EyeWorld India December 2014 Issue

39 EWAP REFRACTIVE December 2014 stable, the children often did not need to change glasses again whilst on treatment. The systemic effects of atropine (e.g., flushing, mood changes, palpitation or dry mouth) were rare but care may need to be exercised if atropine is being considered in younger children (e.g., aged <5 years). The most common adverse effect was an ocular allergy resulting in erythema, itch or occasionally periocular dermatitis (4%). The next challenge was to know when to stop atropine without precipitating a myopic rebound. One solution is to continue the child on atropine till age 10–11 years, and gradually taper the atropine frequency (e.g., by first skipping 1–2 days a week and gradually more) over several months. Our experience is that by doing so, one can achieve a stabilization of myopia which persist even after atropine is stopped (e.g., at 13–14 years of age). As it became evident that lower doses of atropine is also very effective in slowing myopia with less rebound, we now use Atropine 0.01% as a first line treatment. The effect of low dose atropine may not be as dramatic as high dose atropine initially, but the effect appears to build over time so that the efficacy in the second year may be better than the first. The benefits of the atropine 0.01% is that it causes much less glare and near blur, and is well tolerated by children. If you do not have access to low-dose atropine, then a higher dose atropine, used once or twice weekly, may also be quite effective. It may mean that for part of the week, children may require photochromatic or progressive near add glasses, but it would also mean that the atropine may be easier to taper over time. Clinicians, keen on using atropine in control of myopia, need to be aware of how children respond to treatment, the pros and cons of the different doses of atropine, and how to tailor the treatment appropriately for each child. They should also note that some children (7–10%) may not respond as well to treatment, and if myopia progression appears to progress unabated over 1–2 years, then it may be time to stop atropine and try an alternative means of myopia control. In summary, recent research into myopia and its various treatments has led to a better understanding about the pathogenesis of myopia and may provide us with several new avenues of treatment. It is important to keep an open mind, as we decide which treatment or combinations of treatment will provide us with the best ways to control myopia progression in young children. EWAP Editors’ note: Dr. Chia has no relevant financial interests. Contact information Chia: +65-91391996; audrey.chia.w.l@snec.com.sg DATE MEETING VENUE January 10-11 3rd Biennial Scienti c Meeting of Indonesian Society of Cataract & Refractive Surgery (INASCRS) www.inascrs.org/ Jakarta Indonesia February 5-8 73rd Annual Conference of All India Ophthalmology Society (AIOS) www.aios.org New Delhi India April 1-4 30 th Asia-Paci c Academy of Ophthalmology Congress (APAO) www.apaophth.org/ Guangzhou China April 17-21 ASCRS-ASOA Symposium & Congress www.ascrs.org San Diego USA May 22-24 25 th SNEC Anniversary Meeting www.snec.com.sg Singapore July 19-21 30 th Annual Meeting of Japanese Society of Cataract & Refractive Surgery (JSCRS) www.jscrs.org Tokyo Japan August 5-8 28 th Asia-Paci c Association of Cataract and Refractive Surgeons Annual Meeting (APACRS) www.apacrs.org Kuala Lumpur Malaysia September 5-9 XXXIII Congress of European Society of Cataract & Refractive Surgery (ESCRS) www.escrs.org Barcelona Spain November 14-17 Annual Meeting of American Academy of Ophthalmology (AAO) www.aao.org Las Vegas USA CALENDAR OF MEETINGS 2015