Atropine Eye Drops: Clinically Proven to Retard Childhood Myopia Progression

Local ophthalmologists have concluded that topical atropine is well tolerated and effective in slowing the progression of low and moderate myopia and ocular axial elongation in Asian children. This finding represents a significant advance in the management of childhood myopia and improved quality of life for children with myopia.

The Singapore Eye Research Institute (SERI) conducted a 2 years large-scale study on 400 myopic children to assess the effectiveness and safety of atropine eye drops in controlling childhood myopia progression. The clinical study indicated that a once-nightly dose of atropine drops achieved less than 100 degrees myopia increment in 86% of the participating children, compared to 64% that had an increment of 100 degrees myopia without treatment, proving that myopia progression can be retarded pharmacologically. Importantly, safety data from the study confirmed that atropine eye drops is well tolerated and free from significant complications. The highly promising results were published in Ophthalmology, an internationally renowned scientific journal (Ophthalmology 2006; 113:22852291).

Myopia is the most prevalent ocular disorder in children. It can develop as early as kindergarten age and can progress rapidly during the primary school years. According to the Singapore Cohort Study of the Risk Factors of Myopia (SCORM), the prevalence of myopia (defined as less than 50 degrees) in Singapore children was 27.8% at 7 years old, 34.5% at 8 years old and 43.4% at 9 years old. It is particularly serious in local children with its severity rising almost every year. The degree of myopia increases by more than 150 degrees per year in 9 year-olds on average. Myopia typically slows down in teenage years and stabilises by early adulthood. Our preventive efforts therefore focus on children.

Myopia arises from the excessive growth or elongation of the eyeball. This results in light from distant objects falling out of focus within the eye. Distance objects become blurred but near objects remain clearly seen. High degrees of myopia are a major concern in Singapore as more than 5% of 18 year-olds exceed 600 degrees of myopia. It has been shown that high myopia is at greater risk of developing potentially blinding disorders such as retinal detachment, myopic macular degeneration, glaucoma, and cataract. Spectacles, contact lenses and refractive surgery can be used to achieve good distance vision. However, they do nothing to correct the primary problem of increased eyeball length. It is, hence, not surprising that myopia is considered to be a major ophthalmic public health issue.

Atropine is not a new or experimental drug. Eye doctors have been using it for many years in the treatment of a variety of eye conditions found in children such as lazy eye and squints. In fact, the first reports of atropine treatment for myopia were by Wells in the 19th century. Atropine belongs to the group of medicines called anti-muscarinics. It works by blocking accommodation and reduce the putative effects of excessive accommodation on the progression of myopia, thereby, preventing myopia from worsening.

Frequently asked questions

Q1: What are the effects of atropine eye drop?

A1: The effects of atropine eye drops are photophobia (light sensitivity), inability to focus near and rarely, allergic reactions. The child will be prescribed with photochromatic (transitions) progressive addition lenses to overcome the effects of photophobia and inability to focus near. To date, there are no known long term adverse effects from the drops. 

Q2: When was Eagle Myopia Control Program started?

A2: We have been using Atropine eye drops to control myopia progression for children and teens for a few years now but the treatment algorithm was not evidence-based and not standardized. Singapore Eye Research Institute concluded and published the good results of atropine treatment of myopia in Ophthalmology, an internationally renowned scientific journal. We have refined and standardised our treatment algorithm based on the scientific evidence as Eagle Myopia Control Program and the programme was launched in 2007.

Q3: How does EMCP work?

A3: EMCP works on the basis that near work is one of the strongest stimuli for Myopia development and progression and relaxing the eye focusing muscles with atropine eye drops will remove the stress of near work on the eyes. There will be a total of 6 consultations with 6 refraction tests over a 12 months period, including twice axial length (length of eyeball) measurements. The child will apply a single dose of atropine eye drops every night, the atropine eye drops will relax the eye muscles and the child will wear progressive addition eye glasses to aid in near work.

Q4: Why can’t EMCP be used on older children (i.e. above 12-years-old)?

A4: When the child is older, he/she would have developed to almost full scale myopia and the treatment benefit of atropine is drastically reduced. However if the myopia is documented to be rapidly progressive over a 6 months and there are reasons to suspect that the teenager’s myopia will progress further e.g. strong family history of high myopia, we can consider atropine treatment for older children.

Q5: EMCP "decrease the progression of myopia". Does that mean that it can only slow down the process and not halt the full scale of myopia?

A5: No, atropine eyedrop treatment has been shown to reduce myopia in some children initially over 4-6 months but some may still experience progression which is less than prior atropine treatment while some may have no progression at all.

Q6: What is the success rate of this treatment?

A6: 70% of the children have myopia progression less than 50 degrees, and 90% of them progressed less than 100 degrees over 24 months.

Q7: What else can patients expect out of this treatment?

A7: Other than decreased visual morbidity associated with high myopia such as cataracts, glaucoma and retinal detachment, patients can have better quality of life and social ability; with reduced frequency of changing glasses.

Eagle Eye Centre Pte Ltd (EEC)

820 Thomson Road, Mount Alvernia Hospital,

Medical Centre Block B, #02-11/17,

Singapore 574623

Tel: 6456-1000 / 6eagleye (63245393)

Email: eec@eagleeyecentre.com.sg

Website: www.eagleeyecentre.com.sg

Article Written by:

Dr Lim Wee Kiak

Ms Shandy Chng