Myopia treatment level 3 - pharmacologic treatments

When patients with progressive myopia continue to worse even with appropriate behavioral modification and optical treatments, then pharmacologic therapy is appropriate. Unfortunately, there is still, as of January 2024, no FDA-approved and labeled eye drop to treat progressive myopia, so current therapy requires the use of atropine drops prepared on prescription by a specialty compounding pharmacy.

Atropine is a medication that belongs to a class of drugs known as anticholinergics. It is derived from the belladonna plant and is primarily used for its ability to dilate the pupil (mydriasis) and relax the muscles of the eye's ciliary body (cycloplegia). Atropine has several medical applications, including:

1. Ophthalmic use: Atropine is often used by ophthalmologists for diagnostic purposes to dilate the pupil and allow for a better examination of the inside of the eye. It can also be used to manage certain eye conditions such as uveitis and in some cases of strabismus (eye misalignment).

2. Cardiac use: Atropine can be used to increase heart rate and improve conduction in cases of bradycardia (slow heart rate). It is sometimes administered in emergency situations to treat conditions like heart block.

When it comes to myopia control, there has been some research suggesting that atropine eye drops may be effective in slowing the progression of myopia (nearsightedness) in children. Myopia typically occurs when the eyeball grows too long, causing light to focus in front of the retina rather than directly on it. Atropine is thought to work for myopia control by several mechanisms:

1. Slowing eye growth: Atropine appears to inhibit the elongation of the eyeball, which is a primary factor in the development of myopia. It may reduce the excessive axial lengthening of the eye, effectively slowing down the progression of nearsightedness.

2. Pupil dilation: Atropine's ability to dilate the pupil allows more peripheral light to enter the eye, which may stimulate the retina and signal the eye to slow down its growth.

3. Ciliary muscle relaxation: Atropine relaxes the ciliary muscles in the eye, which control the shape of the lens. By relaxing these muscles, it may reduce the eye's ability to accommodate and focus on near objects, potentially reducing the stimulus for myopia progression.

However, the only FDA approved and labeled eye drop is Atropine Sulfate ophthalmic solution at the 1% concentration that is usually used for amblyopia or lazy eye treatments as shown below. The most current myopia control treatments revolve around using atropine concentrations between 0.01% to 0.05% so therefore the medicated eye drops must be obtained from a compounding pharmacy.

At present, in our practice tend to start with the atropine at the 0.01% concentration for most light-eyed patients while most with dark irides, Asian patients and those with highly myopic parents will be started at 0.05%.

It is important to note that while atropine has shown promise in myopia control, its use should be carefully monitored by an eye care professional, and the appropriate concentration and dosing regimen should be determined on an individual basis. Prolonged or inappropriate use of atropine can lead to side effects such as sensitivity to light, blurred vision for near objects, and difficulty in focusing on nearby objects (accommodation). Therefore, if you are interested in using atropine for myopia control, it is essential to consult with an eye specialist to discuss the potential benefits and risks based on your specific situation.