New Hope for Nearsighted Children
Have you noticed that the number of school-aged children wearing glasses has increased since you were a child? It's not your imagination. Statistics show that the rate of myopia, or nearsightedness, has doubled in the US, and is increasing at alarming rates worldwide.
Atropine Slows Progression of Myopia
For decades, doctors have been researching ways to stop or slow the increase of myopia in an individual patient. Many studies have shown that atropine, a powerful dilating drop, can slow the progression of myopia, but the side effects--light sensitivity and blurred near vision--were unacceptable. For this reason, this treatment was rarely prescribed for myopic children.
In 2012, another study of the use of atropine for the treatment of childhood myopia was published in the journal Ophthalmology. In this study of lower strengths of the drug, a very dilute concentration of atropine, one one-hundredth of a percent, was used as a placebo. To the surprise of the researchers, atropine 0.01% decreased the progression of myopia by 60%, without causing the side effects of higher-strength atropine. Only 6% of children who received atropine 0.01% had a problem with near vision, and none of them had any other side effects.
The five year results of the same study were presented at the American Academy of Ophthalmology meeting in November, 2015. Overall, the children who received atropine 0.01% had the lowest progression of myopia, and the least side effects. Compared to children who had not received treatment, myopic progression was reduced by 50%.
Questions remain about which children would best benefit from treatment, in terms of age, level of myopia, rate of progression, and family risk factors. Furthermore, it is not yet clear when atropine should be started and stopped, and for how long it should be used.
Using Atropine 0.01% for Your Child
This is an exciting opportunity for you to help your child have better vision for life. While there is no treatment that can completely stop or reverse the progression of myopia, we can now offer you a way to slow the progression significantly. We have been prescribing atropine 0.01% for myopia since early 2014, with excellent results to date.
At this time, we are recommending one drop of atropine 0.01% in each eye at bedtime every night until your child stops growing. However, as more information is gathered, we may learn that it is not necessary to continue for this many years.
At any time, you may discontinue using atropine, although it is likely that this will cause myopia to progress more rapidly again. However, it is not dangerous to discontinue the drop, and your child's vision will probably simply return to what it would have been without atropine.
Is Atropine Safe?
Atropine has been used for nearly 100 years in ophthalmology without any long-term safety problems. Pediatric ophthalmologists safely use full-strength atropine (1%) every day for years in some of our young patients.
There is a very small chance that your child may be allergic to the drop, causing a rash, flushed face, swelling of the eyelids, fever, change in heart rate, agitation, or confusion. These side effects are very rare at full strength, and are not expected at all at 0.01%. In the unlikely event that these side effects occur, stop using atropine and call us immediately.
If your child is one of the few who experience problems with near vision, you may opt to stop the drop, or we can discuss the option of giving your child bifocal glasses. If your child becomes more sensitive to sunlight, we can discuss Transitions eyeglass lenses or clip-on sunglasses for comfort, or again, you may choose to stop the drop.
Filling the Prescription
While atropine itself is FDA approved, it is not commercially available at 0.01% because it is not approved for the treatment of myopia. Therefore, you cannot simply bring the prescription to a pharmacy to have it filled. Instead, it must be specially mixed at a compounding pharmacy. We can provide information about filling the prescription if you decide that atropine is the right choice for your child. Unfortunately, we have found that prescription plans will not cover atropine 0.01%.
The increasing rate of myopia has been convincingly linked with the lack of outdoor activity in today's children. For this reason, it is recommended that your children go outdoors to play every day. Of course, outdoor activity alone is unlikely to be as effective as atropine.
Some contact lens alternatives are also available and have been shown to slow the rate of myopic progression, although their safety record is not as good as that of atropine.
My staff and I are always available to answer any questions or concerns you may have regarding your child's precious vision.