Eyeworld

62 | EYEWORLD | DECEMBER 2021 R EFRACTIVE by Liz Hillman Editorial Co-Director About the physicians Donald Tan, MD Clinical Professor Eye & Cornea Surgeons Eye & Retina Surgeons Singapore Erin Walsh, MD Assistant Professor of Ophthalmology New York Eye and Ear Infirmary of Mount Sinai New York, New York References 1. Holden BA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016;123:1036– 1042. 2. Grzybowski A, et al. A review on the epidemiology of myopia in school children worldwide. BMC Ophthalmol. 2020;20:27. 3. Chua W, et al. Efficacy results from the Atropine in the Treatment of Myopia (ATOM) study. Invest Ophthalmol Vis Sci. 2003;44:3119. 4. Yam JC, et al. Low- Concentration Atropine for Myopia Progression (LAMP) study: A randomized, double- blinded, placebo-controlled trial of 0.05%, 0.025%, and 0.01% atropine eye drops in myopia control. Ophthalmology. 2019;126:113–124. contact lenses, some spectacles, and orthoker- atology also have produced evidence that they help reduce progression, but Dr. Tan said it's not as robust as the evidence supporting low- dose atropine, and some of these options have potential risks. Orthokeratology and contact lens use, Dr. Tan said, is associated with a risk for infection and corneal ulcers. These risks are higher in the pediatric population than adults, he thinks, due to less attention to hygiene. A closer look at atropine Dr. Tan called low-dose atropine a paradigm shift. When in training, he was taught aware- ness with regard to the potentially sight-threat- ening complications associated with high or pathological myopia. Now, "we're at the preven- tion stage, since it is a reasonable assumption that if we can reduce myopia progression so that less children ultimately develop high or pathological myopia, the percentage of sub- sequent complications associated with high myopia should also be less," he said. The Atropine in the Treatment of Myopia (ATOM) studies first enrolled 400 children aged 6–12 who had –1 D to –6 D of myopia. The patients were randomized to receive either 1% atropine or placebo. 3 The researchers found significantly less progression of myopia in the atropine group. At 1 year, patients in the atropine group saw a regression of myopia by +0.3 D±0.50 D; axial length was reduced by –0.14 mm±0.28 mm. Patients in the placebo group progressed –0.76 D±0.44 D, and axial length increased +0.20 mm±0.30 mm. At year 2, mean myopia progression in the atropine group was –0.25 D±0.92 D with axial length re- maining similar to baseline. The placebo group at year 2 saw progression of –1.20 D±0.69 D with axial elongation of +0.38 mm±0.38 mm. Since this study, even lower doses of atropine have been researched. The Low-Concentration Atropine for Myopia Progression (LAMP) study evaluated 0.05%, 0.025%, and 0.01% atropine against placebo; all concentrations were well tolerated, but 0.05% was most effective in con- trolling progression and axial length elongation over a year. 4 The dose of 0.01% has been found to be effective in reducing myopia progression. 5 M yopia, a condition that for decades has been described in some regions as an epidemic, is well on its way to reaching pandemic proportions. A systematic review and meta- analysis published by Holden et al. in 2016 estimated that in 2000, 22.9% of the world's population would be myopic and 2.7% highly myopic. 1 The authors predicted that by 2050, nearly 50% of the global population would be myopic and nearly 10% highly myopic. A more recent paper looking at myopia in school-age children noted "exceptionally high myopia prevalence rates in school children in East Asia (73%), and high rates in North America (42%)." 2 Though considered easily correctable with glasses, myopia and high myopia are associated with a risk of developing cataracts sooner and a higher risk for glaucoma and retinal issues, said Erin Walsh, MD. It's been documented that myopia rates and myopia progression increase with more near work being performed, such as reading, homework, and screen time, Dr. Walsh said. "I tell my patients that the more reading we do, the higher rates of myopia we're going to see. Countries where children are spending considerable time doing near work are seeing higher rates of increasing progressive myopia." Myopia, its progression, and the long-term issues that can be associated with it have been a topic for a while, Dr. Walsh said, with the conversation shifting toward how to slow down progression in recent years as trends of high population rates of myopia emerged. Options to stall progression There are many options to treat the optical problem of myopia, but they do not necessarily address the complications associated with myo- pia, which could still occur. Progression of myo- pia can, however, be mitigated in some cases. The most common and well-researched therapies to try to prevent progression of myo- pia are low-dose atropine and orthokeratology. Donald Tan, MD, said there have been many studies on reducing myopia progression over the years that have begun to come to fru- ition. Low-dose atropine has the best evidence for stalling myopia progression, he said. Certain Stemming myopia progression

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