Low Dose Atropine for Children with Progressive Myopia
The incidence of childhood myopia (nearsightedness) is increasing in the United States and worldwide. In the US, 40 percent of children now have myopia, compared to only 20 percent 30 years ago. In some Asian countries, over 90 percent of children are myopic by the end of grade school. The epidemic has resulted in research efforts to reduce the progression of myopia in children.
A promising intervention in the current literature, validated by several international studies, is low-dose atropine eye drops given once a day.
We have prepared this FAQ page to help you make a decision on whether to use low-dose atropine to reduce the progression of myopia in your child.
Most kids receiving atropine treatment have no side effects. About 1 percent of children report an allergic reaction that presents as redness or itching in or around the eye.
Atropine does not reverse myopia, and children treated with low dose atropine still require glasses. The goal of treatment is to reduce the rate at which myopia increases.
Myopia results in a greater risk of eye diseases, such as glaucoma, cataract, retinal detachment, and macular degeneration later in life.
Most children can expect to be on the atropine drops at least 2 years or until the age of 15, which ever is longer. The duration is necessary for a meaningful reduction in the rate of myopic progression.
For most children the rate of progression of myopia reduces by about 50%. Atropine may not stop progression altogether, but it will significantly reduce the rate of increase. For some patients, 0.01% concentration is not strong enough and the dosage will be increased, but this is rare if the compliance of daily dosing is strictly followed.
For the first 6 months myopia may still progress. However, after this we would expect significant reduction in the rate to around -0.50 diopters or less over a year.
We do not treat children under the age of 5 with 0.01% atropine, and most patients are between 6 to 15 years. The sooner we start atropine for myopia, the less nearsighted the child will become overall.
The first visit is usually 3 months after starting the drop to assess for side-effects, and we then examine your child every 6 months or so to confirm that we are achieving the expected response.
Atropine for the reduction of myopia is “off-label,” as it is not yet FDA approved for this purpose. Nonetheless, it has become widely adopted across the US, and particularly the world, for this purpose.
Encourage your child to play outdoors. Kids who spend less time outdoors and get less sunlight exposure are more likely to become myopic. In general, kids today are getting less exposure to natural light, spending more time indoors on computers, TVs and smartphones. Also, make sure your child has enough ambient light when pleasure reading and doing homework; reading in the dark is thought to facilitate myopia.
Atropine 0.01% is not commercially produced by a standard pharmaceutical company. It therefore has to be diluted and individually prepared by a compounding pharmacist.
If your prescription plan does not cover compounded medications, the typical cost is roughly $80.00 for a one month supply (at the time of this writing).
Orthokeratology (commonly called ortho-K) is a highly controversial modality for reducing myopic progression. It involves using overnight rigid contact lenses to apply pressure to the cornea to change its shape. While many studies remain inconclusive, a large Singaporean study showed no long term benefit. Additionally, there are many reports of these lenses causing corneal infection and scarring that result in loss of vision. The use of progressive bifocal glasses has also not shown conclusive benefit in reducing myopic progression.
Eye exercise programs have not been proven to provide any long term benefit for myopic reduction.
Articles of interest:
