Purpose

To investigate the effect of age at treatment and other factors on treatment response to atropine in the Low-Concentration Atropine for Myopia Progression (LAMP) Study.

Design

Secondary analysis from a randomized trial.

Participants

Three hundred fifty children aged 4 to 12 years who originally were assigned to receive 0.05%, 0.025%, or 0.01% atropine or placebo once daily, and who completed 2 years of the LAMP Study, were included. In the second year, the placebo group was switched to the 0.05% atropine group.

Methods

Potential predictive factors for change in spherical equivalent (SE) and axial length (AL) over 2 years were evaluated by generalized estimating equations in each treatment group. Evaluated factors included age at treatment, gender, baseline refraction, parental myopia, time outdoors, diopter hours of near work, and treatment compliance. Estimated mean values and 95% confidence intervals (CIs) of change in SE and AL over 2 years also were generated.

Main Outcome Measures

Factors associated with SE change and AL change over 2 years were the primary outcome measures. Associated factors during the first year were secondary outcome measures.

Results

In 0.05%, 0.025%, and 0.01% atropine groups, younger age was the only factor associated with SE progression (coefficient of 0.14, 0.15, and 0.20, respectively) and AL elongation (coefficient of –0.10, –0.11, and –0.12, respectively) over 2 years; the younger the age, the poorer the response. At each year of age from 4 to 12 years across the treatment groups, higher-concentration atropine showed a better treatment response, following a concentration-dependent effect (P_trend <0.05 for each age group). In addition, the mean SE progression in 6-year-old children receiving 0.05% atropine (–0.90 diopter [D]; 95% CI, –0.99 to –0.82) was similar to that of 8-year-old children receiving 0.025% atropine (–0.89 D; 95% CI, –0.94 to –0.83) and 10-year-old children receiving 0.01% atropine (–0.92 D; 95% CI, –0.99 to –0.85). All concentrations were well tolerated in all age groups.

Conclusions

Younger age is associated with poor treatment response to low-concentration atropine at 0.05%, 0.025%, and 0.01%. Among concentrations studied, younger children required the highest 0.05% concentration to achieve similar reduction in myopic progression as older children receiving lower concentrations.

Li FF, Zhang Y, Zhang X, Yip BHK, Tang SM, Kam KW, Young AL, Chen LJ, Tham CC, Pang CP, Yam JC. Age Effect on Treatment Responses to 0.05%, 0.025%, and 0.01% Atropine: Low-Concentration Atropine for Myopia Progression Study. Ophthalmology. 2021 Aug;128(8):1180-1187. doi: 10.1016/j.ophtha.2020.12.036. Epub 2021 Jan 8. PMID: 33422558.

Abstract

Purpose

Identifying axial length growth rate as an indicator of fast progression before initiating atropine 0.01% for myopia progression in children.

Method

From baseline, axial length growth over six months was measured prospectively. Subjects were then initiated on atropine 0.01% if axial length growth was greater than 0.1mm per 6 months (fast progressors), axial length and spherical equivalent change measurements recorded every six months. The rate of change was compared to the baseline pre-treatment rate. If axial length change was below the threshold, subjects received monitoring only.

Results

73 subjects were identified as fast progressors and commenced atropine 0.01%, (mean baseline refraction of OD -2.9±1.6, OS -2.9±1.8 and a mean baseline axial length OD 24.62 ± 1.00 mm, OS 24.53 ± 0.99 mm). At six months, the mean paired difference of axial length growth rate was significantly reduced by 50% of baseline (all 73 subjects, p<0.05). 53 subjects followed to 12 months, and 12 to 24 months maintained a reduced growth rate. Change in mean spherical equivalent was significantly reduced compared to pre-treatment refractive error (mean paired difference p<0.05) and at each subsequent visit. 91 children were slow progressors and remained untreated. Their axial length growth rate did not change significantly out to 24 months. Spherical equivalent changed less than -0.5D annually in this group.

Conclusion

Identifying fast progressors before treatment initiation demonstrated a strong treatment effect with atropine 0.01% reducing their individual rate of myopia progression by 50%. Another large group of myopic children, slow progressors, continued without medical intervention. A baseline axial length growth rate is proposed as a guideline to identify fast progressors who are more likely to benefit from atropine 0.01%.

Citation: Rose LVT, Schulz AM, Graham SL (2021) Use baseline axial length measurements in myopic patients to predict the control of myopia with and without atropine 0.01%. PLoS ONE 16(7): e0254061. https://doi.org/10.1371/journal.pone.0254061

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0254061

Purpose: To evaluate dry eye (DE) and subjective visual display terminal (VDT)-related symptoms in university students who moved their classes online due to the COVID-19 pandemic.

Methods: Cross-sectional study of students who were taking online classes. In May 2020, the participants completed a Dry Eye Questionnaire (DEQ-5) and a self-report survey, which included demographics, medical history, information on the use of VDT and presence of VDT-related symptoms. Participants were classified as having mild/moderate (7-12) or severe (>12) DE symptoms based on their DEQ-5 score. The associations between severe DE symptoms and relevant factors were also evaluated.

Results: The data of 1450 eligible students were analyzed. The mean age of the participants was 21.1 (2.7) years. 42.8% of the participants had mild/moderate DE symptoms, whereas 34.7% had severe symptoms. Associated factors for severe DE were female sex (OR = 2.57, CI [1.97-3.35]), allergic disease (OR = 1.63, CI [1.24-2.13]), previous dry eye diagnosis (OR = 13.49, CI [7.10-25.63]), keratoconus (OR = 5.56, CI [1.27-24.44], contact lens use (OR = 1.77, CI [1.24-2.53]) and duration of VDT use (OR = 1.02, CI [1.01-1.05]). Prior to the pandemic, the mean reported duration of VDT use was 9.8 (4.7) hours; this increased to 15.9 (5.8) hours during the online classes (p < .001). 80.6% of the participants reported a global increase in VDT-related symptoms.

Conclusion: Students taking online classes had a high frequency of dry eye symptoms. They also reported a significant increase in visual display terminal related symptoms. Dry eye should be considered as an emerging health problem among the young population, which is probably related to the recent changes in lifestyle.

Cartes C, Segovia C, Salinas-Toro D, Goya C, Alonso MJ, Lopez-Solis R, Zapata C, Cabezas M, Yañez P, Flores-Rodriguez P, Lopez D, Matus G, Traipe L. Dry Eye and Visual Display Terminal-Related Symptoms among University Students during the Coronavirus Disease Pandemic. Ophthalmic Epidemiol. 2021 Jul 12:1-7.

Purpose: To investigate the efficacy of myopia control defined by axial elongation and safety of orthokeratology lenses (OKL) in a Scandinavian (Danish) population.

Methods: Sixty Danish children aged 6-12 years with myopia ranging from 0.5 to 4.75 dioptres (D) spherical component and refractive astigmatism ≤2.5 D in both eyes were randomly assigned to either OKL or single-vision spectacles (SVS). Study duration was 18 months. Outcome measures were axial length (AL) measured with Lenstar LS900 (Haag-Streit, Koeniz, Switzerland) and adverse events graded with Efron Grading Scale for Contact Lens Complications.

Results: Nineteen participants completed the 18-month follow-up in the OKL group and 28 in the SVS group. The average AL elongation in the OKL group was 0.24 mm smaller as compared to the SVS group (95% confidence interval 0.12-0.36, mixed model adjusted for baseline sex, age and AL). There were no fast progressors (>0.75 D/year) in the OKL group during the follow-up period in contrast to 22% in the SVS group. No treatment-requiring or vision-threatening adverse events were observed.

Conclusion: Orthokeratology lenses reduced AL elongation in myopic Scandinavian children by 59%, with no treatment-requiring or vision-threatening adverse events. The results align with outcomes of previous clinical trials.

Jakobsen TM, Møller F. Control of myopia using orthokeratology lenses in Scandinavian children aged 6 to 12 years. Eighteen-month data from the Danish Randomized Study: Clinical study Of Near-sightedness; Treatment with Orthokeratology Lenses (CONTROL study). Acta Ophthalmol. 2021 Jul 7.

https://onlinelibrary.wiley.com/doi/10.1111/aos.14911

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