If you or your child has myopia, you’ve probably heard of atropine eye drops. For over a decade, various concentrations of these drops have been successfully used in slowing down the rate of progression of myopia – or short-sightedness.
But do they work and, more importantly, are they safe? This post addresses these issues.
What is myopia control?
Short-sightedness is on the increase globally and it’s not a good thing. Aside from the dependence on glasses and contact lenses, this eye condition is associated with a higher incidence of several eye diseases – sometimes far higher.
These diseases include retinal detachment, glaucoma and cataract. In some populations (particularly in East Asia), up to 90% of children are short-sighted by the time they leave school.
This epidemic has led to research into how the progression of myopia can be slowed or even halted. A range of strategies have been found to be effective, including orthokeratology lenses (worn overnight to reshape the eye), multifocal contact lenses and, increasingly, popular atropine eye drops.
What is atropine?
Atropine is a drug that has been used in human eyes for thousands of years. Cleopatra is reported to have used plant extracts containing atropine to dilate her pupils – considered alluring – and Renaissance women used Belladonna (deadly nightshade) for a similar purpose.
The use of atropine in the eye began in the 1800s when it was used to dilate the pupil and temporarily paralyse accommodation (near focus change). Because the effects take several days to wear off, it is more useful as a therapy than as a diagnostic agent, and these days, other drops are used to dilate the pupil for examination of the retina.
Atropine and its derivatives are used to dilate the pupil in certain eye diseases (such as iritis) and, more recently, in myopia control. Atropine has other effects on the body and is also used to treat heart conditions and prevent poisoning.
Myopia control has been researched in a number of large scale studies including the Atropine Treatment of Myopia (ATOM) studies out of Singapore. As more research is published, with positive study results, the popularity of this therapy has steadily grown.
Early treatment protocols used a drop of 1% atropine, but this was associated with significant side effects including dilated pupils, poor near vision, light sensitivity and headaches. But the most recent studies have shown that not only is atropine effective is slowing down myopia progression, but it still works even with a much lower concentration of the drug.
This reduces or eliminates the annoying side effects of the stronger atropine drops used in early studies.
The first ATOM study results were published over a decade ago. Although they showed a 77% reduction in myopia progression compared to the kids not taking the drops, the problem was that as soon as they stopped taking the drops, the myopia quickly returned.
However, a second ATOM study studied the effects of three different strengths of atropine, including a very low strength version (.01%) which is one hundredth the strength of the usual drop. What they found was that side effects of glare and near vision blur were almost non-existent with the low strength drop.
Better still, the effect of the low-strength atropine therapy was far less likely to wear off once the drops were stopped. The study showed that use of low-dose atropine slowed the progression of myopia by 50%. If the child was subsequently retreated with low-dose atropine, these drops were just as effective as the full-strength ones.
It is not understood exactly how the drug works, but there appears to be few side effects to leaving children on this one-drop-per-day therapy for several years.
Where do I get it?
Low-dose atropine has to be made up (compounded) by the pharmacist. Your therapeutically endorsed optometrist can write you a prescription for this as part of the overall management of your child’s myopia.