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0.01% Atropine’s “Puzzling Disconnect”

The use of 0.01% atropine to control paediatric myopia progression continues to increase despite a “puzzling disconnect” highlighted in recent commentary and a paper authored by Dr Safal Khanal and Dr John R Phillips, published in Clinical and Experimental Optometry.

That “puzzling disconnect” is that “0.01% atropine slows the refractive changes associated with myopia progression without slowing the abnormal eye enlargement”.

For myopia management to effectively reduce the risks of myopia-related pathologies in later life, Drs Khanal and Phillips point out it is necessary to slow the rate of eye elongation. They write, “Since the sight-threatening complications of myopia result primarily from excessive tissue stretch, effective slowing of eye growth would significantly ameliorate the risks and consequently help reduce the burden of future sight loss”. According to their paper, nearly two-thirds of members of paediatric ophthalmology societies world-wide regularly prescribe 0.01% atropine to reduce myopia progression. Additionally, many hospital ophthalmology departments in Asia, and private practices, including in Australia and New Zealand, use it.

However, all studies on low dose atropine to date show 0.01% atropine has no effect on axial length, whereas higher concentrations, such as 0.025 and 0.05%, slow eye elongation significantly over one year, with 0.05% concentrations appearing equally as effective as orthokeratology lens wear.

Because myopia progression is most rapid in the early stages of the development, the authors state a shift in clinical practice away from using 0.01% toward prescribing 0.025% to 0.05% atropine is needed until there is at least some evidence for the axial growth efficacy of 0.01% atropine.

Reference onlinelibrary.wiley.com/doi/full/10.1111/cxo.12967