Is low-concentration atropine a "miracle drug" for the prevention and control of myopia?

Focus on myopia in children

On March 11 this year, the official website of the State Drug Administration announced that the first 0.01% atropine sulfate eye drops (hereinafter referred to as "low-atropine") in China was approved for marketing, which is the first low-concentration atropine sulfate eye drops to be marketed with the batch number of "National Medicine Quasi-word" for delaying the progression of myopia in children.

So, what is the effect of "low Ah"?

Can all children with myopia use it?

Is it that you don't need to wear glasses after ordering this magic eye medicine?

Is myopia no longer growing?

Are there any side effects?

The First Affiliated Hospital of China University of Science and Technology (Anhui Provincial Hospital)

Liang Li, deputy chief physician of the Department of Ophthalmology

This will take you to understand the "low Ah"

Scientific prevention and control of myopia

Can atropine control myopia growth?

Atropine eye drops are the only drugs that have been proven to be effective in delaying the progression of myopia.

Atropine itself is not a new drug, but a very common "old" drug with a history of clinical application for 100 years.

As a commonly used mydriatic drug in ophthalmology, it is not unfamiliar to everyone with its role in paralyzing the ciliary muscle, dilating the pupil, and relieving adjustment.

It is worth noting that studies in recent years have found that atropine can directly or indirectly act on the retina, choroida or sclera, and play a role in myopia prevention and control in multiple ways.

Atropine can promote the release of dopamine in the retina and delay the progression of myopia;
Atropine can increase choroidal blood perfusion, alleviate sclera hypoxia, and delay the progression of myopia;
Atropine can thicken the sclera fibrous layer, enhance sclera biomechanics, and delay the progression of myopia.

Why choose a concentration of 0.01%?

The myopia control effect of atropine eye drops showed a concentration-dependent effect, and the control effect of high-concentration atropine eye drops on myopia could be as high as 60%~96%, but high-concentration atropine eye drops had adverse reactions such as severe photophobia, decreased near vision and rebound effect after drug withdrawal.

Continuous clinical studies at home and abroad have found that 0.01% atropine not only has a certain myopia control effect, but also has high safety and fewer side effects, especially after stopping the drug, its rebound effect is smaller.

Who is suitable for "low A"?

The approved eye drops have a concentration of 0.01% and according to their official instructions, they can be used to delay the progression of myopia in children aged 6 to 12 years with spherical power of -1.00D to -4.00D (astigmatism ≤1.50D, anisometropia ≤1.50D).

What are the precautions for the use of "low A"? Are there any contraindications?

So far, in the study of 0.01% atropine eye drops for the prevention and control of myopia, no serious systemic adverse reactions associated with drug use have been identified.

Adverse reactions that may occur in the eye include: mydriasis, photophobia, decreased accommodative ability and near vision, allergic reactions, etc.

Ocular adverse effects are mild, have a low incidence and are gradually tolerated with prolonged use.

However, "low A" is a prescription drug, before the first time to take the drug, we must have a face-to-face consultation, and check the visual function, according to the individual situation of the drug, for the presence of pupillary block, narrow angle, high intraocular pressure and other glaucoma tendencies of children, "low A" will have the possibility of inducing glaucoma attacks, occasionally there may be allergic symptoms due to individual factors, so parents should use it scientifically under the guidance of a doctor, and cannot buy and use it themselves. Long-term use also needs to monitor other adverse reactions and safety after medication.

Currently, atropine sulfate eye drops are not recommended for children without myopia to prevent myopia.

How to judge the effect of using 0.01% atropine eye drops?

According to the criteria in the "Expert Consensus on the Application of Low-concentration Atropine Eye Drops in the Prevention and Control of Myopia in Children and Adolescents (2022)", the refractive progress is regularly reviewed to judge the efficacy, and the efficacy is evaluated quarterly.

(1) Good response

The annual increase in myopia does not exceed 0.25D, or the annual increase in myopia decreases by at least 50%;

(2) The response is average

The annual increase in myopia is more than 0.25D and lower than 0.75D;

(3) Poor response

The annual increase in myopia is 0.75D or more.

In the case of a moderate response or a poor response, an increase in concentration or frequency of dispensing may be considered, or a combination of other prevention and control measures.

Isn't it necessary to wear glasses when using "low A"?

Defocal lenses, orthokeratology lenses, and low-concentration atropine are considered to be the "troika" of effective myopia prevention and control.

For the rapid progression, such as myopia progression of more than 50 degrees a year and the growth of the eye axis more than 0.3mm a year, it is necessary for the doctor to evaluate the patient's other conditions, and take one of the "troikas" or take a combination of combined means to delay the progression of myopia.

Experts remind

Although low-concentration atropine sulfate eye drops can delay the development of myopia to a certain extent, it cannot "reverse myopia", it is not a "miracle drug for myopia", and long-term medication cannot be stopped at will.

The prevention and control of myopia is a comprehensive work, which cannot rely solely on clinical intervention and treatment such as drugs or optical means (wearing glasses, defocusing lenses or OK lenses), but also needs to pay attention to eye hygiene habits and living and learning environment.

For more scientific prevention and control of myopia, please go to the optometry clinic of our hospital for further examination, and establish a visual development file for regular follow-up and reexamination.

Source | Anhui Provincial Hospital of the First Affiliated Hospital of University of Science and Technology of China

Editor-in-charge | Gu Pan Editor | Yuan Dandan

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