The anxiety from finding out that your child needs spectacles for his/her myopia (also known as short-sightedness) is one that many parents around the world can relate to. Adding to that, watching your child’s vision worsen and having to change their spectacles more frequently than you were prepared to is becoming an increasingly common cause of concern. Singapore has one of the highest prevalence of myopia with almost 6 in 10 Singaporean children being myopic by the age of 12 years and to our dismay, this increases to 8 in 10 when they leave secondary school at the age of 16 years! The question now is, can anything be done to better manage myopia? While there is no cure for myopia, its onset may be delayed, and its progression may be slowed down. In this article, we explore the use of atropine eye drops, one of the most effective ways to slow down your child’s myopia progression.
Myopia is a serious eye condition that can develop at any age, although it typically develops during primary school years. In the last decade, many studies have shown that the average age of children who develop myopia is decreasing, with 1 in 10 preschoolers in Singapore now already having myopia. This is a cause for concern, given that the earlier a child develops myopia, the more likely their myopia may worsen and develop into its severe form called high myopia (or severe myopia).
Having high myopia increases the risk of developing other sight-threatening eye diseases later in your child’s life. Such eye diseases include early cataracts, glaucoma, myopic macular degeneration and retinal detachment, all of which can cause blindness.
From prescribing special eye drops to contact lens designs, there are various approaches to slow down the progression of myopia, which can also be used independently or in combination with one another for improved efficacy. In recent years, eye care professionals from around the world have recognized atropine eye drops as one of the most effective ways to slow down the progression of your child’s myopia.
Atropine eye drops have been used to slow down the progression of myopia in children since the 1960s and are becoming an increasingly popular choice among parents nowadays. The concentration of atropine eye drops used for myopia control is commonly prescribed in these doses: the lowest being 0.01%, 0.025%, 0.05%, 0.1%, 0.125%, 0.5% and the highest being 1%.
The effectiveness of using atropine eye drops is dependent on the following few factors:
Emerging research has supported the effectiveness of atropine as a myopia control option that is available to slow the progression of myopia in children, with high effectiveness observed even in low dosages and with minimal side effects.
A study conducted on Singaporean children aged 6 to 12 years revealed that a low dosage (0.01%) of atropine eye drops has been shown to be effective in slowing down myopia progression by 50% to 60%. However, myopia progression may still occur in some children, and if the condition is severe, studies have also shown that prescribing a higher dosage of atropine eye drops may increase its effectiveness.[4-6]
While using doses of atropine eye drops may produce potential side effects such as glare, blurring of vision at near due to the dilation of the pupils, and increased sensitivity to light, these effects can be easily countered with photochromic sunglasses and a pair of reading glasses.
Other potential side effects of a high dosage of atropine eye drops may also include eye redness, dry eye and eye allergy, which are often mild and temporary. If any of these side effects persist or worsen, be sure to contact your eye doctor and seek professional healthcare advice promptly.
Recent studies have started to emerge showing that low-dose atropine may be more effective in slowing myopia progression in a longer control program period and produce minimal side effects that do not require transitional or progressive glasses.
Myopia typically develops and progresses during childhood (5 to 15 years old) and stabilizes in early adulthood (18 to 21 years old). Your eye care professional will be the best person to guide you through your child’s suitability for atropine eye drops based on your child’s level of myopia, their age, and other environmental factors.
As a general rule of thumb, for children aged 6 to 10 years with myopia of at least -1.00D (Dioptre: unit used to measure the power of the concave lens to correct myopia) and progression of -0.50D or worse per year, the World Health Organization (WHO) recommends atropine eye drops as a potential first-line for myopia control. Prompt intervention with an efficient and effective myopia control option such as atropine eye drops will prevent the rapid progression of myopia and therefore, lower the risk of high myopia in your child.
It is also important for you as a parent to understand the influence of your child’s visual environment on the progression of their myopia. Parents must understand that there is also a lifestyle element to myopia control, such as incorporating healthier lifestyle behaviours into your child’s daily routine. These lifestyle behaviours include scheduling more outdoor time and reducing the amount of screen time that will help to further contribute to the successful management of your child’s myopia, and thus maximizing the effectiveness of the control program.
The duration of your child’s atropine control program will depend on several factors, including the age of your child when he/she started atropine and its trend of efficacy on their myopia. It is very important to understand that if atropine eye drops are not administered regularly and timely according to the control program regime, or is terminated prematurely as prescribed by the eye care professional, there could be a rebound effect on your child’s myopia. This is why controlling your child’s myopia using atropine eye drops cannot be stopped suddenly and has to be tapered down accordingly once the eye care professional has noted on the stabilization of myopia.
Choosing the right eye care professional and practice holds heavy weightage in the effectiveness of a myopia control program for your child. Monitoring the level of myopia, the axial length (length of the eyeball), scheduling regular visits, and increasing the dosage and/or frequency of atropine eye drops, are just a few essential components to look out for when selecting an eye care practitioner for your child’s myopia control program. After all, your eye care professional would first be able to provide you with a solid understanding of the rationale behind the treatment and understand your individualized needs to achieve the best results from the program.
Eagle Eye Centre’s Eagle Myopia Control Program (EMCP), eligible for children aged 6 to 12 years old, ensures a holistic approach toward myopia control. Under the program, your child will be prescribed the appropriate concentration of atropine eyedrops to be applied every night. Under the supervision of their clinical optometrist, your child will have their eyes regularly checked every 3 to 6 months. Additionally, there will be professional education on the safe and optimal usage of atropine eye drops to slow down the progression of your child’s myopia.
As part of the holistic program, resources such as “My Eagle Myopia Control Program Booklet” will be provided to further facilitate proper monitoring and documentation of the treatment effectiveness. This is particularly useful for tracking your child’s pattern of response to atropine eye drops, the refractive status (degree of the lens required to correct myopia), and the axial length during each visit. You may also find information outlining the control program and dosage availability in the booklet. This treatment approach is unique to Eagle Eye Centre and it is designed to effectively help both you and your child better understand and monitor the progression of myopia.
 Walline, JJ et al., “Interventions to slow progression of myopia in children,” Cochrane Database Syst Rev, Review vol. 1, no. 1, 2020, 1:CD004916. doi: 10.1002/14651858.CD004916.pub4
 Wu, PC., Chuang, MN., Choi, J. et al. Update in myopia and treatment strategy of atropine use in myopia control. Eye 33, 3–13 (2019). http://doi.org/10.1038/s41433-018-0139-7
 Chia, A., Lu, QS., & Tan, D. “Five-year clinical trial on atropine for the treatment of myopia 2: Myopia control with atropine 0.01% eyedrops, “ Ophthalmology, vol. 123, no. 2, pp. 391-9, 2016, doi: 10.1016/j.ophtha.2015.07.004
 Zhao, C., Cai, C., Ding, Q., & Dai, H. “Efficacy and safety of atropine to control myopia progression: a systematic review and meta-analysis,” BMC Ophthalmol, vol. 20, no. 478, 2020, doi: 10.1186/s12886-020-01746-w
 Song, YY., Wang, H., Wang, B-S., Qi, H., Rong, Z-X., & Chen, H-Z. “Atropine in ameliorating the progression of myopia in children with mild to moderate myopia: a meta-analysis of controlled clinical trials,”J Ocul Pharmacol Ther, vol. 27, no. 4, pp. 361-8, 2011, doi: 10.1089/jop.2011.0017
 J, Gan et al., “Varying dose of atropine in slowing myopia progression in children over different follow-up periods by meta analysis,” Front Med (Lausanne), vol. 8, 2022, doi: 10.3389/fmed.2021.756398.
 “The impact of myopia and high myopia.” Report of the joint World Health Organization-Brien Holden Vision Institute Global Scientific Meeting on Myopia. Mar 16-18 2015. University of New South Wales.
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