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Long-Term Efficacy of Low-Concentration Atropine for Myopia Progression
TAKE-HOME MESSAGE
- This randomized, double-masked trial investigated the efficacy of low-concentration atropine for myopia progression over 5 years. Notably, 0.05% atropine treatment demonstrated significant efficacy for long-term control of myopia progression in pediatric patients.
- Long-term use of low-concentration atropine may be a clinically useful treatment approach for myopia progression.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersPURPOSE
To evaluate (1) the long-term efficacy of low-concentration atropine over 5 years, (2) the proportion of children requiring re-treatment and associated factors, and (3) the efficacy of pro re nata (PRN) re-treatment using 0.05% atropine from years 3 to 5.
DESIGN
Randomized, double-masked extended trial.
PARTICIPANTS
Children 4 to 12 years of age originally from the Low-Concentration Atropine for Myopia Progression (LAMP) study.
METHODS
Children 4 to 12 years of age originally from the LAMP study were followed up for 5 years. During the third year, children in each group originally receiving 0.05%, 0.025%, and 0.01% atropine were randomized to continued treatment and treatment cessation. During years 4 and 5, all continued treatment subgroups were switched to 0.05% atropine for continued treatment, whereas all treatment cessation subgroups followed a PRN re-treatment protocol to resume 0.05% atropine for children with myopic progressions of 0.5 diopter (D) or more over 1 year. Generalized estimating equations were used to compare the changes in spherical equivalent (SE) progression and axial length (AL) elongation among groups.
MAIN OUTCOMES MEASURES
(1) Changes in SE and AL in different groups over 5 years, (2) the proportion of children who needed re-treatment, and (3) changes in SE and AL in the continued treatment and PRN re-treatment groups from years 3 to 5.
RESULTS
Two hundred seventy (82.8%) of 326 children (82.5%) from the third year completed 5 years of follow-up. Over 5 years, the cumulative mean SE progressions were -1.34 ± 1.40 D, -1.97 ± 1.03 D, and -2.34 ± 1.71 D for the continued treatment groups with initial 0.05%, 0.025%, and 0.01% atropine, respectively (P = 0.02). Similar trends were observed in AL elongation (P = 0.01). Among the PRN re-treatment group, 87.9% of children (94/107) needed re-treatment. The proportion of re-treatment across all studied concentrations was similar (P = 0.76). The SE progressions for continued treatment and PRN re-treatment groups from years 3 to 5 were -0.97 ± 0.82 D and -1.00 ± 0.74 D (P = 0.55) and the AL elongations were 0.51 ± 0.34 mm and 0.49 ± 0.32 mm (P = 0.84), respectively.
CONCLUSIONS
Over 5 years, the continued 0.05% atropine treatment demonstrated good efficacy for myopia control. Most children needed to restart treatment after atropine cessation at year 3. Restarted treatment with 0.05% atropine achieved similar efficacy as continued treatment. Children should be considered for re-treatment if myopia progresses after treatment cessation.
FINANCIAL DISCLOSURE(S)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Additional Info
Five-Year Clinical Trial of the Low-Concentration Atropine for Myopia Progression (LAMP) Study: Phase 4 Report
Ophthalmology 2024 Sep 01;131(9)1011-1020, XJ Zhang, Y Zhang, BHK Yip, KW Kam, F Tang, X Ling, MPH Ng, AL Young, PC Wu, CC Tham, LJ Chen, CP Pang, JC YamFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This is the fourth Low-Concentration Atropine for Myopia Progression (LAMP) study, which provided follow-up findings at year 5. Like previous LAMP studies, this study's 5-year findings were consistent with the initial findings that the stronger the concentration of low-dosage atropine administered daily (placebo, 0.010%, 0.025%, and 0.050%), the greater the effect in slowing myopia progression without change over time.1,2 This is consistent with the findings of a previous meta-analysis, which support the concept that, as the concentration increases from 0.01% to 1.00%, the efficacy of atropine in slowing the progression of myopia further improves.3 After year 3, if progression was stopped, patients were allowed to self-determine if they wanted to continue or stop treatment.
Unfortunately, 88% of the patients who had obtained stability after 3 years of using 0.05% atropine and then stopped treatment needed retreatment. The authors also reported that 0.05% atropine was the most effective concentration over time, with minimal symptoms (which is not surprising since the stronger the concentration, the more effective atropine is in slowing myopia progression). However, symptoms increase at 0.05% atropine concentration; thus, photochromic progressive lenses might be needed.4 It is interesting to note that when treatment was resumed, the success for slowing myopia progression returned at the same rate. The authors also noted a phenomenon that was first reported in the ATOM 1 study, which is that 1% atropine, and probably lower concentrations, cause a shift in the hyperopic direction owing to lenticular changes, thus explaining part of the rebound phenomenon — that is, the cycloplegic effect is greater with atropine than with cyclogel. Lastly, the authors found that the younger the child, the greater the chance of needing to restart treatment.
The authors' final conclusion was that patients should begin treatment with 0.05% atropine and continue with that dosage. They should not stop treatment, as the premature stopping of atropine therapy results in the resumption of myopia progression.5 If they continue to progress, clinicians should add optical interventions, such as special lenses or contact lenses. I disagree; I believe that treatment should start with the lowest effective dosage that does not produce symptoms (0.020% or 0.025% atropine) and that the concentration should be increased if (axial length) progression is noted after 3 months. If there is no progression, the patient will be seen in 4 months; if there is progression, then the concentration should be increased, and the patient should return in 3 months for axial length measurement. Further, if there is no progression, then the patient should return in 6 months. The concentration is increased until progression is physiologically stopped. Based on our experience and the reports of other studies, the use of optical methods, such as orthokeratology, specific multifocal contact lenses, and eyeglasses, is individually more powerful and additive to the effect of atropine.6–8
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