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Eye Drops

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Author: Jason Higginbotham
BSc (Hons) MCOptom Prof Cert Glau Prof Cert Med Ret Prof Cert LV FBDO MBCLA

Atropine 0.01% eye drops

When you're talking to your optician or eye care professional, you might hear them mention using Atropine for myopia management. Atropine 0.01% are eye drops that have been shown to help reduce eyeball growth (axial elongation) in myopia management. Atropine has been used in eye care for many years, particularly to conduct what we call a cycloplegic refraction, where the child’s eyes are temporarily partially paralysed in order to relax them to get a more accurate measure of their true spectacle prescription.  

However, in myopia management, the dosage is about one-hundredth of that normally used. This means the child’s vision is less affected or blurred. Also, the child doesn’t usually suffer any adverse eye reactions like redness, soreness, or watering, for example. Sources do however also suggest that Atropine 0.02% or even a fraction higher may be more effective still, whilst keeping side effects at a minimum.

 

The exact mechanism that is being affected is not entirely fully understood, but it is believed that one of the driving forces behind axial elongation is during near work. When we focus on near objects, there are muscles in the eye which facilitate the change in the shape of the lens just behind the pupil.  

This process is known as accommodation and the mechanical tension of prolonged muscular contraction seems to be partly responsible for the impetus to make the eyeball grow in length. 

At present, there is no licenced low-dose Atropine product available in the UK. However, there are some specialist ophthalmologists who have access to the drops in the UK. A licenced option is likely to be made available soon.

TL;DR Key Points
  • Atropine 0.01% eye drops are used for myopia management, reducing eyeball growth.

  • Originally used for cycloplegic refraction, now used at a much lower dosage for myopia control.

  • Low dosage minimises vision blurring and adverse eye reactions in children.

  • Mechanism not fully understood, but near work and prolonged muscle contraction may drive axial elongation.

  • Currently, no licensed low-dose Atropine product in the UK, but some specialists have access.

  • A licensed option for low-dose Atropine may become available in the UK soon.

FOCUS
POINT

 

Atropine 0.01% is now considered a safe and reliable therapy for myopia management , but for many, it is still not considered the best option available. 

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Atropine Eye Drops

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Advantages 

  • Easy to administer and requires minimal effort

  • Applicators are available to make putting in drops much easier

  • Low-concentration atropine eye drops have shown minimal side effects

Disadvantages

  • Limited optometrists can administer atropine drops in the UK.

  • Cause pupil dilation causes light sensitivity and reduced near focus.

  • Temporary myopia progression increase after stopping atropine.

  • Long-term safety of atropine is still being studied.

  • Varying response to atropine among individuals.

Early trials of Atropine used high dosages (1%) typically designed for very short-term use, and the side effects were blurring (especially for near work), glare, eye-strain, headaches and sore/watery eyes. 

Later trials used smaller doses (0.5%, 0.3% and 0.01%) and compared their efficacy and side effects. It became clear that 0.01% had a notable effect on slowing the growth of the eyeball, whilst the side effects were very minimal indeed.  

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Other Drops and drugs

At present, there are a range of experimental myopia management drops and even systemic drugs being trialled to see if they can effectively and safely reduce the growth of the eyeball in progressive myopia.  

 

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Combination Therapies

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Ortho-K Lenses

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