Effects of Atropine Treatment on Choroidal Thickness in Myopic Children
abstract
This abstract is available on the publisher's site.
Access this abstract nowPurpose
To examine the changes in choroidal thickness (ChT) after 6 months of 1% or 0.01% atropine treatment and the independent factors associated with eye elongation.
Methods
A total of 207 myopic children aged 6 to 12 years were recruited and randomly assigned to groups A and B in a ratio of 1:1. Participants in group A received 1% atropine once a day for 1 week, and then once a week for 23 weeks. Participants in group B received 0.01% atropine once a day for 6 months. ChT and internal axial length (IAL) were measured at baseline, 1 week, 3 months, and 6 months.
Results
In group A, the ChT significantly increased after a 1-week loading dose of 1% atropine (26 ± 14 µm; P < 0.001) and the magnitude of increase stabilized throughout the following weekly treatment. The internal axial length did not significantly change at the 6-month visit (-0.01 ± 0.11 mm; P = 0.74). In contrast, a decreased ChT (-5 ± 17 µm; P < 0.001) and pronounced eye elongation (0.19 ± 0.12 mm; P < 0.001) were observed in group B after 6 months. Multivariable regression analysis showed that less increase in ChT at the 1-week visit (P = 0.03), younger age (P < 0.001), and presence of peripapillary atrophy (P = 0.001) were significantly associated with greater internal axial length increase over 6 months in group A.
Conclusions
One percent atropine could increase the ChT, whereas 0.01% atropine caused a decrease in ChT after 6 months of treatment. For participants receiving 1% atropine, the short-term increase in ChT was negatively associated with long-term eye elongation. Younger age and the presence of peripapillary atrophy were found to be risk factors for greater eye elongation.
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Additional Info
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Effects of Atropine Treatment on Choroidal Thickness in Myopic Children
Invest. Ophthalmol. Vis. Sci 2020 Dec 01;61(14)15, L Ye, Y Shi, Y Yin, S Li, J He, J Zhu, X XuFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This study primarily assessed the difference in choroidal thickness (ChT) over the course of 6 months of treatment as a result of weekly 1% atropine as compared with daily 0.1% atropine in children aged 6 to 12 years. The data suggest that 1% atropine could increase ChT, whereas 0.01% atropine caused a decrease in ChT after 6 months of treatment. The increase in ChT with 1% atropine presumably offsets scleral stretching which would contribute to axial elongation, thereby countering progressive myopia.
The authors point out numerous limitations to their study: 1) absence of a placebo control group; 2) relatively short follow-up period of 6 months; 3) no documentation of rebound effect after cessation; 4) inability to evaluate the accuracy with which parents accurately kept medication diaries; 5) baseline pupil size larger than reported in previous studies; 6) time for outdoor activities and time spent on near work, which have been identified as risk factors for high myopia, not taken into consideration. This study, although an important one, seems to raise more questions than it answers, but does provide good data for future studies.
In this paper, the authors sought "to examine the changes in choroidal thickness (ChT) after 6 months of 1% or 0.01% atropine treatment and the independent factors associated with eye elongation." The bottom line is that 1% atropine could increase ChT, which was negatively associated with eye elongation, whereas 0.01% resulted in a decreased ChT. Regarding a possible mechanism for these findings, the authors state, "We speculate that the optic deformation and scleral stretching may influence the function of the retina, retinal pigment epithelium, and choroid, eventually resulting in less choroidal thickening and more eye growth." A sobering statement was that "myopic children with the presence of peripapillary atrophy should be closely monitored because they have a relatively poor response to 1% atropine and are at a high risk of developing high myopia and pathologic myopia." Overall, an interesting perspective on the atropine:myopia relationships.