Low-dose atropine eyedrops no better than placebo for slowing myopia progression

Date:
July 13, 2023
Source:
NIH/National Eye Institute
Summary:
Use of low-dose atropine eyedrops (concentration 0.01%) was
no better than placebo at slowing myopia (nearsightedness)
progression and elongation of the eye among children treated for
two years, according to a randomized controlled trial. The trial
aimed to identify an effective way to manage this leading and
increasingly common cause of refractive error, which can cause
serious uncorrectable vision loss later in life.


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FULL STORY ==========================================================================
Use of low-dose atropine eyedrops (concentration 0.01%) was no better than placebo at slowing myopia (nearsightedness) progression and elongation of
the eye among children treated for two years, according to a randomized controlled trial conducted by the Pediatric Eye Disease Investigator Group (PEDIG) and funded by the National Eye Institute (NEI). The trial aimed
to identify an effective way to manage this leading and increasingly
common cause of refractive error, which can cause serious uncorrectable
vision loss later in life. Results from the trial were published in
JAMA Ophthalmology.

Importantly, the findings contradict results from recent trials,
primarily in East Asia, which showed a benefit from 0.01% atropine in
slowing myopia.

"The overall mixed results on low-dose atropine show us we need more
research.

Would a different dose be more effective in a US population? Would
combining atropine with other strategies have a synergistic effect? Could
we develop other approaches to treatment or prevention based on a better understanding of what causes myopia progression?" said Michael F. Chiang,
M.D., director of the NEI, which is part of the National Institutes
of Health.

Identifying an optimal approach for preventing high (advanced) myopia
is urgently needed given the escalating prevalence of myopia overall and
the risk of it progressing to high myopia. By 2030, it's predicted that
39 million people in the U.S. will have myopia. By 2050, that number
is expected to grow to 44 million in the U.S. and to 50% of the global population.

Much stronger concentrations of atropine eyedrops (0.5-1.0%) have long
been used by pediatric eye doctors to slow myopia progression. While
effective, such doses cause light sensitivity and blurry near vision
while on the nightly eyedrops. Thus, there is interest in clinical
studies assessing lower concentrations that have been shown to have
fewer side effects.

"The absence of a treatment benefit in our U.S.-based study, compared
with East Asian studies, may reflect racial differences in atropine
response. The study enrolled fewer Asian children, whose myopia progresses
more quickly, and included Black children, whose myopia progresses less
quickly compared with other races," noted the study's lead co-author,
Michael X. Repka, M.D., professor of ophthalmology, Johns Hopkins
University.

For the study, 187 children ages 5 to 12 years with low-to-moderate
bilateral myopia were randomly assigned to use nightly atropine (0.01%)
(125 children) or placebo (62 children) eyedrops for two years. Study participants, their parents, and the eye care providers were masked to
the group assignments.

Patient care was provided at 12 study center sites throughout the U.S.

After the treatment period, and 6 months after treatment stopped, there
were no significant differences between the groups in terms of changes
in degree of myopia compared with baseline. Nor were there significant differences in axial length within the two groups when compared with
baseline measurements.

"It's possible that a different concentration of atropine is needed
for U.S.

children to experience a benefit," noted the study's other lead co-author, Katherine K. Weise, O.D., professor, University of Alabama at Birmingham.

"Clinical researchers could evaluate new pharmaceuticals and special wavelengths of light in combination with optical strategies, like
special glasses or contact lenses, to see what works in reducing the progression of myopia." Among children, myopia will stabilize in about
half of children around age 16 years, and among an increasingly larger percentage as they get older. By their early twenties, about 10% of
individuals with myopia will continue to grow more nearsighted, and by
age 24 years that percentage is 4%.

"Vision scientists may help us figure out what's different about the
myopic eye, even among different races and ethnicities, to help create new treatment strategies," she said. It will take a real convergence of eye research to solve the environmental, genetic, and structural mystery of myopia." PEDIG is a collaborative network of pediatric ophthalmologists
and pediatric optometrists dedicated to conducting multi-center trials
on eye disorders that affect children. The trial was funded by the NEI
grants EY11751, EY18810 and EY23198. The ClinicalTrials.gov identifier
is NCT03334253.

* RELATED_TOPICS
o Health_&_Medicine
# Eye_Care # Children's_Health # Infant's_Health #
Diseases_and_Conditions
o Mind_&_Brain
# Child_Psychology # Child_Development # ADD_and_ADHD #
Racial_Issues
* RELATED_TERMS
o Myopia o Refractive_surgery o Cataract o Visual_acuity o
Eye_examination o Rotavirus o Nocebo_-_Placebo o Cirrhosis

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========================================================================== Journal Reference:
1. Michael X. Repka, Katherine K. Weise, Danielle L. Chandler, Rui
Wu, B.

Michele Melia, Ruth E. Manny, Lori Ann F. Kehler, Catherine
O. Jordan, Aparna Raghuram, Allison I. Summers, Katherine A. Lee,
David B. Petersen, S. A. Erzurum, Yi Pang, Phoebe D. Lenhart,
Benjamin H. Ticho, Roy W.

Beck, Raymond T. Kraker, Jonathan M. Holmes, Susan A. Cotter,
Denise D.

Alexopoulous, Megan Allen, Heather A. Anderson, Darrell S. Austin,
Shane C. Black, Nicole M. Boyle, Grant Andrew Casey, Moriah Adine
Chandler, Ryan Chinn, Deborah A. Clausius, Beth J, Colon, Courtney
L. Conner, Linda T. Curtis, Zainab Dinani, Quayleen Donahue,
Michelle Dubois, Patricia L.

Evans, Brooke P. Fimbel, Melanie Kay Fowler, Richard P. Golden,
Beth G.

Harper, Robert J. Henderson, Dieu-Hong Ho, James E. Hoepner,
Kristine B.

Hopkins, Ashli S. Jenks, Joseph D. Kaplon, Shabana Khan,
Cassandra A.

Koutnik, Annie F. Kuo, Jessy Lee, Muriel M. Martinez, Sophia
M. Marusic, Mary Lou McGregor, J. Ryan McMurtrey, Kathryn
B. Miller, Preeti L. Mokka, Jenifer Montejo, Beth A. Morrell,
Elyse Nylin, Kimberly C. Odom, Gillaine Ortiz, Samantha A. Parra,
Kyle J. Perkins, Larry W. Plum, Ellen Fiona Redenbo, Julianne
L. Robinson, Kathleen M. Stutz, Desirae R. Sutherland, Mircea
X. Teodorescu, Lori L. Torgensen, David O. Toro, Phillip B.

Turner, Natalie C. Weil, Emily K. Wiecek, Carsyn S. Wilkins,
Victoria C.

Woodard, Kevin M. Woodruff, Huizi Yin, Marika L. Yumang, Tomohiko
Yamada, Noha S. Ekdawi, David A. Leske, David K. Wallace, Melanie
L. Christian, Stephen R. Glaser, Eileen E. Birch, Angela M. Chen,
Stephen P.

Christiansen, Laura B. Enyedi, Donald F. Everett, Sharon
F. Freedman, William V. Good, Erin C. Jenewein, Richard London,
Vivian M. Manh, David G. Morrison, Stacy L. Pineles, Hantamalala
Ralay Ranaivo, Tawna L.

Roberts, Scott T. Ruark, Bonita R. Schweinler, Jayne L. Silver,
Donny W.

Suh, Lisa C. Verderber, Marie Diener-West, John D. Baker, Barry
Davis, Rosemary D. Higgins, Stephen W. Poff, Richard A. Saunders,
Lawrence Tychsen. Low-Dose 0.01% Atropine Eye Drops vs Placebo
for Myopia Control.

JAMA Ophthalmology, 2023; DOI: 10.1001/jamaophthalmol.2023.2855 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2023/07/230713141942.htm

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