MAR 2014

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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Page 41 of 210

E W NEWS & OPINION 3 9 study for an additional two years (up to year 5), for those who were still continuing to exhibit myopia pro- g ression. "At the end of five years of treat- ment, the 0.01% [group] had the least myopic progression. This was s tatistically significant compared to the other two higher doses," he said. March 2014 Practice Makes Perfect! KITARO ® Lab Kits. The Revolutionary Training Tools to Master Cataract Surgery Kitaro Lab Kits ofer surgeons the ability to practice various procedures and techniques repeatedly using synthetic but realistic materials without complicated preparation and expensive consumable goods such as those needed for porcine wet labs. NEW FCI-Ophthalmics.com 800.932.4202 THREE NEW KITS NOW AVAILABLE: KITARO Dry/Wet Lab to practice: • Capsulorhexis • Grooving & Splitting the Nucleus • Phacoemulsification • Wound Construction • IOL Insertion KITARO Complex Lab 1 to practice: • Small Pupil Management • Weak/Ruptured Zonules • IOL Transcleral Fixation KITARO Complex Lab 2 to practice: • Conventional Extracapsular Extraction (ECCE) • Posterior Capsule Rupture Management (PCRM) Visit FCI-Ophthalmics.com to watch the KITARO Training Video. Call us at 800-932-4202 to receive promotional pricing on your first KITARO Lab Kit. ATOM1 was conducted from 1999 to 2004 with 400 children, 6 to 12 years old. One eye was adminis- tered 1% atropine once at night and the other eye was untreated. There was a second control group with placebo vehicle eye drop application in one eye. Photochromic glasses were given to all study subjects. The three-year study had two years of treatment and one year of washout observation without medication. For the first two years, there was a 77% reduction in the mean pro- gression of myopia, Dr. Tan said. No serious adverse effects were found, but cases of allergic conjunctivitis and dermatitis were reported. The washout year subsequently showed a "quite significant" rebound phenomenon in both refractive and axial length data, Dr. Tan said. "The atropine eyes rapidly tried to become myopic again, although they didn't quite go back," he said. ATOM2 ATOM2 was started at the time of the ATOM1 washout period, with three lower doses of atropine—0.5%, 0.1%, 0.01%—to see if the side ef- fects seen in the first trial could be mitigated. The study had the same amount of children and similar methodology, but slightly older patients and slightly higher myopia. The study was also increased to bilateral treatment over five years, with two years on treatment, one washout year, and restarting on the appropriate concentration for those who continued to progress for an- other two years. The first results at two years showed that the efficacy in retarding myopia progression in the three concentrations was "remarkably similar, and not statistically differ- ent," he said. A dose-related response at that time existed, but with only a small clinical difference. The main differences were in the side effects, with the two higher concentrations still causing signifi- cant pupil dilatation, accommoda- tion loss, and loss of near vision. In contrast, these problems were almost totally obviated with the lowest 0.01% dose. After the washout year, in which no treatment was prescribed for a year, "everything flipped," showing a dose-related rebound phenome- non inversely related, with the 0.01% demonstrating minimal rebound, while significant rebounds were seen in the higher concentra- tions. "At the one-year washout at three years, the 0.01% [cases] had the lowest prevalence of myopia," he said. "By three years, the 0.01% [group] had almost no rebound phe- nomenon and had the lowest axial elongation." The lowest concentration, 0.01%, was chosen as the appropri- ate concentration to treat those who had progressed, and after the washout year, this concentration was offered to all children in the Donald T.H. Tan, FRCOphth, speaking at the 2013 ESCRS Congress in Amsterdam Source: Erin L. Boyle continued on page 40 18-47 News_EW March 2014-DL2 copy_Layout 1 3/6/14 2:47 PM Page 39

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