Use of atropine for prevention of childhood myopia progression in clinical practice: efficacy and safety during treatment and when tapering off medication

Abstract

PURPOSE: To assess the efficacy and safety of daily 0.125% topical atropine solution for the prevention myopia progression in children in the setting of a real life clinical practice. Study period was from July 1st 2011 to June 30th 2014. METHODS: This was a retrospective interventional case series. Patients aged 6-12 years old with spherical equivalent of -1.00D or more were offered treatment with daily 0.125% Atropine solution. Cyclopegic refraction was noted at baseline and then 6 monthly afterwards. If patients were shown to have slow myopic progression (less than -0.5D progression over 12 months), the frequency of application was reduced by one step (daily to alternate day to once weekly to off). In patients who were being tapered off atropine solution, those who demonstrated fast myopia progression (equal to or more than -0.25D progression over 6 months) at follow-up were resumed on their previous application frequency. The primary efficacy outcome measure was change in spherical error and primary safety outcome measure was occurrence of adverse effects or patient intolerance. For comparison between demographics and baseline data, continuous variables were evaluated with Student’s t test or Mann-Whitney U tests, while categorical variables were assessed using a chi-square or Fisher exact test. RESULTS: 27 patients with 54 eyes were treated with topical 0.125% atropine solution for at least one year during the study period. 14 of them were boys and 13 were girls. Average age upon starting treatment was 7.68 years (range 5 – 11) and the mean duration of follow-up during the study period was 19.6 months (range 12.1 – 28.9). Baseline spherical error was -4.07D (range -1.75 to -6.00) Mean myopia progression was -0.29±0.27(SD). There was no significant difference in myopia progression between genders or between age groups. There was also no significant difference in myopia progression between eyes with low baseline myopia and high baseline myopia. 10 patients were able to initiate weaning off treatment during the study period. Amongst them, only 1 patient required subsequent resumption of previous frequency due to fast disease progression on follow-up. There were no reported adverse effects related to the drug the study. CONCLUSIONS: Daily application of atropine 0.125% was well tolerated and effective in clinical practice. More than one-third of patients were able to able to begin reducing treatment frequency during the study period with only one patient having significant rebound effect.