The BAM study: combining 0.01% atropine with soft multifocal contact lenses

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

Authors: Jenny Huang Jones¹, Donald O. Mutti¹, Lisa A. Jones-Jordan¹, Jeffrey J. Walline¹

1. The Ohio State University, College of Optometry, Columbus, Ohio USA

Date: January 2022

Reference: Jones JH, Mutti DO, Jones-Jordan LA, Walline JJ. Effect of Combining 0.01% Atropine with Soft Multifocal Contact Lenses on Myopia Progression in Children. Optom Vis Sci. 2022 May 1;99(5):434-442. [Link to paper] 

The Bifocal & Atropine in Myopia (BAM) study was an extension of the BLINK study (you can read our science write-up of it here) and investigated whether combining 0.01% atropine eye drops with soft multifocal contact lenses (SMCL) with a +2.50D add power would result in more effective myopia control compared to SMCL alone. CooperVision Biofinity centre-distance contact lenses were given to the 49 participants enrolled in the study who were age-matched to participants in the BLINK study to allow for comparison.

The study’s findings revealed that over a 3-year period, there was no significant difference in myopia progression between the two groups. The 3-year adjusted mean myopia progression was:

• -0.52 D SER and 0.31mm axial elongation for the combined approach (Bifocal + Atropine)
• -0.55D SER and 0.39mm axial elongation for SMCL with the add power (Bifocal)
• -1.09D SER and 0.68mm axial elongation for single vision contact lenses (Single Vision)

 In conclusion, the addition of 0.01% atropine to SMCL with +2.50D add power failed to demonstrate better myopia control than SMCL alone, based on the study’s results.

Two meta-analyses indicated that combining orthokeratology with low-dose atropine reduced axial elongation by around 0.09 mm compared to orthokeratology alone,^1-2 which was similar to the 0.08 mm reduction in axial elongation observed in the BAM Study when using atropine and SMCL compared to SMCL alone. However, it’s important to note that the difference was not statistically significant (p = 0.054). The reduction of 0.1 mm in axial elongation corresponds to a myopia progression slowing of approximately 0.25D,³ which is considered clinically insignificant.

Given the daily commitment required for administering atropine, it may not be justified to combine 0.01% atropine with an optical intervention when the optical intervention alone is nearly as effective in slowing myopia progression: in this case, the Biofinity center-distance multifocal contact lens with a +2.50D add.

• Only 0.01% atropine was investigated in the study. The LAMP Study showed that low-concentration atropine effectively slowed myopia progression, but that 0.05% was more effective than 0.01%.⁴ Since the effect of atropine is dose-dependent, further investigations of 0.025% and 0.05% may yield a more comprehensive overview of the myopia control effect of SMCL combined with atropine.
• Orthokeratology combined with 0.01% atropine has demonstrated increased efficacy in various randomized controlled trials:^5-6 our clinical article Combination atropine treatments: when more is more describes this. In the BAM study, historical control comparison was made instead. The combination of 0.01% atropine and SMCL may yield different insights if investigated in a randomized controlled trial.  

Purpose: The Bifocal & Atropine in Myopia (BAM) study investigated whether combining 0.01% atropine and SMCL with +2.50-D add power leads to greater slowing of myopia progression and axial elongation than SMCL alone.

Methods: BAM participants wore SMCL 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 (BLINK) Study who wore SMCL with +2.50-D add (Bifocal) and 46 BLINK 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 age was 10.1 ± 1.2 years, and the mean 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% CI, −0.14 to 0.21) for Bifocal + Atropine vs Bifocal and 0.57 D (95% CI, 0.38-0.77) for Bifocal + Atropine vs 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) for Bifocal + Atropine vs Bifocal and −0.37 mm (95% CI, −0.46 to −0.28) for Bifocal + Atropine vs Single Vision.

Conclusions: Adding 0.01% atropine to SMCL with +2.50-D add power failed to demonstrate better myopia control than SMCL alone.

[Link to paper]