Myopia Control And Atropine Treatment

- 5-10% of 5-6 years old kindergarten children
- 10-20% of 6-7 years old primary 1 children
- 50% of 9 year old primary 3 children
- 66% of 12 year old primary 6 children
- 80% of 18 years old NS men
Myopia is increasing in both frequency and severity and starting younger in Singaporean children. It is unusual for our young in Singapore to have perfect eye-sight without glasses.
Any child with
1. progressive myopia
2. rapidly progressive myopia.
3. strong parental & family history of high myopia
4. moderate to high myopia and still progressing
5. very low myopia whose parents want to reduce spectacle wear / dependence
6. parents unable to bring child outdoors or curb excessive reading & computer gaming
7. family history of vision loss from complications of high myopia
Atropine is the most effective treatment for the prevention of myopia progression in children. With atropine 1%, 50% of patients will stop progressing completely after starting atropine eye-drops. It’s effectiveness has been proven by more than 13-14 large clinical trials which have been published in major international ophthalmology journals and abstracts of these are readily available online.

Atropine is much more effective than wearing hard contact lenses or progressive/ bifocal spectacles. Clinical trials have also been done for these treatments but there have been mixed results for rigid contact lenses. Most trials show progressive/ bifocal spectacles do not prevent myopia progression.

There is little evidence to support the use of the following for myopia control: acupressure massage, Janet Goodrich exercises, pinhole glasses, Neurovision, Bates method and Eye Relax machines.

Orthokeratology or CRT (corneal refractive therapy) seems to be mildly effective with a saving of -0.25D/year (Hiraoka 2012) to -0.40D/year (Cho 2012).

Atropine eyedrops has been discussed for myopia treatment since the 1930s and the first clinical trials on children was done in 1971. Since then there has been more than a dozen large trials of a few hundred children each. Since 1971 or the last 35 years, there has been no case report of any permanent or serious adverse reaction to long term instillation of atropine eyedrops. There has been no case report of cataracts or macular degeneration caused by atropine eye-drops. There is a theoretical risk of premature cataracts from increased sunlight entering the eye through a dilated pupil. Laboratory mice exposed to high UV light develop cataracts earlier. This risk should be guarded against with photochromatic spectacles and sunglasses etc. As for age related macular degeneration, it has not been proven to be due to sunlight exposure.

Whether there will be delayed side-effects appearing after 35 years is unknown. But then the same is true for a lot of long term drugs that are being prescribed eg: medicine for hypertension, high cholesterol, diabetes, heart disease, pain-killers etc.

The eye-drop has been tested in a large trial in Singapore from 1998-2003 with excellent results and there is still a new ongoing trial now to determine the ideal dose of atropine. The safety committee of this local trial did not find any reports of serious adverse reactions to atropine eye-drops in their search.

Atropine eyedrops have been used for the long term treatment of cataracts, lazy eye, and inflammation of the eye without serious side effects. Atropine has been taken orally for decades as treatment for diarrhea, colic, gastritis and irritable bowel syndrome.

You may avoid atropine because of the theoretical risks due to increased exposure to sunlight and UV radiation but you cannot escape the known and real risks of eye complications from high myopia if we do not use atropine. For me, after 35 years of atropine research without complications, it is safer to use atropine than to be highly myopic.