Increased refractive astigmatism found with nightly 0.01% atropine drops

Paper title:  Effects of Atropine 0.01% on Refractive Errors in Myopic Children

Authors:  Yuliang Wang (1), Xingtao Zhou (1) Xiaomei Qu (1)

1. Fudan University Eye Ear Nose and Throat Hospital, Shanghai, Shanghai, China

Date:  June 2022

Reference:  Wang Y, Zhou X, Qu X.  Effects of Atropine 0.01% on Refractive Errors in Myopic Children. Invest. Ophthalmol. Vis. Sci. 2022;63(7):4316 - A0021. [Link to abstract]

The aim of this study was to examine the effects of using 0.01% atropine on myopic spherical and cylindrical refractive errors in Chinese children.

The participants in this randomized clinical trial were children with -6D or less of myopia and with -2D or less refractive astigmatism.  Their refractive error was confirmed using cycloplegic refraction and axial length, and corneal curvature was measured. The extent and direction of refractive astigmatism, the corneal astigmatism and internal astigmatism was then assessed.

The children were randomly assigned to either to the control group (50 eyes) with single vision spectacles only or the group with single vision spectacles and using 0.01% atropine at night (69 eyes). Both groups were followed at 3-, 6- and 9-month intervals.

The treatment group were found to show less myopia progression with -0.35D v -0.56D for the control group and less axial elongation (0.20mm v 0.33mm for the control) over the 9 month study.

An increase of refractive astigmatism of a mean of -0.14D was found for the treatment group. This increase was associated with a -0.17D increase in corneal astigmatism, and a 0.02D reduction in internal astigmatism.

Although 0.01% atropine was able to provide significantly less myopic progression and axial growth over 9 months, a small increase in refractive astigmatism may be expected, particularly in the initial 3-month period. This may amount to less than 0.25DC, though.

1. How an increase in refractive astigmatism and atropine use are related
2. If stronger concentrations of atropine produce a greater increase of refractive astigmatism
3. If there are cumulative and maximum effects
4. The long-term effects on refractive astigmatism in atropine usage longer than 9 months
5. This is an abstract only, and the ages and ethnicities of the children weren't stated. These may be relevant factors for susceptibility of corneal and refractive astigmatism changes with atropine use, which may be reported upon in a full paper.

Title:  Effects of Atropine 0.01% on Refractive Errors in Myopic Children

Authors:  Yuliang Wang, Xingtao Zhou, Xiaomei Qu

Purpose:  To explore the effects of long-term usage of atropine 0.01% eye drops on spherical and cylindrical refractive errors in myopic Chinese children.

Methods:  This study was a single-centre randomized clinical trial. Children with myopia less than -6.0 D and refractive astigmatism (RA) less than - 2.0 D were enrolled and randomized to receive atropine 0.01% once nightly with single vision lenses or simply wear single vision lenses, then followed up every three months. Cycloplegic refraction and ocular biometric measurement of axial length and corneal curvature were obtained. The magnitude and direction of RA, corneal astigmatism (CA), and internal astigmatism (IA) were also evaluated during treatment.

Results:  A total of 119 eyes (69 eyes in the atropine group and 50 eyes in the control group) were included in the final analyses at the 9-month visit. The atropine-treated eyes showed significantly less progression of myopia than those in the control eye (spherical equivalent: -0.35 ± 0.33 D vs. -0.56 ± 0.49 D, P = 0.001 and axial length: 0.20 ± 0.19 vs. 0.33 ± 0.19 mm, P < 0.001). Compared with the control eyes, a statistically significant increase of RA was observed in the atropine-treated eyes (-0.14 ± 0.29 D), which was mainly attributed to the increase of CA (-0.17 ± 0.26 D), instead of a minor decrease of IA (0.02 ± 0.32 D).

Conclusions:  Atropine 0.01% is effective for preventing the progression of myopia and has potential effects on increasing refractive astigmatism in myopic Chinese children over 9 months of treatment.

[Link to abstract]