14. M V - Non-Sx Correction & Management of Myopia III Flashcards
Atropine is a ... and is ....
It’s mechanism of action is .... It’s direct effect is on 1. ... in the ..., on the ... and on 2. ... and interferes with .... It’s indirect effects are ... and ....
Atropine is a topical, muscarinic (M) receptor antagonist and is non-selective.
It’s mechanism of action is uncertain. It’s direct effect is on 1. muscarinic receptors in the retina, on the amacrine cells and on 2. scleral fibroblasts and interferes with scleral remodelling?. It’s indirect effects are reduced accommodation and altered neurotransmitter release.
Describe the ATOM study and its major findings.
ATOM = ....
Involved # myopic children (...-... years) with spherical refraction ...-...D. It was a randomised, double-masked, placebo-controlled clinical trial and involved ... treatments. Was studying the effects of ...% atropine.
Major results were that ...% topical atropine reduced myopia progression by ...% over ... years compared with ... and ... eyes. There were no ....
Describe the ATOM study and its major findings.
ATOM = Atropine in the Treatment of Myopia.
Involved 400 myopic children (6-12 years) with spherical refraction -1.00--6.00D. It was a randomised, double-masked, placebo-controlled clinical trial and involved monocular treatments. Was studying the effects of 1% atropine.
Major results were that 1% topical atropine reduced myopia progression by 77% over two years compared with control and untreated eyes. There were no serious adverse events.
Atropine cessation
The ATOM study children stopped using atropine and were followed up for ... years.
Results: abrupt cessation seemed to result in an ... over time compared to ... and ... eyes.
Atropine cessation
The ATOM study children stopped using atropine and were followed up for 3 years.
Results: abrupt cessation seemed to result in an increased rate of change of refraction/axial length over time compared to non-treated and placebo eyes.
What are the short-term and long-term ocular side effects of 1.0% atropine?
Short-term: ... due to ..., ... due to ..., and ... and .... Potential effects on ... and ... due to ..., so kids are also prescribed ....
Long-term: ... and increased risk of ... and ...?
What are the short-term and long-term ocular side effects of 1.0% atropine?
Short-term: photophobia due to mydriasis, blurred vision due to cycloplegia, and brow ache and headaches. Potential effects on learning and ability in sporting activities due to cycloplegia, so kids are also prescribed photochromatic PALs.
Long-term: not fully known and increased risk of UV-related retinal damage and cataracts?
Describe the ATOM2 study and its major findings.
Aimed to compare the effects of ...%, ...%, and ...% atropine where the smallest amount was intended as the .... However, it was found that ...% atropine had negligible effects on ..., ..., and ....
Major findings were that ...% atropine suggested efficacy in controlling ... but ... increased compared with ATOM-1 findings, however there was no ....
Describe the ATOM2 study and its major findings.
Aimed to compare the effects of 0.5%, 0.1%, and 0.01% atropine where the smallest amount was intended as the placebo. However, it was found that 0.01% atropine had negligible effects on accommodation, pupil size, and near visual acuity.
Major findings were that 0.01% atropine suggested efficacy in controlling myopic refraction progression but axial length increased compared with ATOM-1 findings, however there was no true placebo/control group.
Describe the LAMP study and its major findings.
LAMP - ...
Assessed 0.01% atropine over ... years to try and determine how low the dose can go to ... but still ... of 0.01% atropine.
Main findings were that there was ... between ...% atropine and ... eye drops.
Describe the LAMP study and its major findings.
LAMP - Low-concentration atropine for myopia progression
Assessed 0.01% atropine over 2 years to try and determine how low the dose can go to minimise side effects but still get the effects of 0.01% atropine.
Main findings were that there was no difference between 0.01% atropine and placebo eye drops.
What are the results of the meta-analysis ...?
Efficacy in Asian vs Caucasian children: both favoured the ....
Adverse effects:
* Photophobia incidence was ...% and ... incidence was ...%, both of which increased as ... increased
* Allergy incidence was ...% and was not significantly increased as ... increased
What are the results of the meta-analysis Atropine, 0.01%, for Myopia Control?
Efficacy in Asian vs Caucasian children: both favoured the control group.
Adverse effects:
* Photophobia incidence was 25% and poor near visual acuity incidence was 7.5%, both of which increased as dosage increased
* Allergy incidence was 2.9% and was not significantly increased as dosage increased
What is the highest dose of atropine that does not produce significant clinical symptoms?
0.02%
With regards to atropine, what should be done in practice?
...% atropine may reduce ... change but does not appear to slow .... The evidence suggests that ...%/...% may be beneficial or even ...% atropine (keeping in mind ...). Although, 12% of ATOM children with ...% atropine progessed >...D in the first year.
Seems to suggest that at risk children may benefit from ... doses during the ... year and then ... as maintenance therapy.
With regards to atropine, what should be done in practice?
0.01% atropine may reduce refractive change but does not appear to slow axial elongation. The evidence suggests that 0.02%/0.025% may be beneficial or even 0.05% atropine (keeping in mind side effects). Although, 12% of ATOM children with 1% atropine progessed >0.50D in the first year.
Seems to suggest that at risk children may benefit from slightly higher doses during the first year and then tapered down as maintenance therapy.
What are the current MEC protocols for atropine?
In kids with ..., ... age of onset, and/or ... axial length start with ...% and ...% in kids with ..., ... age of onset, and/or ... axial length.
Need to review in ...-... days and determine if a ... is required (based on ..., ..., ..., and ...) and if ... lenses might be beneficial (based on ... and ...).
What are the current MEC protocols for atropine?
In kids with fair pigmentation, older age of onset, and/or lower axial length start with 0.025% and 0.05% in kids with darker irides, younger age of onset, and/or longer axial length.
Need to review in 5-7 days and determine if a near add is required (based on near VA, near NPA, MEM, and Phoria) and if photochromatic lenses might be beneficial (based on pupil size and symptoms).
Can atropine be safely stopped to avoid rebound effects?
More significant rebound in younger kids; recommended to continue treatment until at least 12years old and ideally 15-18years old in younger-onset myopes.
What important evidence gaps remain for atropine?
(3 points)
- Mechanism of action?
- When and how to discontinue atropine?
- Combination/transfer of therapy?
Explain the LAMP2 study and its major findings.
Goal: ...
There were 474 children with refraction between ...-...D (on a cycloplegic refraction) who were randomised to 0.05%, 0.01%, and placebo groups. 353 children finished the study where the ... was the following for each group: ...% for the placebo group, ...% for the 0.01% atropine group, and ...% for the 0.05% atropine group.
Explain the LAMP2 study and its major findings.
Goal: to determine if atropine can be used for myopia prevention
There were 474 children with refraction between plano-+1D (on a cycloplegic refraction) who were randomised to 0.05%, 0.01%, and placebo groups. 353 children finished the study where the incidence was the following for each group: 53% for the placebo group, 46% for the 0.01% atropine group, and 28% for the 0.05% atropine group.
Combination treatment for myopia:
OrthoK + atropine 0.01% vs OrthoK alone: ...
Soft MF CLs + atropine 0.01% vs soft MF Cls alone: ...
DIMS + atropine 0.01% vs DIMS alone vs atropine 0.01% alone: ... however ....
However, data is limited to ... month treatment time.
Combination treatment for myopia:
OrthoK + atropine 0.01% vs OrthoK alone: benefit occurs for first six months, and then gradients even out
Soft MF CLs + atropine 0.01% vs soft MF Cls alone: no benefit
DIMS + atropine 0.01% vs DIMS alone vs atropine 0.01% alone: both alone are effective, but together is even more effective however children were allocated to their groups by parents' choice.
However, data is limited to 12 month treatment time.
What is still needed to be understood about combination therapy for myopia control?
(3 points)
Whether different doses of atropine show differential effects?
Whether subsets of patients might be better suited?
When combinations should be used over single?
