Atropine treatment for myopia control

[kitty15]

Please refer doctor in los angles that could provide Atropine treatment for myopia control.... thanks.

[eugene85]

The doctor who initially started me on long-term atropine two years ago is in Russia. I have relocated to the U.S. since then, and my ophthalmologist here has offered to refill my prescription. Atropine is very cheap ($1-$5 per month). I do not wear contact lenses, so I cannot say from experience how long one should wait before putting them on, but it is probably the same as with any other eye drops. From the practical perspective, constantly dilated pupils are uncomfortable in bright light, so I have been wearing clip-on sunglasses and a visor outdoors at all times.

Once again, atropine is by no means a standard treatment option in adults. Even in children, I think it is routinely used only in Asia (e.g. Taiwan), and only by a handful of doctors in Europe and the U.S...

[flossy93]

Thank you so much for your comment regarding atropine for myopia control.  It's great that it seems to be slowing your progression; I hope the next appointment brings you the same result.  I'm in a similar boat but much more nearsighted w/ much longer eyes than you.

If you don't mind, could you describe your search to find a doctor that would prescribe this for you?  Is it expensive?  I'm not sure where you are located, but any info you can share about the doctor who is treating you with atropine would be helpful.

Also, are there any practical issues w/ the atropine like how long you must wait before you can put in contact lenses, etc?

thanks again for your feedback!

[eugene85]

I am a 29-y.o. male with high progressive (degenerative) axial myopia. My refraction is currently -9.50 (right) / -12.50 (left), and axial lengths are 26.8 / 27.5.

Since the age of 20, my myopia has been progressing very constantly at -.25 D every year, which made me concerned because with increasing axial length, the incidence of long-term complications rises considerably. I was hoping that my prescription would stabilize around the age of 25, but it did not.

Two years ago, my doctor suggested that I try atropine in an attempt to slow down myopia progression. I was aware that it was not standard treatment in adults, but safety and efficacy in children seemed very good, so I thought I would try.

I have been using the eyedrops (atropine sulfate 1%) two times a day for two years now. After year 1, my refraction was stable. After year 2, myopia increased about .25 from baseline. I am not 100% sure that my progression has slowed down, because .25 D is the tolerance of refraction, and if it has slowed down, there is no way to tell that it was due to the effects of atropine.

On the positive side, there were no adverse side effects of atropine that I could not cope with. I have been wearing sunglasses and a visor when outside to help with glare, and I was intentionally under-corrected in one eye for reading.

I am not sure if it helps, but I thought I would share.

[RICK2014]

Thanks flossy93 for your reply.
I am going to see opthomologist as well as optometrist who suggested ortho k with bifocal might help stabilize my sons myopia and will see atropine as next step. She sound promising so I am hoping for best .
Thanks again

[flossy93]

Regarding doctors in the US who are familiar with the use of atropine for myopia control in children:

Following is a link to an audio podcast (interview) from Nov 2013 with Dr. Jeffrey Cooper, who has studied various dosages of atropine in children for myopia control:

http://www.orthokacademy.com/episodes/2013/11/13/episode-17-dr-jeffrey-cooper

Dr. Cooper is an optometrist based in New York (Manhattan and Brooklyn) and is one of the biggest advocates in the US for atropine use to slow myopia growth in children.  

Although the podcast is long, there are some excellent Q&A points about atropine and myopic kids.  If I were a parent of a child with aggressive myopia, I would certainly be interested in this discussion.

He particularly advocates atropine use for myopic patients age 8 or under with a strong family history of aggressive myopia.  Around age 8+ he views OrthoK as an additional or replacement therapy, but notes that atropine can still be used in low doses in that population to slow the myopia growth.  I think he said the longest he has treated the same patient with atropine for this purpose to date was from age 7 to age 16 or so.

Dr. Cooper also discusses the potential to use atropine in combination with OrthoK, in response to a question about treatment in Asia of highly myopic children with this combination of therapies.

I personally don't know anything about Dr. Cooper, but if I were parent to a child with worsening myopia, I would certainly contact him and inquire about whether atropine or another preventive therapy would be appropriate for my child.

Dr. Cooper's practice is located in Manhattan and Brooklyn and the website is:  http://coopereyecare.com/  There is a 'Contact Us' link on the website as well as phone numbers and addresses.  

There is also a very interesting second segment of the podcast which was a separate, later interview appended to the original recording, during which Dr. Cooper talks about on study reporting a 'rebound' myopia effect of atropine use when it is ceased.

Apparently there was a study that alleged taking patients off atropine caused a rebound (worsening) in their myopia, but apparently it was due to the 'baseline' measurement of their myopia being taken after a few weeks of atropine use.  By that time the children's myopia had already lessened, so stopping the drops allowed it to return to where it had been before treatment.  But the apparent 'worsening myopia' was not the result of myopia progression caused by stopping treatment, but rather by taking the baseline measurement after the treatment had been in use for two weeks.

I hope others interested in atropine and myopia control will find this discussion as interesting as I did.  It was especially interesting that the mechanism by which atropine slows myopia is still not known.  

It also seems clear that Dr. Cooper has persevered in studying this treatment despite initial disapproval from colleagues because he truly believes it can help kids and improve their long term visual outcome, with relatively little risk.

I only wish I knew whether this treatment is relevant to adults (this was not discussed or even mentioned).  I've never heard about atropine being used for adult myopia control.

Best wishes to all of the concerned parents of myopic children.  Investigating safe therapies to slow advancing childhood myopia is time well spent, as some of the side effects of high myopia can be quite problematic later in life.

[RICK2014]

Hi there,
Just wanted to know if you find someone who does atropine treatment or any luck with medication as I am also worried. Bout my sons high myopia. Any luck with any treatment please do share .
Thanks

[John C Hagan III, MD, FACS, FAAO]

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