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Effect of Low-dose Atropine on Binocular Vision and Accommodation
Nora Matland and Yi Pang, OD
As many as five billion people may be myopic by 2050. Put differently, nearly 50% of the world's population may have myopia by 2050. With those statistics, myopia is not only a public health issue, but a pandemic.
These alarming statistics are readily confirmed in the IEI as well. We have seen both the rates of myopia and disease progression increase. A few years ago, the average onset age was around 8 years old, now we see children as young as 5-6 years old with myopia. In fact, we have even diagnosed children as young as 2-3 years old.
At IEI, we approach treating myopia from many different angles. IEI has finished and continues to conduct numerous clinical trials on myopia management, including studies on orthokeratology, low-dose atropine, and special-design spectacle glasses. In this article, we will focus on the side effects from the daily use of low-dose atropine on myopia children.
It is known that low-dose atropine taken as a daily eye drop can slow myopia progression. The optimal dosage is still unclear. Traditionally, atropine is used to dilate the pupil and treat amblyopia. When we suggest these eye drops to parents, their question is often, "What are the side effects from this treatment?" We set out to answer how low doses of atropine (0.01%, 0.03% and 0.05%) affect children’s vision to see far and near, their binocular vision measurements, and the pupil dilation. We measured the children’s habitual visual acuity at distance and near, dissociated phoria at distance and near, negative and positive fusional vergence, near point convergence stamina and fragility, accommodative lag, and amplitude of accommodation. We compared how low-dose atropine affected those functions at 30 mins, 60 mins, and 24 hours after the eye drop application with the patient's baseline. We tested 46 children aged 6 to 17 with these low-dose atropine eyedrops and measured the side effects of this drug. The participants were randomized into four groups: placebo (n= 10), 0.01% (n=13), 0.03% (n= 11), or 0.05% (n= 12) doses of atropine.
What we found is that all three concentrations of atropine eye drops have no significant effect on accommodation, binocular vision measurements, or visual acuity compared to our control group. For those children with a treatment of 0.01% the pupil only slightly enlarged at 60 mins with no change at 30 mins and 24 hours. Children with the 0.03% and 0.05% dosage had enlarged pupils with more effect at 60 mins which had partially recovered at 24 hrs. In conclusion, it is relatively safe to use all three concentrations of atropine in children.
Besides all the available myopia treatment options, we cannot emphasize enough the importance of outdoor activity and visual hygiene. The best thing for a myope to do is to distance themselves from unnecessary screens. Spending time outside and giving your eyes a rest from screens significantly helps in slowing down myopia onset and progression. Lifestyle is an important factor to both the slowing down or speeding up of myopia progression.
You can find the full findings at Breliant R, Pang Y, Bandstra A, Kattouf V. “Effect of Low-dose Atropine on Binocular Vision and Accommodation in Children Ages 6 to 17 Years.” Optom Vis Sci. 2023 Jun 6. doi: 10.1097/OPX.0000000000002031. Epub ahead of print. PMID: 37278695