Nearsightedness(myopia) affects nearly 30 million Americans; meaning close-up vision is clear, but objects farther away require corrective lenses to be seen. Most cases are diagnosed in school-age children, with vision usually worsening throughout their teen years. Previous treatments were limited to either wearing glasses or contact lenses. Fortunately however, recent research shows that Atropine eye drops can significantly slow the worsening of progressive myopia. So a child’s progression to severe myopia requiring specialist lenses may instead have their myopia stabilized at a medium level; thus making correction significantly easier.
At Central Drug we custom compound your child’s Atropine eyedrops based on a prescription from your eye doctor. Read on to find out why we’re thrilled to offer this cutting edge treatment from our state of the art, accredited sterile compounding lab.
Causes of Nearsightedness
- The Shape Of The Eye: Light entering the eye requires a specific shape in order to focus correctly. If the cornea (the front of the eye) is too curved, or the eyeball is more oval-shaped rather than round, distant objects end up looking blurred.
- Genetics: Significant evidence that we may inherit the tendency to develop nearsightedness exists. The risk of a child developing myopia is also increased if both parents are myopic compared to just one.
- Screen Time: Screens are a fact of life these days, in particular with the COVID-19 pandemic. However, spending significant time reading and/or watching a screen increases the development of myopia in all ages. Visual stress can cause temporary or permanent issues, so it is generally accepted that increased screen time may account partly for the increasing prevalence of nearsightedness (myopia) in children. Importantly, research also suggests those children who spend more time outdoors in natural light, and less time in front of a screen, are less likely to develop myopia.
- Diabetes: Chronic health conditions such as diabetes can cause visual impairment, with the most common being Diabetic Retinopathy. Diabetic retinopathy is the loss of vision due to damage in the blood vessels of the eye. However, high blood sugar can also increase the thickness of the lens itself and cause nearsightedness at any age.
Exciting Progress In Pediatric Ophthalmology
Most people diagnosed with myopia do not progress to severe myopia (defined as requiring correction over -5.0 D), and in these mild cases, glasses or contact lenses provide adequate support. However severe myopia increases the risk of serious eye diseases or retinal detachment. Accordingly, as rates of nearsightedness increase, so do rates of severe myopia.
Myopia typically progresses much faster when a child’s eye is still growing rapidly between the ages of 5 and 15, usually stabilizing by the end of puberty.
Recent discoveries indicate that regular application of low-dose Atropine eye drops can significantly slow the progression of myopia as it develops in children. While the existing level of nearsightedness remains, these drops can help avoid worsening and the subsequent development of severe myopia.
Older Treatments For Nearsightedness
Studies show that Atropine is a significant breakthrough as an effective treatment for most children. It has overtaken prior treatments for myopia progression, such as the patient wearing contact lenses overnight to temporarily shape the cornea. This treatment is called orthokeratology and works the way braces work for teeth. By wearing the contact lenses at night, the child may see clearly during the school day. Atropine drops are more convenient to use and have less side effects than orthokeratology. It obviously is more straightforward, effective, and less invasive as well.
What Age Should You Start Atropine Drops?
Research is still emerging as the use of these eye drops is still fairly new. Thus treatment regimes are changing over time. Factors not yet been clarified by research studies include optimal age of starting the drops, the effect of the initial refractive error (i.e. level of short-sightedness), the effect of how fast the myopia is progressing, and the difference that a family history of severe nearsightedness may make to the end treatment results. Between ages 5 and 15, with rapid eye growth, myopia generally progresses much more quickly. Puberty is usually when myopia stabilizes.
Childhood Nearsightedness Is A Serious Concern
Myopia can definitely interfere with a child’s education, daily activities, and self-confidence. These all contribute to the importance of visiting an Ophthalmologist and treating nearsightedness as early as possible with glasses. Your doctor may suggest using atropine eye drops in addition to the lenses, to help delay the progression of your child’s myopia to more severe myopia. The drops may have the additional benefit of helping to decrease the risk of long-term future eye complications, such as retinal detachment, glaucoma, and cataracts.
Atropine Eye Drops for Younger Children
At Central Drug Compounding and Wellness we see prescriptions for atropine drops for children who are between the ages of 5 to 12 years old, who are diagnosed with at least -0.5 D of myopia, and whose vision has clearly been worsening over the preceding 6 months. The greatest concern in this age group is that many years are left for myopia to potentially progress. We are typically asked to produce drops at a strength of 0.01% according to the doctor’s prescription.
Atropine Eye Drops In Puberty
The drops have not been fully tested for predictable results in children over 12 years of age, however, we regularly receive prescriptions for children up to 15 if their myopia is still progressing, particularly if it has increased by more than 1.0 D in a year.
Is Atropine A Legitimate Treatment?
Yes. Although its use in slowing the progression of myopia is fairly new, the use of low-dose atropine is quickly becoming more mainstream compared to even 1-2 years ago. Ophthalmologists are seeing more study results showing the treatment’s benefits and risks, leading to an increase in its popularity.
What Are The Side Effects Of Atropine Eye Drops?
Higher commercially available dosages of atropine eye drops showed some acute side effects such as tachycardia, dry mouth, urinary retention, constipation, and flushing skin. These reactions have not yet been seen in any of the children in studies using low-dose atropine at 0.01%, with the majority of children experiencing little to no side effects from nightly use. There may be rare minor eye irritation with redness, itching and temporary blurred vision.
Current guidelines state that drops should be administered at bedtime – however this is due to previous higher dosages which more commonly caused irritation. With a low dose of atropine that does not irritate the eyes, drops can be administered at a consistent, convenient, set time.
Pupil Dilation in Blue Eyes
High-dose atropine drops are used routinely during office eye exams to dilate the pupil and relax the lens. However. low-dose atropine does not dilate the pupils as much. While a small amount of pupil dilation can occur (up to 1mm for dark eyes and up to 2mm for lighter eyes), it is usually not enough to require the use of sunglasses or reading glasses. Atropine appears to be just as easily tolerated by people with blue eyes as brown, and even with a higher dilation occurring in blue eyes, it is rare for patients to stop using the drops due to “near blur”.
How Does Low Dose Atropine Work?
Low dose Atropine works by blocking receptors in the muscles that normally change the shape of the lens, allowing the lens to relax as the eye grows.
What Results Can Atropine Eye Drops Produce?
Atropine is a long-term treatment that should in time slow the rate of progression of myopia in children by 30-50%. In the first 6 months of use however, you should expect to continue to see progression in the child’s myopia. After 6 months the progression should expectantly slow to –0.50 D per year or less. The complete arrest of myopia developing is a rare occurrence and should therefore not be an expected result.
How Long Do You Have To Take Atropine Eye Drops To See Results?
Currently treatment duration with low dose Atropine starts at 6 months, and may continue up to 2 years if the eye is responding well. After the initial treatment the child’s vision should be monitored to see that the myopia remains relatively stable. Should the myopia begin to worsen again, treatment may be re-started for a year at a time, until the eyes have stopped growing between the ages of 15 and 18.
What Is The Best Dosage Of Atropine For Myopia?
At Central Drug Compounding and Wellness, we follow the prescription provided by your ophthalmologist. They have the expertise to decide the appropriate dose your child requires, and you will be having regular follow-up visits to assess the tolerability and effectiveness of the drops. We will communicate with your provider as needed, and aim to ensure that your child remains on the lowest effective dose with minimal side effects. A dose of 0.01% is a typical low-dose dilution that we see often these days. Previous dosages of 0.5% to 0.1% had increased side effects while showing the same end results.
How To Use Atropine Eye Drops for Myopia
- Keep Your Drops In The Fridge And Respect The Use-By Date: Atropine eye drops need to be kept refrigerated, and like all medications, they should always be thrown out after the ”use by” date written on the bottle. Be sure to call our pharmacy 24 hours before you need a refill so that we can have them ready for you to pick up.
- Prevent Contamination: All eye drops should be administered far enough away from the eye to prevent the tip of the dropper bottle from coming into contact with the eye, or any other surface.
- Start Treatment Early: The earlier treatment is started the better-anticipated end results. It is important to have your eye drops compounded and start using them right away once you have been given a prescription. Myopia tends to progress fastest between the ages of 5 and 15, so the application of low-dose atropine drops can be most effective during those early years.
- Apply The Drops At The Same Time Each Day: Many parents choose to use the drops at bedtime in order to prevent any disruption of the day’s activities due to temporary blurred vision or irritation. However, with low dose atropine, these side effects likely will not occur. Different times of the day should work just as well; as long as those times are consistent. Always check with your prescriber if you intend to apply the drops at a different time than indicated on your prescription.
Where To Buy Atropine Eye Drops
Central Drug in Victoria, Texas is a PCAB accredited sterile and non-sterile compounding pharmacy. We can compound your Atropine drops to your prescription within 24 hours notice. Call us at 361-575-4713.
Holden et al. Ophthalmology. 2016;123(5):1036-1042.
Chua W-H et al. Ophthalmology. 2006;113(12):2285-2291.
Tong L et al. Ophthalmology. 2009;116(5):572-579.
Rauch, K. (31 August 2017). Low-Dose Atropine for Kids with Myopia. Retrieved from https://www.aao.org/eye-health/news/low-dose-atropine-kids-with-myopia
Tan, D. (1 June 2016). Childhood myopia and the use of atropine eye drops. Retrieved from https://www.ndcs.com.sg/news/patient-care/childhood-myopia-use-of-atropine-eye-drops
Heiting, G. (20 August 2018). Myopia control: Is there a cure for nearsightedness? Retrieved from https://www.allaboutvision.com/parents/myopia.htm
Wu, P.C., Chuang, M.N., Choi, J., Chen, H., Wu, G., Ohno-Matsui, K., Jonas, J.B., Cheung, C.M.G. (2018). Update in myopia and treatment strategy of atropine use in myopia control. Eye, 33(1), 3-13.
Coats, D.K., Paysse, E.A. (13 September 2018). Refractive errors in children. Retrieved from https://www.uptodate.com/contents/refractive-errors-in-children?sectionName=REFRACTIVE%20ERRORS&search=treating%20myopia%20in%20children&topicRef=5849&anchor=H3&source=see_link#H3
Chia A, Chua WH, Cheung YB, et al. Atropine for the treatment of childhood myopia: safety and efficacy of 0.5%, 0.1%, and 0.01% doses (Atropine for the Treatment of Myopia 2). Ophthalmology 2012; 119:347.