Abstract
The prevalence of myopia is increasing globally. Complications of myopia are associated with huge economic and social costs. It is believed that high myopia in adulthood can be traced back to school age onset myopia. Therefore, it is crucial and urgent to implement effective measures of myopia control, which may include preventing myopia onset as well as retarding myopia progression in school age children. The mechanism of myopia is still poorly understood. There are some evidences to suggest excessive expansion of Bruch’s membrane, possibly in response to peripheral hyperopic defocus, and it may be one of the mechanisms leading to the uncontrolled axial elongation of the globe. Atropine is currently the most effective therapy for myopia control. Recent clinical trials demonstrated low-dose atropine eye drops such as 0.01% resulted in retardation of myopia progression, with significantly less side effects compared to higher concentration preparation. However, there remain a proportion of patients who are poor responders, in whom the optimal management remains unclear. Proposed strategies include stepwise increase of atropine dosing, and a combination of low-dose atropine with increase outdoor time. This review will focus on the current understanding of epidemiology, pathophysiology in myopia and highlight recent clinical trials using atropine in the school-aged children, as well as the treatment strategy in clinical implementation in hyperopic, pre-myopic and myopic children.
Highlights
1234567890();,: 1234567890();,: Myopia is the most common eye disorder worldwide, but it is often misregarded as merely a refractive error that can be corrected by spectacles, contact lenses, or refractive surgery
The early onset of myopia in Asian schoolchildren is associated with longer duration to reach stability in refraction, and in some cases faster progression rate (-1 D per year) [8], which results in the higher prevalence of high myopia in Asian young adults, with risks to develop sequelae associated with high myopia and resulting in pathologic myopia [9]
There are strong evidences to suggest environmental factors play a crucial role in the development of school age onset myopia [10], which include time spent outdoors [11], prolonged intense education [12], urbanization [10], near work [13], prenatal factors [14], and socioeconomic status [15]
Summary
1234567890();,: 1234567890();,: Myopia is the most common eye disorder worldwide, but it is often misregarded as merely a refractive error that can be corrected by spectacles, contact lenses, or refractive surgery. It fits with the results of clinical trials discussed later in this review, in which atropine applied topically in low concentrations of 0.01% was associated with a reduced progression of myopia in schoolaged children. The randomized control trial in Taiwan, published by Yen et al in 1989, reported that 1% atropine had better effect on controlling myopic progression in a year of follow-up visit when compared to 1% cyclopentolate and placebo [58].
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