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Low Dose Atropine Eye Drops for Myopia Management

Carina Eye Care regularly provides prescriptions for atropine medicated eye drops to slow down myopia progression in children.

Studies for over a decade have shown that these eye drops are effective at slowing down the progression of myopia.

What is atropine?

Atropine is a prescription medication that has been used for over a century by eye care practitioners to dilate pupils. It also reduces the ability for the muscles inside the eyes to adjust the focussing of the lens.

Administering atropine eye drops

Parents usually administer the eye drops for their children. One drop is used in each eye every evening.
The concentration of atropine recommended for each child depends on the situation. If the child has rapidly progressing myopia, they may be advised to commence on a stronger dosage such as 0.05%. If this is not enough, it may be necessary to increase the atropine to 0.5% which is based on an excellent study in Rotterdam, Netherlands. The majority of patients do well on 0.025% low dose atropine. In the past, 0.01% was considered the golden choice, however, further analysis of major studies has shown that 0.01% may potentially be no better than placebo.

Will atropine eye drops always work?

When used in low concentrations it can slow the progression of myopia in children by up to 60%.
However, it’s worth noting that atropine eye drops may not work for everyone and this is why monitoring progression every 3-6 months is very important in assessing the efficacy of the treatment.
In some patients 0.01% is enough, in others we may need to go to 0.2%. The treatment is customised to the patient's needs.
Studies possibly have conflicting results because the formulation of atropine depends on the compounding pharmacy, and the other chemicals used in order to create the eye drop. Some formulations are more stable than others. There is a commercially available atropine formulation called Eikance which is 0.01%.

Are atropine eye drops safe?

Yes, atropine has been shown to be safe for long-term use in children. This may be 2 years or indefinitely.
These are also safely used in combination with other methods of myopia management such as orthokeratology, MiSight daily disposable contact lenses, MiyoSmart or Stellest spectacles, or bifocal glasses.
However, as mentioned earlier, this medication increases pupil size and reduces the ability for the lens to focus and therefore has expected side effects of increasing glare and possibly making near vision more difficult.
Most children tolerate these known and expected side effects very well. However, some may be more sensitive than others therefore requiring photochromatic spectacle lenses, sunglasses, or tweaking of the prescription dosage.

Low dose atropine tips for parents

Uneven pupil size. Occasionally, more atropine may be instilled into one eye compared to the other, this will cause one pupil to be larger than the other. Do not fret, this is simply a side effect of the eye drops and not a serious neurological condition. You will find that over the next few days when equal eye drop volume enters both eyes, they should equalise. It is a normal and expected side effect for the pupils to enlarge with use of these medicated eye drops.
Do not suddenly stop using low dose atropine. These eye drops should never be suddenly stopped. If low dose atropine treatment suddenly comes to a halt, this may lead to a rebound effect causing the prescription at a rapid speed. Therefore, it is important to ensure that you have adequate supply ahead of time from the pharmacy, and that if you wish to cease usage, that you consult with me first. There is a higher chance of rebound at 0.025% and higher. There is little chance of rebound when on 0.01% atropine.
Time of day is not strict, but consistency is best. The timing of the drops can help with reducing blurred vision and light sensitivity, but they do not reduce efficacy as long as they are done at around the same time every day. For example, it is usually recommended to use one drop in each eye every night, however, you can choose to do this right after dinner, or right before bed. Whenever it suits your family routine is the best time to do it.

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