Starting Low Dose Atropine in the Treatment of Myopia

The prevalence of myopia is increasing globally.  Complications of
myopia are associated with huge economic and social costs.  It is believed that high myopia in adulthood can be traced back to school age onset myopia.  Therefore, it is crucial and urgent to implement effective measures of myopia control, which may include preventing myopia onset as well as retarding myopia progression in school age children.  Atropine is currently the most effective therapy for myopia control. Recent clinical trials demonstrated low-dose atropine eye drops such as 0.01% resulted in retardation of myopia progression, with significantly less side effects. However, there remain a proportion of patients who are poor responders, in whom the optimal management remains unclear.  Proposed strategies include stepwise increase of atropine dosing, and a combination of low-dose atropine with increase outdoor time.

Eligibility Criteria for starting low dose Atropine in the Treatment of Myopia according to the international Study (ATOM)

  1. Children aged 6 to 12 years
  2. Refractive error of spherical equivalent (sphere + ½ cylindrical power)
    between -1.00 D to – 6.00 D in each eye as measured by cycloplegic autorefraction
  3. Difference in power of spherical equivalent between both eyes less than
    or equal to 1.50 D.
  4. Astigmatism of – 1.50 D or less.
  5. Distance vision correctable to logMAR 0.2 (Snellen 6/12) or better in
    both eyes
  6. Normal intraocular pressure of less than 21 mmHg
  7. Normal ocular health other than myopia
  8. In good general health with no history of cardiac or significant
    respiratory diseases
  9. No allergy to atropine, cyclopentolate, proparacaine, and benzalkonium
    chloride
  10. No previous or current use of contact lenses, bifocals, progressive
    addition lenses, or other forms of treatment for myopia
  11. Normal binocular function and stereopsis
  12. No lazy eye or squint
  • The treatment once started should be continued for a minimum of 2
    years before considering it as not effective.
  • Single drop of 0.01% ATROPINE should be instilled once daily in both the
    eyes at night time.
  • The consulting ophthalmologist should be immediately contacted if any
    adverse allergic reactions are encountered during or after the
    administration of the drop.
  • Follow up visits as per physicians advice should be strictly followed.

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