Effect of Combining 0.01% Atropine with Soft Multifocal Contact Lenses on Myopia Progression in Children

Abstract

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.

Jones, Jenny Huang PhD, OD, MPH1∗; Mutti, Donald O. OD, PhD, FAAO1; Jones-Jordan, Lisa A. PhD, FAAO1; Walline, Jeffrey J. OD, PhD, FAAO1

Optometry and Vision Science: May 2022 – Volume 99 – Issue 5 – p 434-442doi: 10.1097/OPX.0000000000001884

Orthokeratology for Myopia Control: A New Review

Orthokeratology  has been proven to decrease the progression of myopia in school-aged children, according to a number of studies. Orthokeratology has recently been regarded among the most effective optical treatments for myopia management.

This study examined peer-reviewed research on the effectiveness of Orthokeratology in the treatment of myopia. However, even while myopia advancement cannot be halted completely, Ortho-K it has been shown to have an inhibitory effect of between 32% and 63% compared to single-vision glasses and soft contact lenses over the course of two years.

In addition, multiple studies with up to ten years of data have verified the efficacy and acceptable safety of the therapy.

Myopia progression following Orthokeratology discontinuation may or may not see a rebound phenomenon. It’s also not obvious how long each patient should continue treatment to get the most out of it.

Longer follow-up periods across a broader range of people are needed in the near future to better examine if myopia progression rebounds.

Myopia Control With Orthokeratology: A Review

Hiraoka, Takahiro M.D.

Eye & Contact Lens: Science & Clinical Practice: March 2022 – Volume 48 – Issue 3 – p 100-104

doi: 10.1097/ICL.0000000000000867

Top Experts Weigh In about Eye Care Monitors

Blue light filtering

First, marketers begin with the statement that blue light is dangerous to our eyes, skin, and sleep patterns. This is factually correct, but somewhat intellectually dishonest.

Let’s turn to an expert for a better explanation. As Dr. Norman Shedlo, Optometrist and owner of the Eyecare Center of Maryland, puts it:

“It’s true that blue and ultraviolet light are dangerous to eyes, but only at very high intensities.  The amount of blue light produced by a computer monitor or phone screen is so dim that it has no effect on the health of the eyes.  The blue and UV light from the sun is very dangerous and is a documented source of skin cancer, cataracts and retina disease to millions.  This is why doctors recommend sunglasses and sunscreen to people spending significant time outdoors.”

– Dr. Norman Shedlo

Flicker Rates

If you have ever noticed the flicker of a monitor or other display, you will agree that the flicker can be aggravating and unpleasant to look at. But the important question here is whether or not a “flicker-free” monitor does anything to protect your eyes.

Again, we turn to the experts. Dr. Shedlo tells us that “flicker rates between 70-90 Hz will present a screen that does not appear to ‘flicker’. The flickering itself is not dangerous to your eyes, it’s just annoying. Flicker rates above this are outside the range of human perception and make absolutely no difference. These rates have no effect on eye strain.”

We discussed the topic with Dr. Yuna Rapoport, an Ophthalmologist and owner of Manhattan Eye.

Most of the eye strain that occurs happens because of dry eye and decreased blink. So, while special flicker free monitors and monitor lamps seem fancy and may provide a better user experience, from a medical point of view they do not ‘save the eyes.’

– Dr. Yuna Rapoport

We asked our experts a few simple questions: Would you recommend a special eye care monitor for a friend or family member? And would you pay extra for an eye saving monitor?

Dr. Rapoport stated that she does not “think that they are worth the extra price,” and she “would not get one for myself or for a loved one.”

Dr. Shedlo replied that he “would not pay extra for any eye health benefits claimed by these technologies.”

If we are looking solely at the science and the expert advice, there is insufficient evidence to suggest that eye care monitors actually improve eye health.

Monitor Lamps

The concept behind monitor lamps, monitor light bars, and monitor bias lighting is relatively simple. These products minimize the lighting contrast between your monitor and the surrounding area. A bright display in a dark room causes strain on the eyes, so it is better to have some ambient lighting near your computer.

So, these products probably help minimize eye strain when compared to using no monitor lighting at all. But that doesn’t mean that it makes sense to spend $100+ for a specialty monitor light bar that claims it will save your eyes. Ultimately, these monitor lamps and light bars are simply, as Dr. Shedlo puts it, “smaller lamps placed on the monitor to provide lighting to certain places on the desk. Their function can be substituted for by any suitable desk lamp pointed in the right direction.”

However, much of this “eye saving” technology is actually just marketing hype. As Dr. Shedlo puts it, these computer companies use language that is “scientific and technical [to give] the impression of legitimate benefits based on scientific data.” But “the claims about the relationship of new monitors to eye health have no basis in reality.”

How do I know myopia control is working?

One of the most difficult challenges in myopia control is identifying whether or not patients are receiving a significant therapy benefit. This has been a problem because patients of different ages progress at varying rates, and we can never truly know how far an individual patient would have advanced if they hadn’t received treatment.

A good example of this is the typical 7-year-old non-Asian patient progressing by –1.00D in refractive error and 0.35mm in axial length per year, but the average 12-year-old non-Asian patient progresses by –0.40D in refractive error and 0.21mm in axial length per year.

Individuals of Asian descent make slightly more progress than patients of non-Asian descent. The prevalent thinking that a myope develops 0.50D per year on average only holds true for people of a specific age and racial group (those under the age of ten).

In addition, it is crucial to remember that emmetropic patients might have a neutral refractive error while still experiencing around 0.1mm of axial length advancement per year.

Recently published evidence suggests that the maximal axial length slowing experienced by a myope treated with a multifocal soft contact lens may be similar to that seen by an emmetrope in some cases.

As a result, it is unlikely that we will be able to completely halt axial length growth in children who are still growing. In addition, it is vital to remember that these are averages, which means that certain patients will progress more rapidly than the average myope.

What can we do with this information to determine the effectiveness of myopia management treatments? Efficacy is determined by observing that individuals progress less than the mean value for their age and race after undergoing a particular treatment.

While this is not a perfect sign of effectiveness, it does provide us with some foundation for determining whether a treatment is helpful, and we will most likely continue to rely on this type of data until studies that speak to the effectiveness of treatments in individual patients are conducted.

We discuss with families the potential benefits of combination therapy after at least one year of treatment. Nonetheless, it is up to the parents, after they have been educated, to decide whether or not to change the course of therapy.

Symptoms and ocular findings associated with administration of 0.01% atropine in young adults

Abstract

Clinical relevance: This paper provides eye care practitioners with important information about the potential side effects of 0.01% atropine.

Background: Eye care practitioners routinely administer 0.01% atropine eye drops nightly to slow the progression of myopia, but nobody has assessed accommodative lag or facility, near phoria, intraocular pressure or comfort of drop administration.

Methods: All 21- to 30-year-old adults with no history of accommodative issues or therapy were eligible. During the baseline visit, participants underwent testing related to potential side effects. Participants then administered one drop of 0.01% atropine nightly to both eyes, and all tests were repeated 1 week later.

Results: The average ± standard deviation age of the 31 participants was 23.9 ± 1.6 years, 71% were female, and 81% were Caucasian. The only significant changes were an increase in photopic pupil size from 4.9 ± 0.8 at baseline to 5.1 ± 0.6 mm after 1 week (paired sample t-test, p = 0.002) and an increase of the average intraocular pressure of the two eyes from 15.6 ± 2.7 to 16.7 ± 3.1 mmHg (paired-sample t-test, p = 0.003), but neither of these changes was clinically meaningful. There were no other statistically significant differences before and after 1-week administration of 0.01% atropine for any of the vision, accommodation, reading speed or subjective side effects. When asked how likely they would be to take the atropine drops to delay the onset of myopia on a scale from 1 (definitely not) to 10 (definitely would), participants replied with an average of 8.2 ± 2.0 after taking atropine eye drops for 1 week (paired-sample t-test, p = 0.81).

Conclusion: Nightly administration of 0.01% atropine did not result in any clinically meaningful symptoms, so patients would be very likely to take the drops to delay the onset of myopia.

Cyphers B, Huang J, Walline JJ. Symptoms and ocular findings associated with administration of 0.01% atropine in young adults. Clin Exp Optom. 2022 Feb 20:1-11. doi: 10.1080/08164622.2022.2033603. Epub ahead of print. PMID: 35188076.

https://www.tandfonline.com/doi/abs/10.1080/08164622.2022.2033603?journalCode=tceo20