Abstract

PurposeIdentifying axial length growth rate as an indicator of fast progression before initiating atropine 0.01% for myopia progression in children.MethodFrom baseline, axial length growth over six months was measured prospectively. Subjects were then initiated on atropine 0.01% if axial length growth was greater than 0.1mm per 6 months (fast progressors), axial length and spherical equivalent change measurements recorded every six months. The rate of change was compared to the baseline pre-treatment rate. If axial length change was below the threshold, subjects received monitoring only.Results73 subjects were identified as fast progressors and commenced atropine 0.01%, (mean baseline refraction of OD -2.9±1.6, OS -2.9±1.8 and a mean baseline axial length OD 24.62 ± 1.00 mm, OS 24.53 ± 0.99 mm). At six months, the mean paired difference of axial length growth rate was significantly reduced by 50% of baseline (all 73 subjects, p<0.05). 53 subjects followed to 12 months, and 12 to 24 months maintained a reduced growth rate. Change in mean spherical equivalent was significantly reduced compared to pre-treatment refractive error (mean paired difference p<0.05) and at each subsequent visit. 91 children were slow progressors and remained untreated. Their axial length growth rate did not change significantly out to 24 months. Spherical equivalent changed less than -0.5D annually in this group.ConclusionIdentifying fast progressors before treatment initiation demonstrated a strong treatment effect with atropine 0.01% reducing their individual rate of myopia progression by 50%. Another large group of myopic children, slow progressors, continued without medical intervention. A baseline axial length growth rate is proposed as a guideline to identify fast progressors who are more likely to benefit from atropine 0.01%.

Highlights

  • The prevalence of myopia is increasing worldwide, with pathological myopia a growing cause of vision loss [1, 2]

  • 73 subjects were identified as fast progressors and commenced atropine 0.01%

  • The mean paired difference of axial length growth rate was significantly reduced by 50% of baseline. 53 subjects followed to 12 months, and 12 to 24 months maintained a reduced growth rate

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Summary

Introduction

The prevalence of myopia is increasing worldwide, with pathological myopia (defined by the WHO as -5.0 D or higher) a growing cause of vision loss [1, 2]. Pathological myopia results in an increased risk of glaucoma, retinal detachment, choroidal neovascularisation and macular disease [3, 4]. The recent LAMP study has noted that atropine 0.05% had the most significant effect in retarding both myopic dioptric progression and axial elongation [8, 9]. This dose did result in greater pupil dilation and loss of accommodation. A previous study has noted that doses greater than atropine 0.02% will result in significant clinical symptoms of accommodation paralysis and pupil dilation [11]

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