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Optometry and Vision Science : Official... May 2022Combining 0.01% atropine with soft multifocal contact lenses (SMCLs) failed to demonstrate better myopia control than SMCLs alone.
SIGNIFICANCE
Combining 0.01% atropine with soft multifocal contact lenses (SMCLs) failed to demonstrate better myopia control than SMCLs alone.
PURPOSE
The Bifocal & Atropine in Myopia (BAM) Study investigated whether combining 0.01% atropine and SMCLs with +2.50-D add power leads to greater slowing of myopia progression and axial elongation than SMCLs alone.
METHODS
Participants of the BAM Study wore SMCLs with +2.50-D add power daily and administered 0.01% atropine eye drops nightly (n = 46). The BAM subjects (bifocal-atropine) were age-matched to 46 participants in the Bifocal Lenses in Nearsighted Kids Study who wore SMCLs with +2.50-D add power (bifocal) and 46 Bifocal Lenses in Nearsighted Kids participants who wore single-vision contact lenses (single vision). The primary outcome was the 3-year change in spherical equivalent refractive error determined by cycloplegic autorefraction, and the 3-year change in axial elongation was also evaluated.
RESULTS
Of the total 138 subjects, the mean ± standard deviation age was 10.1 ± 1.2 years, and the mean ± standard deviation spherical equivalent was -2.28 ± 0.89 D. The 3-year adjusted mean myopia progression was -0.52 D for bifocal-atropine, -0.55 D for bifocal, and -1.09 D for single vision. The difference in myopia progression was 0.03 D (95% confidence interval [CI], -0.14 to 0.21 D) for bifocal-atropine versus bifocal and 0.57 D (95% CI, 0.38 to 0.77 D) for bifocal-atropine versus single vision. The 3-year adjusted axial elongation was 0.31 mm for bifocal-atropine, 0.39 mm for bifocal, and 0.68 mm for single vision. The difference in axial elongation was -0.08 mm (95% CI, -0.16 to 0.002 mm) for bifocal-atropine versus bifocal and -0.37 mm (95% CI, -0.46 to -0.28 mm) for bifocal-atropine versus single vision.
CONCLUSIONS
Adding 0.01% atropine to SMCLs with +2.50-D add power failed to demonstrate better myopia control than SMCLs alone.
Topics: Atropine; Child; Contact Lenses, Hydrophilic; Disease Progression; Eyeglasses; Humans; Myopia; Refraction, Ocular
PubMed: 35511120
DOI: 10.1097/OPX.0000000000001884 -
Investigative Ophthalmology & Visual... Dec 2020To 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. (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
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.
Topics: Atropine; Child; Choroid; Fundus Oculi; Humans; Myopia; Ophthalmic Solutions; Tomography, Optical Coherence
PubMed: 33320168
DOI: 10.1167/iovs.61.14.15 -
Vision Research May 2016This study analyzed the luminance and color emmetropization response in chicks treated with the nonselective parasympathetic antagonist atropine and the sympathetic...
This study analyzed the luminance and color emmetropization response in chicks treated with the nonselective parasympathetic antagonist atropine and the sympathetic β-receptor blocker timolol. Chicks were binocularly exposed (8h/day) for 4days to one of three illumination conditions: 2Hz sinusoidal luminance flicker, 2Hz sinusoidal blue/yellow color flicker, or steady light (mean 680lux). Atropine experiments involved monocular daily injections of either 20μl of atropine (18nmol) or 20μl of phosphate-buffered saline. Timolol experiments involved monocular daily applications of 2 drops of 0.5% timolol or 2 drops of distilled H2O. Changes in the experimental eye were compared with those in the fellow eye after correction for the effects of saline/water treatments. Atropine caused a reduction in axial length with both luminance flicker (-0.078±0.021mm) and color flicker (-0.054±0.017mm), and a reduction in vitreous chamber depth with luminance flicker (-0.095±0.023mm), evoking a hyperopic shift in refraction (3.40±1.77D). Timolol produced an increase in axial length with luminance flicker (0.045±0.030mm) and a myopic shift in refraction (-4.07±0.92D), while color flicker caused a significant decrease in axial length (-0.046±0.017mm) that was associated with choroidal thinning (-0.046±0.015mm). The opposing effects on growth and refraction seen with atropine and timolol suggest a balancing mechanism between the parasympathetic and β-receptor mediated sympathetic system through stimulation of the retina with luminance and color contrast.
Topics: Adrenergic beta-Antagonists; Animals; Atropine; Axial Length, Eye; Chickens; Choroid; Color Vision; Contrast Sensitivity; Emmetropia; Lens, Crystalline; Lighting; Muscarinic Antagonists; Mydriatics; Parasympathetic Nervous System; Refraction, Ocular; Sympathetic Nervous System; Timolol
PubMed: 26971621
DOI: 10.1016/j.visres.2016.03.001 -
Optometry and Vision Science : Official... May 2019The Bifocal & Atropine in Myopia (BAM) study aims to determine whether combining 0.01% atropine and +2.50-diopter add center-distance soft bifocal contact lenses (SBCL)... (Comparative Study)
Comparative Study Randomized Controlled Trial
SIGNIFICANCE
The Bifocal & Atropine in Myopia (BAM) study aims to determine whether combining 0.01% atropine and +2.50-diopter add center-distance soft bifocal contact lenses (SBCL) slows myopia progression more than SBCL alone. The results could provide significant information on the myopia control effect of combining optical and pharmacological treatments.
PURPOSE
This article describes the subject characteristics at baseline, the study methods, and the short-term effects of this combination treatment on visual acuity (VA) and vision-related outcomes.
METHODS
Subjects from the BAM study who met the baseline eligibility criteria were dispensed the combination treatment for 2 weeks to determine final eligibility. Outcome measures included VA at near and distance (Bailey-Lovie logMAR charts), near phoria (modified Thorington), accommodative lag (Grand Seiko WAM-5500), and pupil size (NeurOptics VIP-200 Pupillometer). Compliance was monitored using surveys. Two subgroups in the Bifocal Lenses In Nearsighted Kids study, single-vision contact lens wearers and those who wore +2.50-diopter add SBCL, will serve as the age-matched historical controls for BAM study.
RESULTS
Forty-nine BAM subjects (9.6 ± 1.4 years) were enrolled; mean spherical equivalent cycloplegic autorefraction was -2.33 ± 1.03 diopters. After 2 weeks of treatment, the best-corrected low-contrast (10% Michelson) distance VA was reduced (pre-treatment, +0.09 ± 0.07; post-treatment, +0.16 ± 0.08; P < .0001), but the high-contrast VA at near or distance was unaffected. Near phoria increased by approximately 2 in the exo direction (P = .01), but the accommodative lag was unchanged. The pupil size was not significantly different between pre-treatment and post-treatment of either the photopic or mesopic condition. Surveys indicated that the subjects wore SBCL 77 ± 22% of waking hours and used atropine 6.4 ± 0.7 days per week.
CONCLUSIONS
Two weeks of combination treatment reduced low-contrast distance VA and increased near exophoria slightly, but the subjects were compliant and tolerated the treatment well.
Topics: Administration, Ophthalmic; Atropine; Axial Length, Eye; Child; Combined Modality Therapy; Contact Lenses, Hydrophilic; Female; Humans; Male; Mydriatics; Myopia; Ophthalmic Solutions; Pupil; Refraction, Ocular; Research Design; Visual Acuity
PubMed: 31046016
DOI: 10.1097/OPX.0000000000001378 -
The Cochrane Database of Systematic... Aug 2019Amblyopia is defined as impaired visual acuity in one or both eyes without demonstrable abnormality of the visual pathway, and is not immediately resolved by wearing...
BACKGROUND
Amblyopia is defined as impaired visual acuity in one or both eyes without demonstrable abnormality of the visual pathway, and is not immediately resolved by wearing glasses.
OBJECTIVES
In performing this systematic review, we aimed to synthesize the best available evidence regarding the effectiveness and safety of conventional occlusion therapy compared to atropine penalization in treating amblyopia.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2018, Issue 8); Ovid MEDLINE; Ovid Embase; LILACS BIREME; ClinicalTrials.gov; ISRCTN; and the WHO ICTRP on 7 September 2018.
SELECTION CRITERIA
We included randomized/quasi-randomized controlled trials comparing conventional occlusion to atropine penalization for amblyopia.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened abstracts and full-text articles, abstracted data, and assessed risk of bias.
MAIN RESULTS
We included seven trials (five randomized controlled trials and two quasi-randomized controlled trials) conducted in six countries (China, India, Iran, Ireland, Spain, and the United States) with a total of 1177 amblyopic eyes. Three of these seven trials were from the original 2009 version of the review. We assessed two trials as having a low risk of bias across all domains, and the remaining five trials as having unclear or high risk of bias for some domains.As different occlusion modalities, atropine penalization regimens, and populations were used across the included trials, we did not conduct any meta-analysis due to clinical and statistical heterogeneity. Evidence from six trials (two at low risk of bias) suggests that atropine penalization is as effective as conventional occlusion in improving visual acuity. Similar improvement in visual acuity was reported at all time points at which it was assessed, ranging from five weeks (improvement of 1 line) to 10 years (improvement of greater than 3 lines). At six months, although most participants (363/522) come from a trial rated as at low risk of bias with a precise estimate (mean difference (MD) 0.03, 95% confidence interval (CI) 0.00 to 0.06), two other trials rated as at high risk of bias produced inconsistent estimates and wide confidence intervals (MD -0.02, 95% CI -0.11 to 0.07 and MD -0.14, 95% CI -0.23 to -0.05; moderate-certainty evidence). At 24 months, additional improvement was found in both groups, but there continued to be no meaningful difference between those receiving occlusion and those receiving atropine therapies (moderate-certainty evidence).We did not find any difference in ocular alignment, stereo acuity, or sound eye visual acuity between occlusion and atropine penalization groups (moderate-certainty evidence). Both treatments were well tolerated. Atropine was associated with better adherence (moderate-certainty evidence) and quality of life (moderate-certainty evidence), but also a higher reported risk of adverse events in terms of mild reduction in the visual acuity of the sound eye not requiring treatment and light sensitivity (high-certainty evidence). Skin, lid, or conjunctival irritation were more common among participants receiving patching than those receiving atropine (high-certainty evidence). Atropine penalization costs less than conventional occlusion.
AUTHORS' CONCLUSIONS
Both conventional occlusion and atropine penalization produce visual acuity improvement in the amblyopic eye. Atropine penalization appears to be as effective as conventional occlusion, although the magnitude of improvement differed among the trials we analyzed.
Topics: Amblyopia; Atropine; Child; Child, Preschool; Humans; Occlusive Dressings; Ophthalmic Solutions; Randomized Controlled Trials as Topic; Visual Acuity
PubMed: 31461545
DOI: 10.1002/14651858.CD006460.pub3 -
Toxins May 2023Atropine and scopolamine belong to the tropane alkaloid (TA) family of natural toxins. They can contaminate teas and herbal teas and appear in infusions. Therefore, this...
Atropine and scopolamine belong to the tropane alkaloid (TA) family of natural toxins. They can contaminate teas and herbal teas and appear in infusions. Therefore, this study focused on analyzing atropine and scopolamine in 33 samples of tea and herbal tea infusions purchased in Spain and Portugal to determine the presence of these compounds in infusions brewed at 97 °C for 5 min. A rapid microextraction technique (µSPEed) followed by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) was used to analyze the selected TAs. The results showed that 64% of the analyzed samples were contaminated by one or both toxins. White and green teas were generally more contaminated than black and other herbal teas. Of the 21 contaminated samples, 15 had concentrations above the maximum limit for liquid herbal infusions (0.2 ng/mL) set by Commission Regulation (EU) 2021/1408. In addition, the effects of heating conditions (time and temperature) on atropine and scopolamine standards and naturally contaminated samples of white, green, and black teas were evaluated. The results showed that at the concentrations studied (0.2 and 4 ng/mL), there was no degradation in the standard solutions. Brewing with boiling water (decoction) for 5 and 10 min allowed for higher extraction of TAs from dry tea to infusion water.
Topics: Atropine; Scopolamine; Teas, Herbal; Tandem Mass Spectrometry; Temperature; Tropanes; Tea; Water
PubMed: 37368663
DOI: 10.3390/toxins15060362 -
Indian Journal of Ophthalmology Apr 2019To develop a consensus statement for use of dilute atropine in control of myopia progression in children based on review of existing literature, opinions and suggestions... (Review)
Review
PURPOSE
To develop a consensus statement for use of dilute atropine in control of myopia progression in children based on review of existing literature, opinions and suggestions of the members of the Group of Paediatric Ophthalmologist and Strabismologists, Mumbai (GPOS).
METHODS
Literature review, group discussions, questionnaire study and consensus building by supermajority voting.
RESULTS
About 65% of paediatric ophthalmologists in Mumbai have started prescribing atropine sulphate 0.01% as routine in their patients showing myopia progression. Majority of the respondents who have used it for >1 year in their patient population are extremely happy with the results. About 47% respondents expressed concerns regarding some yet unknown side effects of long-term use in our patient population. Majority of the respondents agree that it is safe and have rarely encountered side effects with its use.
CONCLUSION
Atropine sulphate 0.01% is a safe and effective treatment for myopia control. Most trained paediatric ophthalmologists recommend its use in children with progressive simple myopia.
Topics: Atropine; Consensus; Disease Progression; Humans; Mydriatics; Myopia, Degenerative; Ophthalmic Solutions; Practice Guidelines as Topic; Refraction, Ocular; Treatment Outcome
PubMed: 30900574
DOI: 10.4103/ijo.IJO_1457_18 -
Klinische Monatsblatter Fur... Oct 2022The aim of this study was to evaluate traffic safety of Defocus Incorporated Multiple Segments (DIMS) spectacle lenses in combination therapy with atropine.
BACKGROUND
The aim of this study was to evaluate traffic safety of Defocus Incorporated Multiple Segments (DIMS) spectacle lenses in combination therapy with atropine.
PATIENTS AND METHODS
12 young adults (age: 24 - 45; 30,1 ± 5,7 years) were recruited to evaluate corrected distance visual acuity (CDVA), contrast sensitivity (CS; FrACT), glare sensitivity (Mesotest) under the influence of DIMS spectacle correction alone and combination therapy with 0,01% atropine.
RESULTS
When looking through the central area of the DIMS lens, far vision does not decrease due to the influence of atropine; influence of glare and atropine leads to a reduction of CDVA by 0.10 logMAR. When forced to look through the DIMS area, far vision is reduced by 0.09 logMAR due to the influence of atropine in the absence of glare; in the presence of glare, no further loss of visual acuity can be observed under the influence of atropine. Contrast vision with DIMS glasses is not altered by the effects of atropine. Concerning glare sensitivity, DIMS lenses did not show any visual impairment that would be relevant to vision and road safety. Additional atropinization does not affect glare sensitivity.
CONCLUSION
DIMS spectacle lenses are safe for participation in road traffic and do not relevantly impair traffic safety, neither alone nor under the acute influence of 0,01% atropine.
Topics: Young Adult; Humans; Adult; Middle Aged; Eyeglasses; Atropine; Myopia; Visual Acuity; Contrast Sensitivity; Vision Disorders; Lenses, Intraocular; Glare
PubMed: 36008055
DOI: 10.1055/a-1930-7116 -
Ophthalmic Research 2021Myopia has become a worldwide public health issue, which is occurring at a younger age, leading to an increased risk of high myopia. Ocular complications associated with... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Myopia has become a worldwide public health issue, which is occurring at a younger age, leading to an increased risk of high myopia. Ocular complications associated with high myopia can lead to irreversible vision loss. It is urgent and critical to explore effective treatment to slow down or even stop the progression of myopia in young children.
OBJECTIVE
The aim of the study was to evaluate the additive effects of orthokeratology (OK) and 0.01% atropine ophthalmic solution for myopia in children.
METHODS
We searched PubMed, Cochrane Library, EMBASE, MEDLINE, Web of science, Ovid, EBSCO host, CNKI, and CBM to collect eligible studies. Efficacy and safety were evaluated in terms of the axial length (AL), uncorrected distant visual acuity (UCVA), corneal endothelial cell density (CECD), and intraocular pressure (IOP). We calculated the weighted mean difference (WMD) and the 95% confidence intervals (CIs) of all outcomes and plotted on forest plots.
RESULTS
Four studies were ultimately included, involving a total of 267 subjects. This meta-analysis revealed that the mean AL of the subjects in the experimental group was 0.09 mm less than that of subjects in the control group (WMD = -0.09, 95% CI [-0.15, -0.03], p = 0.003). There was no significant difference in UCVA, CECD, and IOP between the 2 groups (WMD was -0.01 [95% CI: -0.03, 0.01], 11.75 [95% CI: -4.09, 27.58], 0.12 [95% CI: -0.40, 0.63], respectively). None of the studies reported severe adverse events.
CONCLUSION
Our study suggests that the combination of OK and 0.01% atropine is more effective in slowing axial elongation than OK monotherapy in children with myopia in a relatively short duration of treatment. In addition, the combination therapy has no negative influence on UCVA, CECD, and IOP.
Topics: Atropine; Axial Length, Eye; Child, Preschool; Humans; Myopia; Orthokeratologic Procedures; Refraction, Ocular
PubMed: 32781450
DOI: 10.1159/000510779 -
Indian Journal of Ophthalmology Jun 2022The present study was performed to compare the optical quality of the eyes of myopic children before and after treatment with atropine eye drops of different...
PURPOSE
The present study was performed to compare the optical quality of the eyes of myopic children before and after treatment with atropine eye drops of different concentrations.
METHODS
In the study population of 71 patients (131 eyes), 34 patients (63 eyes) were given 0.01% atropine eye drops and 37 patients (68 eyes) were given 0.05% atropine eye drops. The modulation transfer function (MTF) cutoff frequency, Strehl ratio, objective scattering index (OSI), and predicted visual acuities (PVAs 100%, 20%, and 9%) under different lighting conditions were measured before and after two weeks of atropine treatment.
RESULTS
After using 0.05% atropine eye drops for two weeks, the Strehl ratio decreased from 0.27 ± 0.07 to 0.23 ± 0.07 (P = 0.0026), PVA 20% decreased from 1.15 ± 0.32 to 1.03 ± 0.36 (P = 0.0344), and PVA 9% decreased from 0.74 ± 0.23 to 0.64 ± 0.23 (P = 0.0073). The OSI was significantly higher after using 0.05% than 0.01% atropine eye drops (P = 0.0396), while both the Strehl ratio and PVA 20% were lower after using 0.05% than 0.01% atropine eye drops (P = 0.0087 and P = 0.0492, respectively).
CONCLUSION
The children's optical quality did not change significantly after using 0.01% atropine eye drops, whereas it decreased after using 0.05% atropine eye drops.
Topics: Atropine; Child; Eye; Humans; Myopia; Ophthalmic Solutions; Visual Acuity
PubMed: 35647992
DOI: 10.4103/ijo.IJO_2886_21