Atropine eye drops are among
three types of treatment
options for childhood myopia,
the other two being specially
designed spectacles and
contact lenses.
Although atropine eye drops have been
used since the 1960s for the treatment
of amblyopia (lazy eye) and in the past
three decades for childhood myopia, there
have been some concerns regarding the
safety of this treatment option, especially
with prolonged usage. A 2024 study by
researchers at the Singapore National
Eye Centre (SNEC) and Singapore Eye
Research Institute (SERI) has shown
that the long-term use of atropine
eye drops is safe. The first-of-itskind
study examined the longterm
effects of these eye drops
and found no complications
arising in patients 10 to
20 years after treatment.
There was also no association
between those who had
undergone atropine treatment
and the increased incidence of
treatment- or myopia-related
ocular complications.
Side effects of
atropine eye drops
Earlier studies have shown that, while
high-dose atropine was safe and effective
in reducing myopia progression, it caused
side effects such as glare and blurring for
reading and near work, said Dr Loh Kai
Lyn, Consultant, Myopia Centre, SNEC.
But these side effects can be mitigated
by using photochromic and progressive
lenses, she added.
A subsequent study showed that lowdose
atropine was an effective alternative
to high-dose atropine, leading to much
reduced side effects.
Dr Loh shared that low-dose atropine is
more commonly prescribed nowadays. “Most
of the time, when we start with low-dose
atropine, the child should be able to cope
well. If they should have glare issues, they
can use headgear or clip-on sunglasses while
out in the sun, or have photochromic or
tinted glasses. For reading issues, they can
use progressive glasses to help them read
well,” she said.
Importance of follow-ups
The effectiveness of atropine eyedrops in
managing childhood myopia also hinges on
its proper and consistent use.
“One of the most common issues we
come across is patients not adhering to
regular use of the drops. If eye drops are not
used as frequently as prescribed, the effect may be suboptimal. This is especially true
for the low-dose range. We try to engage
patients and their caregivers to see what
the underlying issue is, and give tips or
alternatives as appropriate,” said Dr Loh.
Patients should also continue with their
long-term follow-up appointments so that
doctors can evaluate the appropriateness
of the treatment. “Unlike a short course
of antibiotics, atropine eye drops should
be used as long as they are still effective in
reducing myopia progression,” advised
Dr Loh. “This usually means that they
should be continued till the patient’s myopia
naturally stops progressing, meaning the
eyeball itself stops growing, which usually
occurs around 13 to 15 years of age.”
Other treatment options
Other treatment options to curb the
progression of childhood myopia include
specially designed myopia-control
spectacle lenses, such as the ones using
defocus incorporated multiple segments
(DIMS) technology, or contact lenses with
highly aspherical lenslets target (HALT)
technology. Contact lenses, such as daily
disposable multifocal soft lenses (used in
the day) or orthokeratology (OK) rigid
lenses that are used at night, may also be
prescribed. These alternative treatment
options can be used in conjunction with
atropine eye drops to provide a more optimal
response in some patients, said Dr Loh.
However, she warned that parents
should be wary of other treatments touted as
myopia-control options. “It is important that
parents educate themselves on separating
those that have legitimate effects from those
that have no effect or, worse, may cause
increased myopia progression.”
Dr Loh recommends that parents
bring their children for an evaluation
with their eye care practitioner to get
customised treatments.
Treatments of the future
There may soon be more options available when it comes to the
treatment of myopia in children.
One of them is the Repeated Low Level Red Light (RLRL)
treatment. “RLRL is a new form of myopia control treatment that
started in China and has shown good results in terms of efficacy,”
said Dr Loh. “It requires patients to have a device at home and
receive therapy for three minutes at a time, twice daily. In contrast
to myopia control glasses or contact lenses, RLRL, like atropine, is
not restricted by the patient’s degree of myopia or astigmatism for
effective treatment. This would be useful, for example, in patients
with very high myopia or high astigmatism.” She added that many
studies are now being performed to assess its efficacy and safety
profile in other countries, including Singapore.
Tips to manage
myopia in children
and reduce risk of
high myopia and
ocular diseases
- Maintain good functional vision for
daily activities by getting the right
visual aid such as spectacles
-
Form good eye habits, including:
