Effect of 0.02% and 0.01% atropine on astigmatism: a two-year clinical trial.

BACKGROUND: To evaluate the effects of 0.02% and 0.01% atropine eye drops on ocular and corneal astigmatism over 2 years. METHODS: A prospective clinic-controlled trail. The cohort study assessed 400 myopic children and divided them into three groups: 138 and 142 children were randomized to use either 0.02% or 0.01% atropine eye drops, respectively. They wore single-vision (SV) spectacles, with one drop of atropine applied to both eyes once nightly. Control children (n = 120) only wore SV spectacles. Spherical equivalent refractive errors (SER) and corneal curvature were measured every 4 months. The SER and corneal curvature were assessed by cycloplegic autorefraction and IOLMaster. Ocular and corneal astigmatism were calculated by Thibos vector analysis and then split into its power vector components, J0 (with-the-rule astigmatism) and J45 (oblique). RESULTS: After 2 years, the ocular astigmatism increased by -0.38 ± 0.29 D, -0.47 ± 0.38 D, -0.41 ± 0.35 D in the 0.02%, 0.01% atropine groups and control group, respectively (p = 0.15). The corresponding corneal astigmatism increased by -0.20 ± 0.34 D, -0.28 ± 0.35 D and -0.26 ± 0.26 D (p = 0.18). The ocular astigmatism J0 increased by 0.19 ± 0.28 D, 0.22 ± 0.36 D, 0.18 ± 0.31 D in the 0.02% atropine, 0.01% atropine and control groups, respectively (p = 0.65). The corresponding corneal astigmatism J0 increased by -0.05 ± 0.34 D, -0.11 ± 0.37 D and -0.13 ± 0.30 D (p = 0.23). There was a small but significant increase in ocular astigmatism (including J0) (all P < 0.05), but there were no changes in the ocular astigmatism J45 and corneal astigmatism (including J0 and J45) in the three groups over time (all p > 0.05). However, there were no significant differences in the changes in ocular astigmatism (including J0) among the three groups. CONCLUSIONS: Treatment with 0.02% and 0.01% atropine had no clinically significant effect on ocular and corneal astigmatism over 2 years. TRIAL REGISTRATION: The First Affiliated Hospital of Zhengzhou University, ChiCTR-IPD-16008844 . Registered 14/07/2016.

Orthokeratology Lenses Versus Administration of 0.01% Atropine Eye Drops for Axial Length Elongation in Children With Myopic Anisometropia.

OBJECTIVE: To investigate the effect of orthokeratology (OK) lenses and that of 0.01% atropine eye drops on axial length (AL) elongation in children with myopic anisometropia. METHODS: Ninety-five children with myopic anisometropia who used OK lenses (N=49) or 0.01% atropine eye drops (N=46) were enrolled in this retrospective 1-year study. For all children, the eyes with higher spherical equivalent refractive error (SER) were assigned to the H-eye subgroup, whereas the fellow eyes with lower SER were assigned to the L-eye subgroup. RESULTS: After 1-year treatment, the mean change in the AL of H eyes and L eyes in the OK lenses group was 0.18±0.16 mm and 0.24±0.15 mm, respectively (P=0.15), and 0.28±0.20 mm and 0.25±0.18 mm, respectively (P=0.48), in the 0.01% atropine group. Multivariate regression analyses showed significant differences in AL change between H and L eyes after treatment with OK lens (P=0.03), whereas no significant difference in the 0.01% atropine (P=0.22). The change in the AL in the H-eye group was less with OK lenses than with 0.01% atropine (P=0.04), whereas there was no significant difference between the change in AL in the L-eye group between treatment with OK lens and 0.01% atropine (P=0.89). CONCLUSIONS: In myopic anisometropic children, AL differences between 2 eyes decrease by wearing OK lenses but do not change after administration of 0.01% atropine eye drops. The increased effect of OK lenses, but not 0.01% atropine, in reducing axial elongation at 1 year in the eye with higher SER in anisometropic children warrants further investigation.

Comparison of Administration of 0.02% Atropine and Orthokeratology for Myopia Control.

OBJECTIVE: To compare the efficacies of 0.02% atropine eye drops and orthokeratology to control axial length (AL) elongation in children with myopia. METHODS: In this historical control study, 247 children with myopia whose administration of 0.02% atropine (n=142) or underwent orthokeratology from an earlier study (n=105, control group) were enrolled. Data on AL and other baseline parameters were recorded at baseline and after 1 and 2 years of treatment. RESULTS: The mean changes in AL in the first and second years of treatment were 0.30±0.21 and 0.28±0.20 mm, respectively, in the 0.02% atropine group and 0.16±0.20 and 0.20±0.16 mm, respectively, in the orthokeratology group. Axial length elongations after 2 years of treatment were 0.58±0.35 and 0.36±0.30 mm (P=0.007) in the 0.02% atropine and orthokeratology groups, respectively. Multivariate regression analyses showed that the AL elongation was significantly faster in the 0.02% atropine group than in the orthokeratology group (ß=0.18, P=0.009). In multivariate regression analyses, younger age and shorter baseline AL were associated with a rapid AL elongation in the 0.02% atropine group (ßage=-0.04, P=0.01; ßAL=-0.17, P=0.03), while younger age, lower baseline spherical equivalent refractive error (SER), and shorter baseline AL were associated with a greater increase in AL in the orthokeratology group (ßage=-0.03, P=0.04; ßSER=0.06, P=0.03; ßAL=-0.11, P=0.009). Faster AL elongation was found in the 0.02% atropine group compared with the orthokeratology group at higher baseline SER (P=0.04, interaction test). CONCLUSION: Within the limits of this study design, orthokeratology seems to be a better method for controlling AL elongation compared with administration of 0.02% atropine in children with higher myopia over a treatment period of 2 years.

Effect of 0.02% and 0.01% atropine on ocular biometrics: A two-year clinical trial.

Background: Several studies have shown that various concentrations of low-concentration atropine can reduce myopia progression and control axial elongation safely and efficiently in children. The aim of this study was to evaluate the effects of 0.02% and 0.01% atropine on ocular biometrics. Methods: Cohort study. 138 and 142 children were randomized to use either 0.02% or 0.01% atropine eye drops, respectively. They wore single-vision (SV) spectacles, with one drop of atropine applied to both eyes nightly. Controls (N = 120) wore only SV spectacles. Ocular and corneal astigmatism were calculated using Thibos vector analysis and split into J0 and J45. Results: The changes in cycloplegic spherical equivalent refraction (SER) and axial length (AL) were -0.81 ± 0.52D, -0.94 ± 0.59D, and -1.33 ± 0.72D; and 0.62 ± 0.29 mm, 0.72 ± 0.31 mm, and 0.89 ± 0.35 mm in the 0.02% and 0.01% atropine and control groups, respectively (all P < 0.05). Both anterior chamber depth (ACD) and ocular astigmatism (including J0) increased, and lens power decreased in the three groups (all P < 0.05). However, there were no differences in the changes in ACD, ocular astigmatism, and lens power among the three groups (all P > 0.05). Intraocular pressure (IOP), corneal curvature, ocular astigmatism J45, and corneal astigmatism (including J0 and J45) remained stable over time in the three groups (all P > 0.05). The contributions to SER progression from the changes in AL, lens and corneal power of the three groups were similar (P > 0.05). The contribution of AL change alone to the change in SER was 56.3%, 63.4% and 78.2% in the above corresponding three groups. Conclusions: After 2 years, 0.02% and 0.01% atropine had no clinical effects on corneal and lens power, ocular and corneal astigmatism, ACD or IOP compared to the control group. 0.02% and 0.01% atropine helped to control myopia progression mainly by reducing AL elongation.

Comparison of 0.02% atropine eye drops, peripheral myopia defocus design spectacle lenses, and orthokeratology for myopia control.

CLINICAL RELEVANCE: There are many methods to control the progression of myopia. However, it is currently unknown which method could better control myopia progression: 0.02% atropine eye drops, peripheral myopic defocus design spectacle lenses (PMDSL), or orthokeratology (OK). BACKGROUND: To compare the efficacy of 0.02% atropine, PMDSL, and OK to control axial length (AL) elongation in children with myopia. METHODS: This study was analysed based on a previous cohort study (0.02% atropine group) and retrospective data (PMDSL and OK group). Overall, 387 children aged 6-14 years with myopia - 1.00D to - 6.00D in the three groups were divided into four subgroups according to age and spherical equivalent refraction (SER). The primary outcome was changed in AL over 1-year. RESULTS: The mean axial elongation was 0.30 ± 0.21 mm, 0.23 ± 0.16 mm, and 0.17 ± 0.19 mm in the 0.02% atropine, PMDSL, and OK groups, respectively. Multivariate linear regression analyses showed significant differences in axial elongation among the three groups, especially in children aged 6-10, but not in children aged 10.1-14; the corresponding axial elongation was 0.35 ± 0.21 mm, 0.23 ± 0.17 mm, and 0.21 ± 0.20 mm (P < 0.05 between any two groups, except between PMDSL and OK groups at P > 0.05) and 0.22 ± 0.20 mm, 0.21 ± 0.13 mm, and 0.13 ± 0.18 mm (P < 0.05 between any two groups, except between 0.02% atropine and PMDSL groups at P > 0.05) in children with SER from - 1.00D to - 3.00D and from - 3.01D to - 6.00D, respectively. CONCLUSIONS: Within the limits of this study design and using only the current brand of PMDSL, OK appeared to be the best method, followed by PMDSL and then 0.02% atropine, for controlling AL elongation over one year. However, different effects were found in the various age and SER subgroups.

Effects of orthokeratology lens on axial length elongation in unilateral myopia and bilateral myopia with anisometropia children.

PURPOSE: To investigate the effect of orthokeratology (OK) lens on axial length (AL) elongation in unilateral myopia and bilateral myopia with anisometropia children. METHODS: Twenty-seven unilateral myopia (group 1) and 25 bilateral myopia with anisometropia children (group 2) were involved in this 1-year retrospective study. The eyes with higher spherical equivalent refractive error (SER) were assigned to the H eyes subgroup and the fellow eyes with lower SER to the L eyes subgroup in the two groups. RESULTS: The mean change in AL of H eyes and L eyes were 0.11 ± 0.19 mm, 0.30 ± 0.28 mm in group 1 (P = 0.04) and 0.09± 0.14mm, 0.13± 0.16mm in group 2 (P = 0.36), respectively. Multivariate regression analyses showed that significant difference of change in AL was found between H eyes and L eyes in group1 (ß=0.25, P = 0.03), but no difference in group 2 (ß=0.09, P = 0.12). The AL of H eyes in group 1 and group 2, H eyes in group 1 and L eyes in group 2 had the same increased rate (ß= -0.04, P = 0.43; ß = 0.02, P = 0.56). CONCLUSIONS: Monocular OK lens is effective on suppression AL elongation of the myopic eyes and reduce anisometropia value in unilateral myopic children. The OK lens can control the AL elongation in both eyes at the same rate, but it cannot reduce anisometropia value in bilateral myopia with anisometropia children after 1-year follow-up.

Clinical investigation of off-flap epi-LASIK for moderate to high myopia.

PURPOSE: To compare the clinical outcome of on-flap and off-flap epi-LASIK for moderate to high myopia. METHODS: This prospective, observer-masked, randomized study included 62 eyes of 31 patients with myopia who underwent off-flap epi-LASIK (epikeratome; Moria, Antony, France) in one eye (off-flap group) and on-flap epi-LASIK in the contralateral eye (on-flap group). Corneal ablation was performed with a commercially available laser (Mel-80; Carl Zeiss Meditec, Oberkochen, Germany). Patients were seen at 3, 5, and 12 days and 1 and 3 months after surgery. Clinical outcomes were compared between groups. RESULTS: No significant between-group differences in the mean preoperative spherical equivalent (-6.18 +/- 1.29 D vs. -6.47 +/- 1.70 D), the change in lines of best corrected visual acuity at 3 months after surgery, and postoperative pain were found. Compared with the on-flap group, outcomes of better uncorrected visual acuity at 3 and 5 days after surgery (P < 0.001), rapider reepithelialization (P < 0.001), and lower level of haze at 1 and 3 months after surgery (P = 0.04, 0.04) were found in the off-flap group. Three months after surgery, contrast sensitivity function (CSF), with and without glare, did not differ from before surgery in both groups (P > 0.05) except CSF at 18 cpd with glare increased significantly in the off-flap group 3 months after surgery (P = 0.04). Wavefront aberration increased significantly from baseline in both groups 3 months after surgery (P < 0.05). The on-flap group revealed greater but insignificant increasing amplitude in wavefront aberration compared with the off-flap group. CONCLUSIONS: In comparison with on-flap epi-LASIK, off-flap epi-LASIK offers comparable postoperative pain, a lower level of haze formation, a rapider visual recovery, and better visual quality. Further investigations of a larger number of subjects and longer follow-up periods are warranted.

Higher spherical equivalent refractive errors is associated with slower axial elongation wearing orthokeratology.

PURPOSE: To investigate the relationship between axial length (AL) increase and baseline spherical equivalent refractive errors (SER) in myopic children wearing orthokeratology contact lenses (OK). METHODS: One hundred fifteen Chinese (115 right eyes) children wearing OK were enrolled in this cohort study. Gender, age, baseline SER, corneal power, corneal astigmatism, and AL at baseline and 2 years after wearing OK were collected. Univariate analysis and trend test were used to estimate the relationship between change in AL and baseline SER. RESULTS: After univariate analysis, a statistically significant relationship was found between change in AL and baseline SER (ß=0.061, 95% CI: 0.015-0.111, P=0.015). In the trend test, after adjusting for potential confounders, higher SER was associated with smaller increases in AL (P trend=0.041). CONCLUSIONS: The SER at baseline was associated with AL growth in myopic children wearing OK. The higher SER was associated with slower AL growth and control the development of myopia.