors examined 0.5%, 0.1% and 0.01% strengths of atropine eye drops. They found that side effects were minimal with 0.01% as compared to the other treatment arms with similar efficacy (Chia, 2012). A literature review confirmed that dosing consistently showed 0.01% with one drop into affected eye(s) once daily at bedtime as the most effective dose in children.
There has been discussion of higher dosing dependent on the degree of myopia. When determining numbers to support slowing disease progression and atropine, Joachimsen et al. studied 56 children undergoing treatment with atropine 0.01%. The authors noted a mean progression of myopia was found of 0.4 diopters per year vs 1.05 diopters per year in study arms before and after implementation of atropine. ATOM2 found that between 0.01%, 0.05% and 0.1% that the 0.01% had similar effect with lower side effects in a study population of 400 patients.
It is important to note that myopia is not reversible and children treated with atropine will more than likely still need prescription glasses. However, the implementation of atropine will slow the progression of their myopia and vision deterioration. Promptness of myopia diagnosis and initiating therapy are important to maximize results since myopia will only worsen during the rapid eye growth years of childhood. Atropine ophthalmic drops at these particular concentrations must be compounded by a sterile certified compounding pharmacy and who better than Pharmacy Solutions to fulfill your needs?
Chia A., Chua W.H., Cheung Y.B., Wong W.L., Lingham A., Fong A., & Tan D. (2012). Atropine for the treatment of childhood myopia: safety and efficacy of 0.5%, 0.1%, and 0.01% doses (Atropine for the Treatment of Myopia 2). Ophthalmology;119:347–54. doi : https://doi.org/10.1016/j.ophtha.2011.07.031
Chia A., Lu Q.-S., Tan D. (2016) Five-Year Clinical Trial on Atropine for the Treatment of Myopia 2 Myopia Control with Atropine 0.01% Eyedrops. Ophthalmology;123(2), pp. 391-399. doi:https://doi.org/10.1016/j.ophtha.2015.07.004
Holden B.A., Fricke T.R., Wilson D.A., Jong M., Naidoo K.S., Sankaridurg P. et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. (2016).Ophthalmology; 123(5):1036–42.doi: https://doi.org/10.1016/j.ophtha.2016.01.006
Joachimsen, L., Böhringer, D., Gross, N. J., Reich, M., Stifter, J., Reinhard, T., & Lagrèze, W. A. (2019). A Pilot Study on the Efficacy and Safety of 0.01% Atropine in German Schoolchildren with Progressive Myopia. Ophthalmology and Therapy; 8(3), 427–433. doi:10.1007/s40123-019-0194-6
Sacchi, M. , Serafino, M. , Villani, E. , Tagliabue, E. , Luccarelli, S. , Bonsignore, F. & Nucci, P. (2019), Efficacy of atropine 0.01% for the treatment of childhood myopia in European patients. Acta Ophthalmol. doi:10.1111/aos.14166