The LAMP2 study explored the efficacy of low-concentration atropine to delay the onset of myopia in at-risk children. The results found there was no significant difference between 0.01% atropine and the placebo, but 0.05% atropine was able to reduce myopia incidence and speed of myopic progression for pre-myopes.
A mixed-race cohort of Australian children demonstrated that atropine 0.01% was safe and well tolerated, although myopia control effects were only found in those of European or other/mixed ancestry. Those of East Asian or South Asian ethnicity showed no benefit. Overall results were impacted by high drop-out in the control group in the second year of the study.
Low dose atropine is a popular off-label choice for myopia control, and typically needs to be compounded. The results of this survey show there are varying methods for producing, storing and labelling low concentration, compounded atropine in the Unites States. This could influence the safety and efficacy of these atropine formulations for myopia control.
This prospective observational study found that DIMS spectacle lenses, atropine 0.01% and the combination of the two all showed robust efficacy for myopia control in European children. The combination treatment showed slightly better refractive control than the mono-therapies, but axial length growth was similar in all treatment groups.
Nightly use of atropine 0.01% was able to reduce myopia progression and axial elongation for Chinese children over 9 months. However, this study also found that refractive astigmatism may increase within the first 3 months of treatment as a result.
Low-dose atropine (0.05% or less) has a maximum effect on pupil size for both bright and dim light conditions within an hour of instillation, but has little to no effect on binocular vision in myopic children when used for myopia management.
Atropine 0.01% combined with orthokeratology slows axial elongation to less than 0.1mm/year over two years in Chinese children aged 6-11 years. This is the equal-longest study on this topic and first to measure potential mechanisms of pupil size and choroidal thickness. The largest effect of the combination occurred in the first 6 months.
The Low-Concentration Atropine for Myopia Progression (LAMP) Study has provided invaluable data on comparisons between 0.05%, 0.025% and 0.01% atropine treatment. The three year data has shown 0.05% to be most effective for continued treatment, while children discontinued showed a small, ‘clinically insignificant’ rebound effect. Learn more about the one, two and three year LAMP data here.
This meta-analysis of 5 studies of 1, 6 and 12 months duration found that slower axial growth is evident when using orthokeratology in conjunction with atropine as a combined therapy compared to orthokeratology alone. A slowing effect of 0.09mm was seen with the combined approach for up to a 12 month follow-up period. Longer data was not available for the meta-analysis.
The Erasmus Medical Group in the Netherlands set out four steps in their myopia management protocol: providing visual environment advice, identifying high-risk myopes by axial length and treating them with atropine 0.5%, managing other myopes with optical treatments or lower-concentration atropine, and ceasing treatment in the late teens once axial length is stable. The described use of axial length percentile growth charts for diagnosis, choice of treatment, monitoring and cessation is a world-first.
