Halting myopia

Atropine halts myopia progression in Israeli study

Dermot McGrath

Posted: Thursday, February 1, 2018

A low-dose formulation of atropine slowed the progression of myopia for a majority of treated children over a two-year period with no adverse side-effects, according to a study presented at the European Society of Ophthalmology (SOE) Congress in Barcelona.

“Our experience in this small study shows that atropine seems to be safe and effective in preventing myopic progression in children. Before treatment the mean progression was around 0.75D per year compared to 0.32D a year after treatment. Importantly there were no side-effects and no patient discomfort associated with its use,” said Yair Morad MD, Assaf Harofeh Medical Center, Tel Aviv University, Israel.

Dr Morad noted that the best responders seemed to be children with myopia less than -6.0D and no family history of the disease. The most difficult children to treat were those with high myopia and with both parents classed as myopic.

As the most common eye disorder in the world, myopia affects between 25 and 50% of all adults in the United States and Europe. In Asia, the disease has reached epidemic proportions, said Dr Morad, with 85 to 90% of young adults affected in that region. In Israel, the myopia prevalence increased from 20% in 1990 to 28% in 2002.

“This is already before the introduction of smartphones and tablets, so the problem has undoubtedly worsened since then,” he said.

The annual economic burden of the disease is estimated at $268 billion worldwide, with high myopes at greater risk for other ocular conditions such as myopic maculopathy, retinal detachment, cataracts, glaucoma and strabismus.

While the exact mechanism of how atropine works to delay myopia remains unknown, one hypothesis is that the drug blocks muscarinic receptors in the human ciliary muscle, retina and sclera, thus inhibiting thinning or stretching of the sclera, and thereby eye growth.

Dr Morad’s study started in January 2015 and included 83 children with a mean age of 9.2 years and a mean refraction of -4.7D, whose myopia had progressed 0.75D or more in the previous 12 months. All of the children received 0.01% atropine nightly and were examined every six months. After six months, 82 patients progressed between 0 and 0.025D, while one patient who progressed 0.75D was switched to atropine 0.05%. At 12 months, 46 out of 56 children showed very little sign of progression, while eight patients progressed 0.5 D and two patients progressed 0.75D.

Dr Morad said that further study was needed to answer questions relating to the optimal time and duration of treatment. He also noted that the high cost of current treatments should be alleviated with the commercialisation of atropine in the near future.

Yair Morad: