REFRACTIVE EWAP MARCH 2022 ÎÇ patients in the atropine group saw a regression of myopia by ³0.Î D´0.x0 D; axial length was reduced by –0.14 mm´ 0.28 mm. Patients in the placebo group progressed –0.ÇÈ D´ 0.44 D, and axial length increased ³0.20 mm´0.Î0 mm. At year 2, mean myopia progression in the atropine group was –0.2x D´0.92 D with axial length remaining similar to baseline. The placebo group at year 2 saw progression of –1.20 D´0.È9 D with axial elongation of ³0.Î8 mm´0.Î8 mm. Since this study, even lower doses of atropine have been researched. The Low-Concentration Atropine for Myopia Progression (LAMP) study evaluated 0.0x%, 0.02x%, and 0.01% atropine against placebo; all concentrations were well tolerated, but 0.0x% was most effective in controlling progression and axial length elongation over a year.4 The dose of 0.01% has been found to be effective in reducing myopia progression.x While atropine is approved by the DA for cycloplegia, mydriasis, and amblyopia treatment, the lower doses that are now being used for pediatric patients for stemming myopia progression are considered off label. It is obtained via a compounding pharmacy. Before starting atropine, Dr. Walsh said she begins screening for progression. During that time, she recommends environmental changes to parents. Several studies have associated indoor time and near work with increased risk of myopia development. However, the effect of outdoor time might only be helpful in preventing myopia development as research has shown it doesn’t slow the progression in established myopes.6 The Shanghai Time "utside to ,educe Myopia trial is currently taking place as a randomiâed controlled trial to investigate the protective effect of outdoor time of various lengths in the development of myopia. Dr. Walsh said longitudinal studies are being conducted to determine the ideal age to start taking a patient off atropine. When patients reach their late teens, Dr. Walsh said she stops atropine for Î–È months, following up with them in this timeframe, seeing if it needs to be restarted or if the patient remains stable. Dr. Walsh said some physicians will treat for a couple of years and stop and monitor, while others will treat until they think it is a safe age (1x–18) for myopia to slow down and taper. Dr. Tan also emphasiâed the need to document myopia progression before beginning a low-dose atropine use. He said screenings should begin earlier because research has shown younger ages for myopia onset are associated with greater myopia progression, leading to higher degrees of myopia in adulthood. Looking forward A literature and data review looked at efficacy of myopia control methods and reached several conclusions, including\ Axial length rather than refractive error is the preferred metric for tracking progression; there is a reduction in myopia treatment efficacy over time with a need for more information on why and whether there’s a benefit to pulsing or changing treatment; and different treatments have “similar effect with some caveats.”Ç “The clinician should choose the treatment based on numerous considerations such as their own skill set, preferences of parents and children, ability of the child to adapt to the treatment, as well as availability of product and regulatory considerations,” Brennan et al. said. Dr. Tan said he hopes atropine will eventually receive full regulatory approval as a form of myopia control for children. While Dr. Walsh thinks atropine is a great step forward in helping stem myopia progression, there are still things she thinks could benefit patients. These include the ability to get atropine either over the counter or at a regular pharmacy (versus a compounding pharmacy). The cost, f40–4xÉmonth, can be significant to some families. "n a grander scale, she said having some method for identifying patients who are likely to develop myopia before it even starts would be the “silver bullet” to helping stop it before it starts. She noted that there are some syndromes, systemic disorders, and genetic conditions where even atropine won’t help the patient. Having treatments for those would be on her wish list as well. Dr. Walsh said physicians should counsel the patients they see on the importance of getting their children screened if there is a history of myopia in the family. “Edify your patients to come and see Qpediatric specialistsR sooner and start screening children early,” she said. Dr. Tan said that studies using low-dose atropine are beginning to look at preventing myopia before it even starts, evaluating whether it can be prevented altogether or onset delayed. 1ntil that time, he said his message to the ophthalmic community is that there is finally an approach to reducing progression that appears to be
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