Professor Nicola Logan provides an update on atropine

Aston University academic and optometrist, Professor Nicola Logan, delivered an update on atropine for myopia control during her presentation at 100% Optical (28 February, Excel London).

Logan highlighted that the Medicines and Healthcare products Regulatory Agency have approved 0.01% atropine for myopia control in children.

She noted that Santen’s Ryjunea is indicated for use in children between the ages of three and 14 with myopia between -0.50 DS and -6.00 DS, with a progression rate of 0.50 DS per year.

“It’s currently undergoing NICE [National Institute for Health and Care Excellence] appraisal, so we will await the outcome of that with interest,” Logan shared.

Assessing the evidence on atropine for myopia control, Logan observed that there are fewer studies with long term data compared to the evidence base for optical methods of myopia control.

“If we look at the studies that have been published to date on low concentration atropine, there is variability in terms of that data,” she highlighted.

“Is it sufficient to give us the myopia control effect that we want to see in our children? We know from other, higher concentrations of atropine, we can get a much greater effect,” Logan shared.

She added that with increased concentrations of atropine there is an increased risk of side effects.

“I think we are in a position where we know that atropine has an effect on myopia progression and axial elongation,” Logan observed.

“We know we can get greater efficacy with higher concentrations, but at the risk of unwanted side effects. I think the jury is still out on what exactly the optimum concentration of atropine is, especially for a UK population,” she said.

Logan shared that there are ongoing studies based in Birmingham, Northern Ireland and London exploring the use of different concentrations of atropine.

“What happens if we put children into a slightly higher concentration of atropine? Will we see a greater effect on efficacy, and importantly, will they tolerate that?” she said.

The professor of optometry noted that the consequences of stopping an intervention are also a consideration.

Logan shared that while clinicians ideally would like to start a myopia control intervention early and continue with the intervention until a patient reaches young adulthood, this does not always happen in practice.

“Maybe the child doesn't want to wear the intervention anymore or use drops any longer. They may move away and stop the intervention,” she said.

“What's the impact on their myopia? What we don't want to see is a rebound effect,” Logan emphasised.

She observed that while higher concentrations of atropine have shown evidence of a rebound effect, this does not appear to be the case for 0.01% atropine or optical interventions.

Logan shared that so far, the emerging evidence on atropine suggests that its efficacy in myopia control is “not quite at the same level” as optical interventions.

However, she noted that it is helpful to have a range of interventions available to children.

“Not all children comply with wearing glasses. If they are not wearing their spectacles, they are not going to get that treatment effect,” she said.

Logan emphasised the importance of tailoring myopia control interventions to the patient in the chair.

“You need to think about that child’s lifestyle. What will fit into their busy family life?” Logan shared.

She added that whatever interventions a practice offers, it is important to consider how the practice will monitor the effectiveness of myopia control.