Myopia Control And Atropine Treatment

Myopia prevention and control
  • Increase outdoor activities
    • Spend more time outdoors and looking into the distance
    • Encourage outdoor hobbies like sports, cycling, jogging, fishing, swimming, tennis, basketball, photography, bird-watching etc
    • 14 hours of outdoor per week, average 2 hours per day
    • Outdoor activities protect against myopia in children who read a lot
  • Increase daylight exposure
    • Lots of light exposure reduce myopia.
    • Outdoor sports better than indoor sports
    • Read next to window, a balcony, or a patio with good lighting
    • Do not read in dim lighting
  • Reduce near work
    • Reduce the total time spent on near work such as reading & computer work/ games.
    • The nearer the work, the more myopia it causes, eg TV is better than hand-held computer games
  • Orthokeratotology lenses
    • Orthokeratology uses overnight contact lenses to correct low to moderate myopia
    • Patients have to be careful not to get infective keratitis as it can scar the cornea permanently
  • Myopia control glasses or contact lenses
    • Myopia control lenses such as that of Essilor Stellest Lenses or MiYOSMART Hoya lenses
    • Misight contact lenses
  • ATROPINE EYE DROPS
    • Atropine eye-drops for preventing myopia progression

Myopia is not only a cosmetic condition, it is an eye disease.

The main aim of controlling myopia progression is to prevent the complications of high myopia later on in life. Adults with high myopia are 10-20 times more likely to develop retinal tears, retinal detachments, macular degeneration, premature cataracts, and glaucoma.

A secondary aim is keep the degree of myopia as low as possible so as to achieve some degree of spectacle/contact lens independence: e.g. being able to play soccer or go jogging without spectacles.

Any child with

  1. Progressive myopia
  2. Strong parental & family history of high myopia
  3. Moderate to high myopia and still progressing
  4. Very low myopia whose parents want to reduce spectacle wear / dependence
  5. Family history of vision loss from complications of high myopia

Atropine is the most effective treatment for the prevention of myopia progression in children. Its effectiveness has been proven by many large clinical trials which have been published in major international ophthalmology journals and abstracts of these are readily available online.

Since 1971 or the last 35 years, there has been no case report of any permanent or serious adverse reaction to long term instillation of atropine eye drops.

There is a theoretical risk of premature cataracts from increased sunlight entering the eye through a dilated pupil. Laboratory mice exposed to high UV light develop cataracts earlier. This risk should be guarded against with photochromatic spectacles and sunglasses.

Photophobia (discomfort with bright lights) Atropine eye-drops dilate the pupils. This lets in more light into the eyeball. The pupils are unable to constrict to block out the sunlight and your child may be uncomfortable in bright sunlight. There is usually no problem indoors. Your child may get used to it after a while.

Presbyopia (inability to read and focus near) Atropine weakens the focusing muscle of the eye that helps the child to read and focus near. This effect will wear off completely sometime after the atropine is stopped.

Other common side-effects

Allergy with itchiness, red eye and a lower eyelid rash after instilling the eye-drops. The allergy may be to the preservative. The solution is to change to preservative free eye-drops. The preservative is usually benzylkonium chloride. If the allergy is to atropine, then we can change to another drug eg. homatropine.

Systemic side effects such as flushed face, fever, rapid heart rate, dry mouth and skin, constipation, drowsiness, occurs mostly in infants and toddlers. Such young children rarely have myopia. Glaucoma is not a side effect of atropine treatment for myopic children.

Management of the side-effects of photophobia
  1. Photochromatic lenses (e.g. Transition lenses), clip-on sunglasses, prescription sunglasses, caps, hats, sun-visors, sunshields. A standard letter can be given upon request to the teacher allowing sunglasses in school.
  2. Omitting the eyedrops before long periods of intense sun exposure eg going to the beach or park for a picnic or going to a beach resort for a sunny holiday.
  3. Varying the time of instillation of the eye-drops eg. After coming home from the beach
  4. Reducing the dosage of the atropine eye-drops

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