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Atropine offers the most hope for myopia treatment

International evidence stacks up for low-concentrate atropine to prevent myopia progression

Atropine droplet

Low-dose atropine eye drops have emerged as the best treatment for myopic patients. Yet, with the concentration unavailable in the UK, the next best alternative for British patients is orthokeratology, a researcher told 100% Optical attendees.

Aston University optometry lecturer, Dr Janis Orr, said slowing – rather than simply correcting – myopia progression was vital for patient health.

She emphasised during her talk Does the solution to myopia progression come in a bottle? that myopia was a major risk factor for developing more serious eye conditions, such as retinal detachment. She added: “[Treating myopia] is going to reduce the lifetime risk of other ocular conditions … Asian countries are intervening but the rest of the world is a wee bit behind.”

Dr Orr’s talk referred to a new international meta-analysis study that concluded atropine and pirenzepine held the most potential as myopia treatments.

The paper, published in the journal Ophthalmology, compared 16 treatments from specialist lenses to pharmaceuticals, said first co-author and Wenzhou Medical University visiting professor, Dr Colm McAlinden.

The drug atropine was found to be the most effective, but the high dosages currently available in the UK had issues, Dr McAlinden said.

He told OT that other research has shown high-dose atropine has a rebound effect, where myopia progression speeds up after treatment ceases. He also said side effects, including glare and photophobia, were another problem: “High-dose atropine causes loss of accommodation.”

Meanwhile, the unavailable 0.01% atropine strength has minimal side effects, the paper noted.

Despite low-dose atropine’s unavailability in the UK, Dr McAlinden thought that optometrists and patients should be aware of the statistical and clinical significance of its effectiveness, emphasising: “The evidence is there. It’s quite clear.”

The paper also noted that pirenzepine, currently offered internationally to gastric ulcer sufferers, was another highly effective treatment.

Dr McAlinden added: “Certain specially designed contact lenses, including orthokeratology and peripheral defocus modifying contact lenses, had moderate effects, whereas specially designed spectacle lenses showed minimal effect.”

Dr Orr similarly concluded in her 100% Optical talk that atropine has shown the most promise as a medicinal treatment, explaining: “We don’t know why it works at all but we know it works … The most likely site of action is the retina.”

However, as the 0.01% concentration is not yet available, she recommended optometrists might like to suggest that their myopic patients, of any age, try orthokeratology.

The rebound effect of ortho-k lenses was not well-known, she told conference attendees, adding: “We can’t get that sort of data – kids won’t stop wearing them.”

She noted that the twice-a-day dosage required for pirenzepine – as opposed to atropine’s once-a-day – had seen the push for the drug to be used in myopia treatment ebb.