Myopia is a global health threat. By year 2025, it is predicted approximately 50% and 10% of world’s population being myopic and highly myopic respectively. Notably, high myopia is associated with sight-threatening complications, including pre-senile cataract, glaucoma, retinal detachment, and choroidal neovascularization etc. Effective methods for myopia control is important. In this lecture, the author will present his works on Low-concentration Atropine for Myopia Progression (LAMP) Study.
Purpose: Low-concentration atropine is an emerging therapy for myopia progression, but its efficacy and optimal concentration remained uncertain. Our study aimed to evaluate the efficacy and safety of low-concentration atropine eye drops at 0.05%, 0.025%, and 0.01% compared with placebo over a one-year period.
Design: Randomized, placebo-controlled, double-masked trial.
Participants: 438 children aged 4-12 years with myopia of at least -1.0 diopter (D) and astigmatism of -2.5D or less.
Intervention: Subjects were randomly assigned in a 1:1:1:1 ratio to receive 0.05%, 0.025% and 0.01% atropine, or placebo eye drop, respectively, once nightly to both eyes for one year. Cycloplegic refraction, axial length, accommodation amplitude, pupil diameter, and best-corrected visual acuity were documented measured at baseline, 2 weeks, 4 months, 8 months, and 12 months. Visual function questionnaire CHI-VFQ-25 was administered at the one-year visit.
Main outcome measures: Changes in spherical equivalent (SE) and axial length (AL) were measured, and their differences among groups were compared using generalized estimating equation.
Results: After one year, the mean SE change was -0.27±0.61D, -0.46±0.45D, -0.59±0.61D, and -0.81±0.53D, in the atropine 0.05%, 0.025%, 0.01%, and placebo groups, respectively (P < 0.001), with respective mean increase in AL at 0.20±0.25mm, 0.29±0.20mm, 0.36±0.29mm and 0.41±0.22mm (P < 0.001). The accommodation amplitude was reduced by 1.98±2.82D, 1.61±2.61D, 0.26±3.04 D, and 0.32±2.91D, respectively (P < 0.001). The There was an increase in the pupil sizes under photopic and mesopic conditions were increased respectively by in the treatment groups (1.03±1.02mm and 0.58±0.63mm in 0.05% atropine, 0.76±0.90mm and 0.43±0.61mm in 0.025% atropine, and 0.49±0.80mm and 0.23±0.46mm in 0.01% atropine), and 0.13±1.07mm and 0.02±0.55mm compared with minimal change in the placebo group (P < 0.001). Distant or near visual acuity; and vision-related quality of life was not affected in each group. Vision-related quality of life was similar between groups.
Conclusions: The 0.05%, 0.025% and 0.01% atropine eye drops could reduce myopia progression along a concentration-related dependent response. All concentrations were well tolerated without adverse effect on vision-related quality of life. Of the three concentrations used, 0.05% atropine was more most effective in controlling myopia SE progression and AL elongation over a period of one year.
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