Use of Atropine eye drops in controlling myopia progression
Atropine eye drops are used to retard or slow myopia progression. A decision is made to use atropine in your child when myopia increases rapidly despite your child observing healthy eye habits.
Before starting your child on atropine, please read this information sheet carefully. If you any questions, please do not hesitate to consult your doctor.
Information on myopia and its possible problems
Myopia can develop as early as kindergarten age and can progress rapidly (1,005-1,50D per year) during the primary school years. Progression typically slows down during the teenage years and stabilizes by early adulthood. In Singapore, 10% of kindergarten children, 60% of primary 6 students and 80% of 18 year olds are myopic.
Myopia arises from the excessive growth or elongation of the eyeball. This result in light from distance objects falling out of focus with the eye.
Distance objects become blurred but near objects remain clear, Spectacles, contact lenses and refractive surgery can be used to help achieve good distance vision, however, and they do nothing to correct the primary problem of increased eye ball length.
An eye with high myopia (increased length) is at greater risk of developing potentially blinding conditions such as glaucoma, cataract, macular degeneration and retinal detachment later in life.
Treating myopia with atropine
Atropine eye drop is not a new or experimental drug. Eye doctors have been using it for many years in the treatment of a variety of eye conditions found in children such as lazy eye and squint. In fact, atropine has been prescribed for myopia in children since the 1960s.
Higher does atropine
Higher-does (1.0%) atropine has been used to treat myopia at the Singapore National Eye Centre since the 1990s. Studies show that is slows myopia progression by 80% over a 2 years period. Unfortunately, t also has several uncomfortable side-effects.
Higher-does atropine causes the pupil to open wide, allowing more light to enter the eye causing glare. It also causes blurring of near vision by paralyzing the eye muscles used to focus for near.
This glare or blur can last 4-7 days after administration of one drop of 1.0% atropine. If only one eye is treated at any one time, your child should still be able to read, write, and watch TV, or work on the computer with the other eye. However, if both eyes are receiving atropine simultaneously, your child may have difficulty with near work. For these reason, children on higher-does atropine often require photo chromatic or sun-glasses with UV filter, and a progressive or reading add in their glasses.
Other possible side-effects are often mild and not serious e.g. dry eye, eye allergy, dry mouth, palpitations and flushed skin. Such effects are usually temporary and only occur in a minority of children who use atropine.
More severe side-effects such as confusion, high fever, and coma are extremely rare and mostly occur after improper use (e.g. swallowing of the drug resulting in over-dosage or poisoning). To our knowledge, not a single case of serve side effect has been reported in myopic children who were treated with atropine in Singapore.
Low dose atropine
More recently, low-does (0.01%) atropine was shown to be effective in slowing myopia by 50-60% over a 2 year period, and with very little side-effects. The effect of low-dose atropine appears to build over time, being better in the second than first years. As it causes only minimal increases in pupil size, children do not require tinted or progressive add glasses. Children are less likely to have other side-effects like dry eye or allergy.
As such, low-dose atropine is safer and more comfortable eye drop to use than high-dose atropine. However, some myopia progression may still occur, and if this is sill rapid, we many head to discuss if your child needs a higher dose of atropine. Our studies, however, show that 10% of children respond poorly (i.e. myopia continue to progress rapidly) even to higher- dose atropine.
Changing from higher-dose to low dose atropine
Not all children on higher-dose atropine will need to change to low dose, especially if they are already responding to and tolerating higher-dose atropine well. However, if you wish to do so, you will need to discuss this with your doctor, as a gradual change may be needed.
The long-term effects of atropine on the eye are not known. Of most concern are:
- 1. The possible long-term toxic effects of the drug, and
- 2. The long-term effects of paralysis of focusing for near, and
- 3. Effect of increased light on the lens and retina which may lead to earlier formation of cataract and retinal dysfunction.
The decision to use atropine is therefore a balance between the known short-term benefits of reduction in myopia progression (thereby decreasing the risk of blinding myopia-related eye problems), and he as yet unknown risk of long-term ocular problem from atropine use. The long-term risks of low-dose atropine, however, are expected to be less than higher-dose atropine.
Regular Eye Check-up
Children on topical atropine treatment should be reviewed by an eye doctor every 3-6 months. This will allow regular monitoring of their myopia progression as well as identification of any side-effects.
What Causes Near-sightedness?
Near-sightedness (Myopia) is the inability to see objects at a distance clearly. In people with myopia, the eyeball is usually slightly longer than normal from front to back. Light rays which make up the images you see, focus in front of, rather than directly on the retina, the light-sensitive part of the eye. When this happens, objects at a distance seem blurry and unclear.
Progressive myopia or near-sightedness is predominantly caused by genetics. Children inherit a tendency to develop the eye condition from their parents, but these days because of increasing use of Near Vision devices by children like mobiles, tablets, and Laptops we are getting children who do not have a family history of myopia.
How Do I Know If My Child Is Nearsighted?
Most often, young children with nearsightedness don’t complain or only complain of difficulties seeing things far away. A nearsighted child may move closer to objects to see clearly. If your child seems to have trouble seeing things at a distance, make an appointment with an eye doctor.
Remember that child’s visual system continues to develop until the age of 8. During this period so problems during this period can lead to permanent visual loss called amblyopia or “lazy eye” if this is not corrected with the appropriate glasses. Routine vision screening is important in pre-school and school children to pick up refractive errors early Children need their vision checked at 6 months, 3 years, and before first grade. This is especially important if there is a family history of progressive nearsightedness or other eye conditions.
Who is likely to develop myopia?
A child is more likely to develop myopia if he/she:
- 1. has one or both parents who have myopia
- 1. has one or both parents who have myopia
How Is Near-sightedness Treated In Children?
After a detailed examination with eye drops to check the amount of Myopia, glasses are then prescribed. Regular 6 monthly check-up is important to check if the spectacle power has gone up, remained the same.
Contact Lenses are options for children in their teens, they are mature enough to take care of them.
My child’s spectacle power continues to go up, is there any way of slowing down the increase?
In my training in Singapore and Germany, I did find a beneficial effect of these special eye drops on reducing the progression of problem though the effect could vary between children. Some recent studies suggest that the use of these eye drops combined with bifocals slows the progression of myopia. This of course needs to be discussed with the parents in detail before starting the treatment. Doing eye exercises may also help in these children.
Can Nearsightedness Be Prevented?
It is may not be possible to prevent it. However, there are steps you can take to minimize its effect. Make sure your child is examined early, cut down on computer games, handheld games and make sure your child takes take periods of rest in between periods of reading or writing.