Concentrations Of Atropine Research Articles

Comparison of different concentrations atropine in controlling children and adolescent myopia: an umbrella review of systematic reviews and meta-analyses

PurposeTo evaluate the myopia control effect of different concentrations atropine in children and adolescent.MethodsMeta-analyses and systematic reviews available in the Pubmed, Embase, and Cochrane Library databases from the databases’ inception to August 2023 were searched to evaluate the efficacy and tolerability of different concentrations’ atropine in controlling myopia progression. Overall effects were performed using random-effects model. AMSTAR 2 tool was used to assess the quality of included studies. Prespecified outcomes were weight mean difference (WMD) with 95% credible interval (95% CI) of annual spherical equivalent refraction (SER) changes and annual axial length (AL) changes.Results19 systematic reviews/meta-analyses of different atropine concentrations were included in the analysis. 14 studies reported SER changes, and 17 reported AL changes. In terms of the studies’ overall methodological quality level (measured using AMSTAR 2), 1 study was rated high, 7 moderate, 7 low, and 4 critically low. The 0.01% atropine was found to have statistically significance (annual SER change WMD 0.27 [95% CI 0.21 - 0.34] D/year; annual AL change WMD -0.09 [95% CI -0.1 to -0.07]) mm/year), 0.05% atropine was preferred considering efficacy and tolerability (annual SER change WMD 0.54 [95% CI 0.49 - 0.58] D/year; annual AL change WMD -0.21 [95% CI -0.12 to -0.02]) mm/year).ConclusionsDifferent atropine concentrations alleviated children and adolescent myopia progression. However, higher-quality evidence and further investigation are needed to clarify the dose–response relationship, and practical guidelines must be developed to determine myopia control efficacy.

Can we really distinguish 'responders' from 'non-responders' to myopia control interventions?

It is common to hear talk of 'responders' and 'non-responders' with respect to myopia control interventions. We consider the reality of distinguishing these sub-groups using data from the first year of the Low-concentration Atropine for Myopia Progression (LAMP) study. The first year of the LAMP study was a robustly designed, placebo-controlled trial of three different low concentrations of atropine using a large sample size (N > 100 randomised to each group). The authors subsequently published mean axial elongation and myopia progression rates by age group. We used these data to calculate efficacy in terms of both absolute reduction in myopic progression and absolute reduction in axial elongation for each of the different atropine concentrations at each age group. We then compared these efficacy data to the overall progression for each of the two progression metrics. Plotting efficacy as a function of overall myopia progression and axial elongation for each of the different atropine concentrations demonstrates the invariant nature of efficacy, in terms of clinically meaningful reduction in progression, despite a substantial range of underlying overall progression. That is, faster progressors-the so-called non-responders-achieved similar reduction in axial elongation and myopia progression as the slower progressors-the so-called responders-within the various atropine treatment groups. The use of the terms, responders and non-responders, during myopia progression interventions is not supported by evidence. Those designated as such may simply be slower or faster progressors, who, on average achieve the same benefit from treatment.

Comparative UV-Spectroscopic and Chemical estimations of Atropine Alkaloid present in Datura stramonium found in Saudi Arabia

Aim: To find out the concentration of Atropine alkaloid in Datura stramonium of Saudi Arabian Region and to develop a new method of the Atropine estimation. Methods: The presence of Atropine in the alcoholic extract of leaves of Datura stramonium was known by Qualitative TLC profile. Quantitative estimation of Atropine in the extract was done with UV Spectrophotometric Method (new proposed method for determination of Atropine in plant extract) and Titrimetric Method (Pharmacopoeial method) and results were compared. Results: Qualitative (TLC) Result showing the presence of Atropine in the Datura stramonium extract. After applying the calculations the concentration of Atropine was found to be 0.3% (w/w). Since the both quantitative results were comparable and the values of the results were approximately equal supporting the validation of New Method. Conclusion: The Saudi Arabian geographical variety of Datura stramonium contains the Atropine Alkaloid as 0.3% (w/w) which is close to the reported value. The new method for the quantitative estimation of Atropine i.e. UV spectroscopic method was developed successfully.

Isolation and investigation of antibacterial activities and cytotoxicity of atropine and scopolamine

Medicinal plants contain various secondary metabolites, such as alkaloids, polyphenols, terpenes, tannins, terpenoids, and flavonoids. These compounds are important sources for treating numerous diseases. Datura stramonium, a plant from the Solonaceae family, is rich in alkaloids, glycosides, terpenoids, steroids, flavonoids, tannins, and saponins. Over time, this plant has demonstrated significant therapeutic effects. The objective of this study was to extract atropine and scopolamine compounds, which are alkaloids found in D. stramonium leaves, and investigate their antibacterial and cytotoxic effects. Atropine and scopolamine were isolated from D. stramonium and analyzed using high-performance chromatography (HPLC) and carbon and proton NMR (NMR H1, C13). The antibacterial activity of atropine and scopolamine against Shigella dysenteriae (PTCC 1188), Streptococcus pyogenes (ATCC 19615), and Staphylococcus epidermidis (CIP 81.55) was investigated using the disc diffusion and microdilution methods. The cytotoxic activity on AsPC-1 (pancreatic adenocarcinoma), MCF-7 (breast cancer), and ACHN (renal carcinoma) cell lines was studied using the MTT reagent assay method. Both compounds exhibited the highest antibacterial activity against S. dysenteriae, while the lowest antibacterial activity was observed against S. pyogenes. All three cancer cell lines were treated with different concentrations of atropine and scopolamine for 24 and 48 h. The results of both extracts showed that increasing the concentration of the extracts decreased the viability of all three cell lines. The IC50 values of both extracts were measured at 24 and 48 h. Preliminary results confirm the therapeutic potential of these two compounds, but further studies are required to investigate there in vivo effects.

Colorimetric enzymatic rapid test for the determination of atropine in baby food using a smartphone.

A method for the enzymatic determination of atropine has been developed, which is based on a sequence of reactions involving (1) the hydrolysis of atropine to give tropine; (2) the enzymatic oxidation of tropine with NAD (catalysed by tropinone reductase); and (3) an indicator reaction, in which the NADH previously formed reduces the dye iodonitrotetrazolium chloride (INT) to a reddish species, the reaction catalysed by diaphorase. The method was first developed in solution (linear response range from 2.4 × 10-6M to 1.0 × 10-4M). It was then implemented in cellulose platforms to develop a rapid test where the determination is made by measuring the RGB coordinates of the platforms using a smartphone-based device. The device is based on the integrating sphere concept and contains a light source to avoid external illumination effects. The smartphone is controlled by an app that allows a calibration line to be generated and the atropine concentration to be quantified; moreover, since the app normalizes the CCD response of the smartphone, the results and calibrations obtained with different smartphones are similar and can be shared. Using the G coordinate, the results were shown to have a linear response with the concentration of atropine ranging from 1.2 × 10-5M to 3.0 × 10-4M with an RSD of 1.4% (n = 5). The method has been applied to the determination of atropine in baby food and buckwheat samples with good results.

Impact of Myopia Progression and Its Intervention Methods on Choroidal Thickness

As the prevalence of myopia has recently increased, there is growing interest in interventions to slow myopia progression. The choroid, the rearmost and largest part of the uveal layer, is a tissue rich in blood vessels located between the retina and the sclera. Recent advancements in diagnostic equipment have enabled direct imaging of the choroid, leading to increased research on its role in both normal and pathological conditions. Regarding myopia, it has been reported that; 1) the choroidal thickness decreases as the degree of myopia and axial length increase, 2) in the case of moderate to high concentrations of atropine or orthokeratology lenses, which are known to slow myopic progression, choroidal thickening is accompanied from the early stages of application, and 3) the mechanism by which choroidal thickening slows myopia progression is also being actively investigated. As a result, the choroid is being recognized as a therapeutic target for developing new interventions to slow myopia progression. Additionally, the increase in choroidal thickness has been reported as a predictive factor for the subsequent myopia progression, suggesting its potential role as a biomarker for assessing the likelihood of future myopia progression.

The optimal atropine concentration for myopia control in Chinese children: a systematic review and network Meta-analysis.

To figure out whether various atropine dosages may slow the progression of myopia in Chinese kids and teenagers and to determine the optimal atropine concentration for effectively slowing the progression of myopia. A systematic search was conducted across the Cochrane Library, PubMed, Web of Science, EMBASE, CNKI, CBM, VIP, and Wanfang database, encompassing literature on slowing progression of myopia with varying atropine concentrations from database inception to January 17, 2024. Data extraction and quality assessment were performed, and a network Meta-analysis was executed using Stata version 14.0 Software. Results were visually represented through graphs. Fourteen papers comprising 2475 cases were included; five different concentrations of atropine solution were used. The network Meta-analysis, along with the surface under the cumulative ranking curve (SUCRA), showed that 1% atropine (100%)>0.05% atropine (74.9%) >0.025% atropine (51.6%)>0.02% atropine (47.9%)>0.01% atropine (25.6%)>control in refraction change and 1% atropine (98.7%)>0.05% atropine (70.4%)>0.02% atropine (61.4%)>0.025% atropine (42%)>0.01% atropine (27.4%)>control in axial length (AL) change. In Chinese children and teenagers, the five various concentrations of atropine can reduce the progression of myopia. Although the network Meta-analysis showed that 1% atropine is the best one for controlling refraction and AL change, there is a high incidence of adverse effects with the use of 1% atropine. Therefore, we suggest that 0.05% atropine is optimal for Chinese children to slow myopia progression.

Human Plasma Butyrylcholinesterase Hydrolyzes Atropine: Kinetic and Molecular Modeling Studies.

The participation of butyrylcholinesterase (BChE) in the degradation of atropine has been recurrently addressed for more than 70 years. However, no conclusive answer has been provided for the human enzyme so far. In the present work, a steady-state kinetic analysis performed by spectrophotometry showed that highly purified human plasma BChE tetramer slowly hydrolyzes atropine at pH 7.0 and 25 °C. The affinity of atropine for the enzyme is weak, and the observed kinetic rates versus the atropine concentration was of the first order: the maximum atropine concentration in essays was much less than Km. Thus, the bimolecular rate constant was found to be kcat/Km = 7.7 × 104 M-1 min-1. Rough estimates of catalytic parameters provided slow kcat < 40 min-1 and high Km = 0.3-3.3 mM. Then, using a specific organophosphoryl agent, echothiophate, the time-dependent irreversible inhibition profiles of BChE for hydrolysis of atropine and the standard substrate butyrylthiocholine (BTC) were investigated. This established that both substrates are hydrolyzed at the same site, i.e., S198, as for all substrates of this enzyme. Lastly, molecular docking provided evidence that both atropine isomers bind to the active center of BChE. However, free energy perturbations yielded by the Bennett Acceptance Ratio method suggest that the L-atropine isomer is the most reactive enantiomer. In conclusion, the results provided evidence that plasma BChE slowly hydrolyzes atropine but should have no significant role in its metabolism under current conditions of medical use and even under administration of the highest possible doses of this antimuscarinic drug.

Evidence for the use of atropine to control myopia in children

To describe the effectiveness of using atropine as a method of controlling the progression of myopia in children. This is a systematic review study of literature, which search strategies in the Biblioteca Virtual em Saúde (BVS) and PubMed, through different combinations of the descriptors “Myopia”, “Control”, “Children” and “Atropine ” in the 2020-2023 timeframe. After selecting the inclusion and exclusion criteria, 30 articles compose the sample corpus. Atropine concentration is directly related to efficacy, with higher doses being more effective, however, also is associated with the appearance of adverse effects, especially photophobia. The most used dose is 0.01%, which presents positive results in control and fewer side effects; most of these studies involve the Asian population. There is a variation in results between populations, due to the different level of pigment in the iris, in addition to sociocultural differences between ethnicities. The lack of intervention can result in complications, with an increased risk related to the degree among children, and is not reduced with optical correction alone. The use of atropine is promising for controlling myopia in children, however it must be tested in association with other control methods and in different populations, so that the treatment is individualized and carried out in a way that presents results, in addition to reducing complications related to refractive disorder.

Differential Impact of 0.01% and 0.05% Atropine Eyedrops on Ocular Surface in Young Adults.

To evaluate the effect of low-concentration (0.01% and 0.05%) atropine eyedrops on ocular surface characteristics in young adults. Twenty-six myopic students aged 18 to 30 years were randomly assigned to receive either 0.01% or 0.05% atropine once nightly for 14 days, followed by cessation, with a ≥14-day interval between each administration. Assessments were conducted one, two, seven, and 14 days after using atropine with corresponding timepoints after atropine cessation. Tear meniscus height and first and average noninvasive keratograph tear film breakup time (NIKBUT-first, NIKBUT-average) were measured using Keratograph 5M, whereas the objective scatter index (OSI) was measured by OQAS II devices; the ocular surface disease index (OSDI) score was also obtained. The mean OSI peaked after two days of administration of 0.05% atropine (β = 0.51, P = 0.001), accompanied by significant decreases in NIKBUT-first (β = -7.73, P < 0.001) and NIKBUT-average (β = -8.10, P < 0.001); the OSDI peaked after 14 days (β = 15.41, P < 0.001). The above parameters returned to baseline one week after atropine discontinuation (all P > 0.05). NIKBUT-first and NIKBUT-average reached their lowest points after 14 days of 0.01% atropine administration (NIKBUT-first: β = -4.46, P = 0.005; NIKBUT-average: β = -4.42, P = 0.001), but those significant changes were diminished once atropine treatment stopped. Young adult myopes experienced a significant but temporary impact on the ocular surface with 0.05% atropine administration, whereas 0.01% atropine had a minimal effect. The investigation of the ocular surface effects of different concentrations of atropine may inform evidence-based clinical decisions regarding myopia control in young adults.

Impact of Various Concentrations of Low-Dose Atropine on Pupillary Diameter and Accommodative Amplitude in Children with Myopia.

Purpose: To assess over 2 weeks, the effect of 3 different low concentrations of atropine on pupillary diameter and accommodative amplitude in children with myopia. Methods: Fifty-eight children with myopia [spherical equivalent (SE) of -0.50 diopters (D) or worse, astigmatism of less than or equal to 2.00 D] were randomly allocated to 3 groups receiving 0.01%, 0.02%, or 0.03% atropine eye drops, once nightly for 2 weeks. The primary outcome was the change from baseline in pupillary diameter and accommodative amplitude with each of the concentrations. Results: Fifty-seven participants (114 eyes), aged between 6 and 12 years, completed the 2-week trial (mean age 9.3 ± 1.7 years and mean SE -3.53 ± 1.79 D). After 2 weeks of use, all the 3 concentrations were found to have a statistically significant effect on both the pupillary diameter and accommodative amplitude. Accommodative amplitude reduced by an average of 5.23 D, 9.28 D, and 9.32 D, and photopic pupil size increased by an average of 0.95 ± 1.05 mm, 1.65 ± 0.93 mm, and 2.16 ± 0.88 mm with 0.01%, 0.02%, and 0.03%, respectively. Of the eyes, a total of 5.3% and 5.9% of the eyes on 0.02% and 0.03% atropine had a mean residual accommodative amplitude of <5 D. The percentage of eyes having a pupillary dilation >3 mm were 4.8%, 10.5%, and 23.5% for 0.01%, 0.02%, and 0.03% atropine, respectively. Conclusions: Low-dose atropine had an effect on pupillary diameter and accommodative amplitude. With the highest concentration assessed, that is, 0.03% nearly 1 of 4 eyes had pupillary dilation of >3 mm. Clinical Trial Registration number: NCT03699423.

Occurrence and health risk assessment of tropane alkaloids in cereal foods consumed in Korea

Tropane alkaloids (TA) are natural toxins found in certain plants, including cereals, of which atropine and scopolamine are the main species of concern due to their acute toxicity. This study aimed to determine the occurrence of TA in cereal foods and assess the potential health risks associated with their consumption in Korea. TA levels were analyzed in 80 raw and 71 processed cereal samples, which were distributed throughout Korea in 2021, using ultra-performance liquid chromatography-tandem mass spectrometry. At least one of the six TA species, namely atropine, scopolamine, pseudotropine, tropinone, scopine, and 6-hydroxytropinone, was detected in 10 out of the 151 samples at levels ranging from 0.12 to 88.10 μg kg−1. Dietary exposure (mean, 0.23 ng kg−1 bw day−1) to atropine and scopolamine in the Korean population was estimated to be low across all age groups. This is despite considering worst-case scenarios using the total concentrations of atropine and scopolamine in a millet sample, both of which were detected, and 95th percentile consumption for consumers of millet only. Both the hazard index and margin of exposure methods indicated that the current levels of TA exposure from millet consumption were unlikely to pose significant health risks to the Korean population.

Efficacy and Safety of Low-Dose Atropine on Myopia Prevention in Premyopic Children: Systematic Review and Meta-Analysis.

Background: Early-onset myopia increases the risk of irreversible high myopia. Methods: This study systematically evaluated the efficacy and safety of low-dose atropine for myopia control in children with premyopia through meta-analysis using random-effects models. Effect sizes were calculated using risk ratios (RRs) with 95% confidence intervals (CIs). Comprehensive searches of PubMed, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov were conducted until 20 December 2023, without language restrictions. Results: Four studies involving 644 children with premyopia aged 4-12 years were identified, with atropine concentrations ranging from 0.01% to 0.05%. The analysis focused on myopia incidence and atropine-related adverse events. Lower myopia incidence (RR, 0.62; 95% CI, 0.40-0.97 D/y; p = 0.03) and reduction in rapid myopia shift (≥0.5 D/1y) (RR, 0.50; 95% CI, 0.26-0.96 D/y; p < 0.01) were observed in the 12-24-month period. Spherical equivalent and axial length exhibited attenuated progression in the atropine group. No major adverse events were detected in either group, whereas the incidence of photophobia and allergic conjunctivitis did not vary in the 12-24-month period. Conclusions: Our meta-analysis supports atropine's efficacy and safety for delaying myopia incidence and controlling progression in children with premyopia. However, further investigation is warranted due to limited studies.

The effect of topical atropine 0.05% compared to atropine 0.01% for Myopia control in Children : A Meta-analysis

Introduction &amp; Objectives : Myopia is the most common ocular anomaly manifesting during primary school and progresses until a mean age of 16, but rarely beyond age of 25. Atropine, a nonselective muscarinic antagonist, has been studied widely in recent years as an option for myopia control. To analyse the efficacy of Atropine 0,05% compared with Atropine 0,01 % for myopia control in children aged 4-16 years toward the axial length examination through a meta-analysis.&#x0D; Methods : A systematic search was performed using Medline and Cochrane database up to December 2022. Review was performed according to the PRISMA Statement. The eligible studies were RCTs which comparing Atropine concentration 0.05% with 0.01%.&#x0D; Results : From 101 retrieved articles, 5 trials involving total 1035 patients were included. The follow-up period of the studies was 1-2 year. The analysis shows Atropine 0,05% significantly decrease axial length (Mean Difference [MD]: -0.11, 95%CI [-0.15-0.07], p&lt;0.00001, I2= 99 %) comparing to Atropine 0,01%.&#x0D; Conclusion : In myopia control in children, atropine 0,05 % was more effective to reduce myopia progression in controlling axial length elongation over a period of 1-2 year comparing to atropine 0,01%.

Atropine: Updates on myopia pharmacotherapy.

The prevalence of myopia has rapidly increased over the last 30 years, with the World Health Organization estimating a worldwide incidence of 23%, projected to increase to 50% by 2050. The myopia epidemic has prompted a reincarnation in efforts to overcome this challenge. The exploration of atropine use in myopia was a result due to a lack of treatment in effect. This study aimed at reviewing the role of atropine in the management of myopia worldwide based on currently available findings. A literature search was conducted using PubMed/MEDLINE and Google Scholar for studies published up to April 2022 inclusive. Articles with high or medium clinical relevance were selected for this review. Multiple studies have demonstrated the relevance and efficacy rates of different concentrations of atropine, despite still insufficiently explained the exact site and mechanism of action of atropine in slowing myopia progression. Currently available findings highlight that topical atropine opened a new page in pharmacotherapy of myopia and have shown a high therapeutic effect on myopia progression in Asian and European child population, irrespective of ethnicity. There is potential for myopia control with fewer side effects using lower concentrations but still exists a room for improvement, underscoring the requirement of modified atropine topical preparations with increased bioavailability, potentially with nanoparticle formulations, to enable the effective management of myopia.

Case reports of tropane alkaloid contamination in spinach from Italy and its potential implications for consumer health

This study reports cases of intoxication that occurred in various regions of Italy in October 2022. These incidents were linked to the consumption of leafy vegetables contaminated with tropane alkaloids (TAs), likely due to suspected cross-contamination with toxic plants from the Datura genus. Although official controls were unable to identify the specific weed responsible for the contamination, chemical analysis of the remaining spinach and spinach-based foods consumed by the affected patients revealed concentrations of atropine and scopolamine up to 4642 μg/kg and 8158 μg/kg, respectively. While European regulations currently lack maximum limits for TAs in leafy vegetables, the concentrations detected in 4 out of 5 samples exceeded the maximum limits currently established for cereal-based foods, infant cereal-based foods, and herbal infusions.To assess the acute dietary exposure to atropine and scopolamine, estimated daily intakes of the Italian population were calculated using the TA concentrations measured in spinach samples or assuming the presence of 1 % of the weight of one Datura stramonium leaf in a 500 g spinach pouch. Both exposure scenarios resulted in concerning exposure levels, far exceeding the acute reference dose of 0.016 μg/kg bw by 2–1200 times. Toddlers exhibited the highest mean and 95th percentile acute dietary exposures compared to adults and the elderly. These findings emphasize the necessity of intensifying monitoring efforts and enacting regulatory measures to minimize exposure to TAs from dietary sources that are less commonly associated with contamination, especially for mitigating potential health risks for vulnerable population groups.

Benefits and limitations of low dose atropine

Atropine is an anti‐muscarinic agent and can be used as a monotherapy or as a combination to slow the progression of myopia. It has been advocated as the first line of treatment in children with lower cost compared with other therapies, and it is a good option for children intolerant to contact lenses and when other treatment options are rejected by parents. The major limitations of topical atropine therapy include the adverse effects with higher concentrations (0.1% and higher), such as reduced amplitude of accommodation and photophobia, and the need for daily dosing. Efficacy of low‐dose atropine treatment has been confirmed by several meta‐analysis showing reduced SE progression and decreased axial elongation. The results from the Low‐Concentration Atropine for Myopia Progression (LAMP) study (3‐year RCT results) in Chinese children showed that 0.05% atropine conferred the best efficacy compared with 0.025% and 0.01%. However, it was postulated that the use of 0.05% topical atropine in Caucasian children may lead to more side effects compared to 0.01%, which can compromise parent's acceptance or children's compliance. The efficacy and safety of 8 atropine concentrations for myopia control in children was reported in a recent network meta‐analysis, in which the 0.05% was found the most beneficial for control of overall myopia progression. It is generally believed that the atropine dose should be adjusted based on the risk factors and progression.

Topical Atropine for Childhood Myopia Control

Clinical trial results of topical atropine eye drops for childhood myopia control have shown inconsistent outcomes across short-term studies, with little long-term safety or other outcomes reported. To report the long-term safety and outcomes of topical atropine for childhood myopia control. This prospective, double-masked observational study of the Atropine for the Treatment of Myopia (ATOM) 1 and ATOM2 randomized clinical trials took place at 2 single centers and included adults reviewed in 2021 through 2022 from the ATOM1 study (atropine 1% vs placebo; 1999 through 2003) and the ATOM2 study (atropine 0.01% vs 0.1% vs 0.5%; 2006 through 2012). Change in cycloplegic spherical equivalent (SE) with axial length (AL); incidence of ocular complications. Among the original 400 participants in each original cohort, the study team evaluated 71 of 400 ATOM1 adult participants (17.8% of original cohort; study age, mean [SD] 30.5 [1.2] years; 40.6% female) and 158 of 400 ATOM2 adult participants (39.5% of original cohort; study age, mean [SD], 24.5 [1.5] years; 42.9% female) whose baseline characteristics (SE and AL) were representative of the original cohort. In this study, evaluating ATOM1 participants, the mean (SD) SE and AL were -5.20 (2.46) diopters (D), 25.87 (1.23) mm and -6.00 (1.63) D, 25.90 (1.21) mm in the 1% atropine-treated and placebo groups, respectively (difference of SE, 0.80 D; 95% CI, -0.25 to 1.85 D; P = .13; difference of AL, -0.03 mm; 95% CI, -0.65 to 0.58 mm; P = .92). In ATOM2 participants, the mean (SD) SE and AL was -6.40 (2.21) D; 26.25 (1.34) mm; -6.81 (1.92) D, 26.28 (0.99) mm; and -7.19 (2.87) D, 26.31 (1.31) mm in the 0.01%, 0.1%, and 0.5% atropine groups, respectively. There was no difference in the 20-year incidence of cataract/lens opacities, myopic macular degeneration, or parapapillary atrophy (β/γ zone) comparing the 1% atropine-treated group vs the placebo group. Among approximately one-quarter of the original participants, use of short-term topical atropine eye drops ranging from 0.01% to 1.0% for a duration of 2 to 4 years during childhood was not associated with differences in final refractive errors 10 to 20 years after treatment. There was no increased incidence of treatment or myopia-related ocular complications in the 1% atropine-treated group vs the placebo group. These findings may affect the design of future clinical trials, as further studies are required to investigate the duration and concentration of atropine for childhood myopia control.

Observation of the effect of posterior scleral reinforcement combined with orthokeratology and 0.01% atropine in the treatment of congenital myopia: a case report

BackgroundMyopia has recently emerged as a significant threat to global public health. The high and pathological myopia in children and adolescents could result in irreversible damage to eye tissues and severe impairment of visual function without timely control. Posterior scleral reinforcement (PSR) can effectively control the progression of high myopia by limiting posterior scleral expansion, improving retrobulbar vascular perfusion, thereby stabilizing the axial length and refraction of the eye. Moreover, orthokeratology and low concentrations of atropine are also effective in slowing myopia progression.Case presentationA female child was diagnosed with binocular congenital myopia and amblyopia at the age of 3 and the patient’s vision had never been rectified with spectacles at the first consultation. The patient’s ophthalmological findings suggested, high refractive error with low best corrected visual acuity, longer axial length beyond the standard level of her age, and fundus examination suggesting posterior scleral staphyloma with weakened hemodynamics of the posterior ciliary artery. Thereby, PSR was performed to improve fundus health and the combination of orthokeratology and 0.01% atropine were performed to control the development of myopia. Following up to 8 years of clinical treatment and observations, the progression of myopia could be well controlled and fundus health was stable.ConclusionIn this report, 8-year of clinical observation indicated that PSR could improve choroidal thickness and hemodynamic parameters of the retrobulbar vessels, postoperative orthokeratology combined with 0.01% atropine treatment strategy may be a good choice for myopia control effectively.

Efficacy of Atropine Eye Drops for Suppressing Myopia Progression in Thai Children

Objective: This retrospective cohort study aimed to assess the efficacy and safety of low-dose atropine eye drops in retarding myopic progression among school-age children at Siriraj hospital. Materials and Methods: The medical records of 248 myopia-diagnosed patients were reviewed. All patients were received low-dose atropine eye drops and had at least one follow-up visit within 1 year after the treatment initiation. Spherical equivalent (SE) measurements were collected at pre- and post-treatment visits, as well as any reported side effects. Comparing the SE changes observed between the pre- and post-treatment periods, as well as between the two different concentrations of atropine was analyzed. Results: A total of 495 eyes were analyzed, with 461 eyes receiving 0.01% atropine eye drops and 32 eyes being administered 0.05%. The demographic data between two groups showed no significant difference. The comparison of SE change one year prior to and one year after treatment in the 0.01% and 0.05% group yielded a p-value of less than 0.001 and 0.003, respectively, (SE change are -0.38 (-0.75-0.00) and -0.25 (-0.72-(-0.25)) in the 0.01% and 0.05% group, respectively). However, the between-group comparison of SE change at 6 months and 1 year showed no significant difference. Regarding side effects, one-third of the eyes in the 0.05% group (37.5%) experienced adverse effects while only eight eyes (1.7%) in the 0.01% group reported side effects. Conclusion: This research contributes support to the effectiveness of employing low-dose atropine for the treatment of myopia in Thai children. Nonetheless, it is worth noting that the use of 0.05% atropine was associated with a higher incidence of side effects.