Hey Good optometry morning. Dr. Michael Nelson, Winnipeg optometrist here and if you have child that was diagnosed with myopia at thier eye exam in Winnipeg you may want be aware of atropine treatment for myoipa managment.
This study is a called Atropine for the Treatment of Childhood Myopia: Safety and Efficacy of 0.5%, 0.1%, and 0.01% Doses (Atropine for the Treatment of Myopia 2) and sometimes it is referred to as the ATOM 2 Study. It was published in the journal Ophthalmology in 2012. The results of ATOM 2 were actually released in 3 papers because there were 3 phases to this study.
ATOM 1 study showed that 1 % atropine works to reduce myopia progression there are 2 problems (lets call them symptoms) with 1% atropine: 1. It dilates your pupil so you may be sensitivite to lights and you may need to wear tinted lenses. And 2. It freezes your accommodation or ability to focus to will need to wear a bifocal lens.
So the ATOM 2 study looks at whether lower dosages of atropine are as effective as 1% atropine AND if the kids get less symptoms of atropine
So this is a double masked randomized study that looked at 400 kids between the ages 6-12. So this study has 2 phases to it. Phase one the kids used lower dosages atropine in each both eyes of either 0.5%, 0.1% or 0.01% atropine. One drop in each eye every evening for 2 years.
This is different from ATOM 1 because ATOM 1 they used 1% but only in one eye for 2 years.
So do patients get symptoms of pupil dilation and loss of focus with the lower concentrations. The answer is that 0.01% had very little effect on pupils and accommodation. The 0.1 and 0.5% had some effects on pupil size and accommodation but not as much as 1%.
Okay so do lower dosages of atropine work as well at 1%?
So the ATOM 1 study showed over 2 years…in untreated eyes the progression of myopia over 2 years is 1.2D and with 1% atropine the change in myopia was 0.28.
The results for the lower dosages of atropine also showed a that they reduced the progression of myopia….and almost as much as the 1% atropine.
They also looked at axial length. t. You will note that in the ATOM 2 study that the 0.1% and the 0.5% concentrations showed less growth of the eye than the 0.01%….what is interested is when you add the ATOM 1 data….it shows the ATOM 1 placebo group had similar growth as the 0.01% group… It is important to note that the ATOM2 and ATOM 1 studies did not use the same method to measure axial length…so that could explain the difference.
So I mentioned that ATOM 2 has 2 phases….well in actual fact it has 3 phases. So phase one was what I just described. In Phase 2 they after the first 2 years of treatment they stopped the drops in everyone and waited a year to see how much the myopia started to increase…what they found out was There was a myopic rebound after atropine was stopped, and it was greater in eyes that had received the higher concentrations of 0.5%and 0.1%atropine. The 0.01% atropine effect, however was more modulated and sustained.
So if your child have had an children’s eye exam by your Winnipeg optometrist and they have myopia, you should contact our eye doctors at Eyes on Bridgwater and we would be happy talk to about the option of atropine eye drops for myopia control and managment.
