Atropine 0.01% is a specific formulation of eye drops used to slow the progression of myopia, or nearsightedness, in children by managing the condition’s worsening over time. This treatment does not correct existing vision problems, so children still require glasses or contact lenses to see clearly. The drops do not reverse nearsightedness but instead aim to inhibit its development.
Mechanism for Myopia Control
Myopia progression is caused by the physical elongation of the eyeball, which makes light focus in front of the retina instead of on it. While the exact way atropine counters this is not fully understood, research suggests it involves a complex biochemical influence on the eye’s outer layers. This is different from its traditional use of dilating the pupil.
The mechanism is believed to involve non-muscarinic receptors on the retina and the sclera, the eye’s white outer layer. One theory suggests atropine stimulates the release of dopamine from the retina, a neurotransmitter known to inhibit eye growth. This signaling may help regulate the structural changes that cause eyeball elongation.
Another hypothesis is that atropine acts directly on fibroblasts within the sclera. By influencing these cells, the medication may strengthen the scleral tissue. This makes it more resistant to the stretching and thinning that accompanies myopia progression, helping to maintain a more stable eye length.
Efficacy and Clinical Evidence
The effectiveness of low-dose atropine in managing childhood myopia is supported by clinical research. Studies consistently show that 0.01% atropine can reduce the progression of myopia by approximately 50-60%.
Influential research includes the Atropine for the Treatment of Myopia (ATOM) and the Low-Concentration Atropine for Myopia Progression (LAMP) studies. The initial ATOM study found that a high 1% concentration was effective but caused significant side effects. This led to subsequent research exploring lower doses to find a better balance.
Later studies confirmed that the 0.01% concentration provided a good compromise, slowing myopia with minimal side effects. Long-term research found that over five years, the 0.01% formulation remained effective. This dose has been shown to reduce both the refractive error and the physical elongation of the eye.
Potential Side Effects and Safety Profile
The 0.01% concentration is favored for its safety profile, but potential side effects exist. The most common are related to the drug’s influence on the pupil and focusing ability. These include pupil dilation, leading to light sensitivity (photophobia), and slightly blurred near vision from weakened focusing muscles.
With the 0.01% formulation, these side effects are minimal and often not noticeable. Most children tolerate this low concentration without issues of light sensitivity or difficulty reading. This favorable balance of efficacy and comfort distinguishes it from higher concentrations.
A consideration is the “rebound effect,” where myopia progression can accelerate after treatment is discontinued. This phenomenon is more pronounced with higher concentrations of atropine. To manage this risk, eye care professionals often recommend gradually tapering the dosage over several months instead of stopping abruptly, which helps maintain the treatment’s gains.
Administration and Treatment Course
Treatment involves administering one drop into each eye every night before bedtime. This timing is intentional, as applying the drops at night allows minor side effects like light sensitivity or blurred vision to occur while the child is asleep. This minimizes impact on their waking hours.
Treatment is a long-term commitment, often spanning several years during a child’s growth when myopia progresses most. The exact duration is determined by the eye doctor based on ongoing monitoring. Regular follow-up appointments are part of the process.
During check-ups, often every six months, the eye doctor measures the child’s refractive error and the axial length of their eyes. These measurements track the medication’s effectiveness. The appointments are also used to monitor for side effects and adjust the treatment plan as needed.
Obtaining Low-Dose Atropine
Atropine 0.01% eye drops are not available as a mass-produced pharmaceutical and must be prescribed by an eye care professional. An ophthalmologist or optometrist will issue a prescription after an exam confirms the child is a suitable candidate. The decision is based on the child’s age, degree of myopia, and rate of progression.
In many countries, using atropine for myopia control is considered “off-label,” meaning it is used for a purpose other than its original approval. While higher concentrations of atropine are approved for other eye conditions, the low-dose formulation for myopia is based on clinical evidence rather than a formal regulatory indication.
Since major pharmaceutical manufacturers do not produce this specific 0.01% concentration, the prescription must be filled by a compounding pharmacy. These specialized pharmacies prepare the medication on-demand. They do this by diluting a higher concentration of atropine to the precise, low-dose strength required for treatment.