MSGID: 1:317/3 64b0cfa7   
   PID: hpt/lnx 1.9.0-cur 2019-01-08   
   TID: hpt/lnx 1.9.0-cur 2019-01-08   
    Low-dose atropine eyedrops no better than placebo for slowing myopia   
   progression    
      
     Date:   
         July 13, 2023   
     Source:   
         NIH/National Eye Institute   
     Summary:   
         Use of low-dose atropine eyedrops (concentration 0.01%) was   
         no better than placebo at slowing myopia (nearsightedness)   
         progression and elongation of the eye among children treated for   
         two years, according to a randomized controlled trial. The trial   
         aimed to identify an effective way to manage this leading and   
         increasingly common cause of refractive error, which can cause   
         serious uncorrectable vision loss later in life.   
      
      
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   Use of low-dose atropine eyedrops (concentration 0.01%) was no better than   
   placebo at slowing myopia (nearsightedness) progression and elongation of   
   the eye among children treated for two years, according to a randomized   
   controlled trial conducted by the Pediatric Eye Disease Investigator Group   
   (PEDIG) and funded by the National Eye Institute (NEI). The trial aimed   
   to identify an effective way to manage this leading and increasingly   
   common cause of refractive error, which can cause serious uncorrectable   
   vision loss later in life. Results from the trial were published in   
   JAMA Ophthalmology.   
      
   Importantly, the findings contradict results from recent trials,   
   primarily in East Asia, which showed a benefit from 0.01% atropine in   
   slowing myopia.   
      
   "The overall mixed results on low-dose atropine show us we need more   
   research.   
      
   Would a different dose be more effective in a US population? Would   
   combining atropine with other strategies have a synergistic effect? Could   
   we develop other approaches to treatment or prevention based on a better   
   understanding of what causes myopia progression?" said Michael F. Chiang,   
   M.D., director of the NEI, which is part of the National Institutes   
   of Health.   
      
   Identifying an optimal approach for preventing high (advanced) myopia   
   is urgently needed given the escalating prevalence of myopia overall and   
   the risk of it progressing to high myopia. By 2030, it's predicted that   
   39 million people in the U.S. will have myopia. By 2050, that number   
   is expected to grow to 44 million in the U.S. and to 50% of the global   
   population.   
      
   Much stronger concentrations of atropine eyedrops (0.5-1.0%) have long   
   been used by pediatric eye doctors to slow myopia progression. While   
   effective, such doses cause light sensitivity and blurry near vision   
   while on the nightly eyedrops. Thus, there is interest in clinical   
   studies assessing lower concentrations that have been shown to have   
   fewer side effects.   
      
   "The absence of a treatment benefit in our U.S.-based study, compared   
   with East Asian studies, may reflect racial differences in atropine   
   response. The study enrolled fewer Asian children, whose myopia progresses   
   more quickly, and included Black children, whose myopia progresses less   
   quickly compared with other races," noted the study's lead co-author,   
   Michael X. Repka, M.D., professor of ophthalmology, Johns Hopkins   
   University.   
      
   For the study, 187 children ages 5 to 12 years with low-to-moderate   
   bilateral myopia were randomly assigned to use nightly atropine (0.01%)   
   (125 children) or placebo (62 children) eyedrops for two years. Study   
   participants, their parents, and the eye care providers were masked to   
   the group assignments.   
      
   Patient care was provided at 12 study center sites throughout the U.S.   
      
   After the treatment period, and 6 months after treatment stopped, there   
   were no significant differences between the groups in terms of changes   
   in degree of myopia compared with baseline. Nor were there significant   
   differences in axial length within the two groups when compared with   
   baseline measurements.   
      
   "It's possible that a different concentration of atropine is needed   
   for U.S.   
      
   children to experience a benefit," noted the study's other lead co-author,   
   Katherine K. Weise, O.D., professor, University of Alabama at Birmingham.   
      
   "Clinical researchers could evaluate new pharmaceuticals and special   
   wavelengths of light in combination with optical strategies, like   
   special glasses or contact lenses, to see what works in reducing the   
   progression of myopia."  Among children, myopia will stabilize in about   
   half of children around age 16 years, and among an increasingly larger   
   percentage as they get older. By their early twenties, about 10% of   
   individuals with myopia will continue to grow more nearsighted, and by   
   age 24 years that percentage is 4%.   
      
   "Vision scientists may help us figure out what's different about the   
   myopic eye, even among different races and ethnicities, to help create new   
   treatment strategies," she said. It will take a real convergence of eye   
   research to solve the environmental, genetic, and structural mystery of   
   myopia."  PEDIG is a collaborative network of pediatric ophthalmologists   
   and pediatric optometrists dedicated to conducting multi-center trials   
   on eye disorders that affect children. The trial was funded by the NEI   
   grants EY11751, EY18810 and EY23198. The ClinicalTrials.gov identifier   
   is NCT03334253.   
      
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   Journal Reference:   
      1. Michael X. Repka, Katherine K. Weise, Danielle L. Chandler, Rui   
      Wu, B.   
      
         Michele Melia, Ruth E. Manny, Lori Ann F. Kehler, Catherine   
         O. Jordan, Aparna Raghuram, Allison I. Summers, Katherine A. Lee,   
         David B. Petersen, S. A. Erzurum, Yi Pang, Phoebe D. Lenhart,   
         Benjamin H. Ticho, Roy W.   
      
         Beck, Raymond T. Kraker, Jonathan M. Holmes, Susan A. Cotter,   
         Denise D.   
      
         Alexopoulous, Megan Allen, Heather A. Anderson, Darrell S. Austin,   
         Shane C. Black, Nicole M. Boyle, Grant Andrew Casey, Moriah Adine   
         Chandler, Ryan Chinn, Deborah A. Clausius, Beth J, Colon, Courtney   
         L. Conner, Linda T. Curtis, Zainab Dinani, Quayleen Donahue,   
         Michelle Dubois, Patricia L.   
      
         Evans, Brooke P. Fimbel, Melanie Kay Fowler, Richard P. Golden,   
         Beth G.   
      
         Harper, Robert J. Henderson, Dieu-Hong Ho, James E. Hoepner,   
         Kristine B.   
      
         Hopkins, Ashli S. Jenks, Joseph D. Kaplon, Shabana Khan,   
         Cassandra A.   
      
         Koutnik, Annie F. Kuo, Jessy Lee, Muriel M. Martinez, Sophia   
         M. Marusic, Mary Lou McGregor, J. Ryan McMurtrey, Kathryn   
         B. Miller, Preeti L. Mokka, Jenifer Montejo, Beth A. Morrell,   
         Elyse Nylin, Kimberly C. Odom, Gillaine Ortiz, Samantha A. Parra,   
         Kyle J. Perkins, Larry W. Plum, Ellen Fiona Redenbo, Julianne   
         L. Robinson, Kathleen M. Stutz, Desirae R. Sutherland, Mircea   
         X. Teodorescu, Lori L. Torgensen, David O. Toro, Phillip B.   
      
         Turner, Natalie C. Weil, Emily K. Wiecek, Carsyn S. Wilkins,   
         Victoria C.   
      
         Woodard, Kevin M. Woodruff, Huizi Yin, Marika L. Yumang, Tomohiko   
         Yamada, Noha S. Ekdawi, David A. Leske, David K. Wallace, Melanie   
         L. Christian, Stephen R. Glaser, Eileen E. Birch, Angela M. Chen,   
         Stephen P.   
      
         Christiansen, Laura B. Enyedi, Donald F. Everett, Sharon   
         F. Freedman, William V. Good, Erin C. Jenewein, Richard London,   
         Vivian M. Manh, David G. Morrison, Stacy L. Pineles, Hantamalala   
         Ralay Ranaivo, Tawna L.   
      
         Roberts, Scott T. Ruark, Bonita R. Schweinler, Jayne L. Silver,   
         Donny W.   
      
         Suh, Lisa C. Verderber, Marie Diener-West, John D. Baker, Barry   
         Davis, Rosemary D. Higgins, Stephen W. Poff, Richard A. Saunders,   
         Lawrence Tychsen. Low-Dose 0.01% Atropine Eye Drops vs Placebo   
         for Myopia Control.   
      
         JAMA Ophthalmology, 2023; DOI: 10.1001/jamaophthalmol.2023.2855   
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   Link to news story:   
   https://www.sciencedaily.com/releases/2023/07/230713141942.htm   
      
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