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Age Effect on Treatment Responses to Atropine
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This secondary analysis of the 2-year results of the LAMP study evaluates the effect of age (4–12 years) on efficacy of 0.05%, 0.025%, and 0.01% atropine treatment for slowing myopia in children. Results indicate that younger age is associated with poorer response to the lowest dose treatment.
- A higher concentration of atropine ophthalmic solution should be used in younger patients for slowing the development of myopia. Dosages were well tolerated in all age groups.
abstract
This abstract is available on the publisher's site.
Access this abstract nowPURPOSE
To investigate the effect of age at treatment and other factors on the treatment response to atropine in the Low-concentration Atropine for Myopia Progression (LAMP) study.
DESIGN
Secondary analysis from a randomized trial.
PARTICIPANTS
350 children, aged 4 to 12 years, randomization stratified by age and gender, originally assigned to receive 0.05%, 0.025%, 0.01% atropine, or placebo once daily in both eyes who completed 2 years of the LAMP study were included in this study. In the second year, the placebo group was switched to 0.05% atropine group.
METHODS
Potential predictive factors for treatment response, that is, change in spherical equivalent (SE) and axial length (AL) over two years, were evaluated by generalized estimating equations in each of treatment group separately. The factors evaluated included age at treatment, gender, baseline refraction, parental myopia, time outdoors, diopter hours of near work, and treatment compliance. Estimated mean values and 95% CIs of change in SE and AL over two years were also generated.
MAIN OUTCOME MEASURES
Factors associated with SE change and AL change over two years were the primary outcome measures. The associated factors during the first year were secondary outcome measures.
RESULTS
In 0.05%, 0.025%, and 0.01% atropine group, younger age was the only factor associated with SE progression (coefficient=0.14, 0.15, and 0.20, respectively) and AL elongation (coefficient=-0.10, -0.11, and -0.12, respectively) over two years; the younger age, the poorer response. At each year of age from 4 to 12 across the treatment groups, higher-concentration atropine showed a better treatment response, following a concentration-dependent effect (P-trend for each age group <0.05). In addition, the mean SE progression in 6-years-old children in 0.05% atropine (-0.90D, 95%CI: -0.99, -0.82) was similar to that of 8-years-old in 0.025% atropine (-0.89D, 95%CI: -0.94, -0.83), and 10-years-old in 0.01% atropine (-0.92D, 95%CI: -0.99, -0.85). All concentrations were well tolerated at all age groups.
CONCLUSIONS
Younger age is associated with poor treatment outcomes to low-concentration atropine at 0.05%, 0.025%, and 0.01%. Among atropine concentrations studied, younger children required the highest 0.05% concentration to achieve similar reduction in myopic progression as older children on lower concentrations.
Additional Info
Age Effect on Treatment Responses to 0.05%, 0.025%, and 0.01% Atropine: Low-concentration Atropine for Myopia Progression (LAMP) Study
Ophthalmology 2021 Jan 07;[EPub Ahead of Print], FF Li, Y Zhang, X Zhang, BH Kei Yip, SM Tang, KW Kam, AL Young, LJ Chen, CC Tham, CP Pang, JC YamFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Eye Care
The global myopia epidemic has directed research into possible methods of myopia control in children, including the use of low-dose atropine. The LAMP (Low-concentration Atropine for Myopia Progression) study, a randomized, double-masked clinical trial, previously reported 2-year outcome data using 0.05%, 0.025%, and 0.01% topical atropine for myopia control in children 4 to 12 years of age. The LAMP study found a dose-dependent response to low-dose atropine, and the group concluded that 0.05% atropine was the optimal dosing for myopia control; this dosage was well tolerated in children.1 This current study examines a secondary analysis of the 2-year LAMP study data, focusing on identifying which factors had an influence on treatment success in children 4 to 12 years of age. The analysis found that, within each treatment group (0.05%, 0.025%, and 0.01% atropine), age was the only factor that was associated with an increase in spherical equivalent refractive error and an increase in axial length. No other factors, including parental myopia, baseline refractive error, time outdoors, or hours of near work, were associated with progression. This information is of great importance for practitioners who are using low-dose atropine for myopia control. Based on this paper, patient age should be considered when choosing the concentration of low-dose atropine to be prescribed.
Reference