Atropine for Myopia Control

Atropine for Myopia Control

Myopia (short-sightedness) is increasing around the world, with many now calling it an epidemic. Aside from the burden of needing spectacles or contact lenses to function normally, people with myopia have a much higher risk of blinding eye disease later in life.

Low dose atropine eye drops are a proven treatment to slow myopia progression of myopia in children, protecting your child's eye health in the future.

Atropine eye drops

Atropine drops have been used for many years to control myopia; however, until recently they have been prescribed at a much stronger concentration (0.5% - 1%). Atropine at this level causes loss of focusing in young children for near tasks and dilates the pupil significantly, leading to light sensitivity.

Studies over the last decade have found that much lower concentrations of atropine, such as 0.02%, have a comparable reduction in myopia progression, without any noticeable effect on pupil size or near-focusing. For example, the ATOM2 study showed the myopia control effect of 75% reduction for the 1%, 0.5% and 0.1% concentrations and 65% reduction with 0.01%. Studies have told us that 0.02% is the highest concentration of atropine that shows no significant change to near focusing or pupil size in children, and has no reported allergic side effects.

How do atropine drops slow myopia?

It was initially thought that as atropine drops paralysed the focusing muscles of the eye, this was the reason for the myopia control. Our understanding now suggests that the atropine molecule affects a receptor in the tissue of the back of the eye, signalling the eye to stop growing excessively. This mechanism is still being studied around the world.

How should atropine eye-drops be used?

- One drop of atropine eye drops should be instilled into each eye every night 

- The child should close their eyes for 1 minute following instillation 

- No other eye drop should be used for 5 minutes after instillation 

- The drops sometimes sting a little but this should not last more than a minute. If the eye continues to 
sting beyond a minute advise your optometrist. 

- The child should continue to use glasses or contact lenses during the day as atropine will not improve the vision. Uncorrected or under-corrected myopia has been shown to be a risk factor for myopia progression, so any glasses should be accurate and worn during the waking hours. 


What are the side effects of atropine eye drops?

Eye-related side effects of general atropine eye drops can include: blurred near vision, sensitivity to sunlight, pupil dilation (the amount varies from patient to patient and concentration of medication used), stinging and burning, or swelling of the eyelids. However, these side effects are rare at the low concentration prescribed at OCULA, however, may still occur to some degree.

General side effects of high-dose atropine eye drops include allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives), an irregular or fast heart rate, hallucinations or unusual behaviour (especially in children). Other, less serious side effects may be more likely to occur.

It is not expected that the low dose atropine eye drops prescribed by OCULA will cause any general side effects, however, talk to your optometrist about any side effect that seems unusual or that is especially bothersome.

How do I get my atropine eye drops?

Atropine drops need to be specially prepared by a compounding pharmacy in Auckland as they are not readily available at concentrations below 0.5%. Drops will come in individual bottles, which should be used for 30 days, before discarding and starting a new bottle.

- Every 3 months, your optometrist will email the pharmacy a prescription for a 3-month supply of atropine eye drops. You will be copied on the email, so you are aware that the prescription is ready to be filled.
- You will then need to contact the pharmacy directly to arrange the payment and shipping of the drops. A 3-month supply (3 bottles) of compounded atropine is $148.28. The drops are costly due to the need for each bottle to be individually diluted, and only two pharmacies in New Zealand is capable of doing this with the necessary accuracy and sterility.
- Pharmacy details: 
Optimus Healthcare
4 Walls Rd, Penrose, Auckland
PO Box 99-467, Newmarket, Auckland, 1149
Tel 095800915, Fax 095800917, email: pharmacist@optimushealth.co.nz

Review Appointments

At OCULA we take myopia progression in children very seriously. At your initial myopia control assessment, a variety of specialised measurements will be taken including corneal shape, the length of each eye, a measurement of prescription, assessment of binocular vision and thorough checking of eye health.

Once started on atropine treatment for myopia control it is expected that patients will return for a review of prescription and eye length measurement every 6 months, or sooner if required. At these visits, we will assess the ongoing level of myopia and the success of the treatment, as well as check other aspects of vision and ocular health.

Review Appointment Schedule for Atropine Only Treatment Plan:

1. 3 months after the start of the atropine treatment ($65 per short review)
2.  Every 6 months thereafter ($65 per short review)
3.  Every 12 months, a comprehensive review ($187 per comprehensive annual myopia control assessment) which includes; a review of the Clinical Myopia Profile will be completed to assess the risk of myopia progression
 - A repeat of specialized diagnostic measurements including corneal shape, the length of each eye, a measurement of myopia, assessment of binocular vision, a thorough check of eye health, measurements of objective and subjective responses to therapy or detection of symptoms associated with potential side effects from the medication
 - A review of the most appropriate myopia control treatment will be discussed

For continued effect, myopia control treatment needs to continue for as long as there is a risk of myopia progression, which may be through the tertiary study years. If atropine therapy is still agreed by the optometrist, the patient and parent/guardian, then the treatment will be continued for another 12 months. 

Review Appointment Schedule for Atropine – Orthokeratology Combination Treatment Plan:

1. 3 months after the start of combination atropine-orthokeratology therapy treatment ($75 per short review)
2. Every 6 months thereafter ($75 per short review)
3. Every 12 months, a comprehensive review ($249 per combination atropine-orthokeratology therapy assessment) which includes; a review of the Clinical Myopia Profile will be completed to assess the risk of myopia progression
 - A repeat of specialized diagnostic measurements including corneal shape, the length of each eye, a measurement of myopia, assessment of binocular vision, a thorough check of eye health, measurements of objective and subjective responses to therapy or detection of symptoms associated with potential side effects from the medication and/or orthokeratology treatment
 - A review of the most appropriate myopia control treatment will be discussed

For continued effect, myopia control treatment needs to continue for as long as there is a risk of myopia progression, which may be through the tertiary study years. If combination atropine-orthokeratology therapy is still agreed by the optometrist, the patient and parent/guardian, then the treatment will be continued for another 12 months