https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710262/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9522992/
两篇研究论文
https://www.aao.org/eyenet/article/how-to-use-low-dose-atropine-to-slow-myopic-progre
美国眼科学会对用阿托品治疗近视眼的指南
Treatment Advice
Whom and when to treat. Prof. Tan uses 0.01% atropine in children from 6 to 12 years of age “who are at least –0.5 D myopic, and with a definite history of progression over the last few months—usually at least 0.5 D over the last 6 months.” Although the medication hasn’t yet been tested in children over 12 years of age, he added that it would not be unreasonable to use it in teenag-ers if their myopia is still progressing.
Similarly, Dr. Epley recommends low-dose atropine for children from 5 to 15 years of age. “Younger children are more likely to become more myopic over time than older children are, so they are of greatest concern.” He partic-ularly recommends atropine for a child whose myopia is rapidly increasing. “I discuss this with any patient, or family of a patient, who has more than –1.0 D of myopia or who is increasing more than 1.0 D in a year,” he said.
Dr. Siatkowski follows a similar rule of thumb for starting the treatment: “Certainly, 1.0 D per year progression would be a red flag for me.”
Very young children. Both Drs. Epley and Siatkowksi said that axial myopia is rare in children under 5 years of age. “It’s not clear that children in this very young age group have the same mech-anism for myopia as occurs in older children,” Dr. Epley said, “so I’m not currently treating the very young with atropine.” Dr. Siatkowski agreed and added that a refractive error of –1.0 D or more in a child under 5 years of age would be atypical and concerning, and it would lead him to first rule out other etiologies (such as anterior segment congenital malformation). Prof. Tan noted that a new trial will soon evaluate low-dose atropine in young children. “We intend to test it in children as young as 5 years of age who have progressive myopia,” he said.
How to treat. The treatment regimen requires patients or parents to admin-ister 1 drop of 0.01% atropine, daily, in each eye. However, Drs. Epley and Siatkowski both agreed that the time of administration is not very important. Nighttime administration was tradi-tionally the standard with higher doses of the drug because the side effects of the medication (pupillary dilation, reduction of accommodation) are less bothersome while the patient is asleep. However, Dr. Siatkowski stressed that this may not work well for some fam-ilies. “Some do better remembering to administer it in the morning, or when they see it in their lunch box,” he said.
Duration of treatment. According to Prof. Tan, “it would seem prudent that we should use atropine for at least 6 months to see if it is working, and if it is having good results—i.e., myopia progression is lessening—then contin-ue for at least 1 year in total in the first instance. One could then stop treat-ment and, if myopia starts up again, restart for another 6 months or a year.”
Dr. Epley uses 0.01% atropine to treat myopia in children either for 2 years or to 15 years of age, whichever is longer. “If a child’s myopia increases when we stop the atropine, I place them back on it for a year at a time until the eye has stopped growing.” He added that treatment has little effect on the child’s quality of life, “aside from the challenges of administering eye drops to children, who generally don’t like water in their eyes.” And Dr. Siatkowski tells parents to be prepared for their children to continue using the medi-cation until they are 18 years old, and then wean off it—or to stop it sooner if they experience any problems.
What to expect. “In the first 6 months, the myopia may still prog-ress—a finding that was also seen in the ATOM2 study,” Dr. Epley said. “After 6 months, the progression should slow significantly to –0.50 D change, or less, per year,” he added. According to Dr. Si-atkowski, low-dose atropine has slowed the rate of myopic progression in his patients by between 30% and 50%. And 2 patients have had complete arrest of their myopic progression. “Both of these are Asian children with dark eyes who were moderate myopes to begin with,” he noted.
Follow-up during treatment. After starting a child on low-dose atropine, Prof. Tan stressed that follow-up after 6 months is the earliest time at which to begin assessing treatment efficacy. However, he typically evaluates chil-dren 3 months after treatment starts, to ensure they have no significant side ef-fects. “It seems sensible to review every 6 months, thereafter, with cycloplegic refraction,” he said.
Dr. Epley said that he follows children “every 6 months while on the medication, to ensure compliance, to look for side effects, and to verify that the medication is working.”
Dr. Siatkowski typically follows up every 6 to 12 months (or sooner if the patient is having problems), depending on the child’s refractive error, as well as how quickly their myopia progresses. “If they’ve been progressing 1.0 D or more in a year, follow-up in 6 months would let me know whether the treat-ment has slowed it down,” he said. “But if their progression has been slower—say 0.5 D per year—I might wait 1 year to follow up.”
Follow-up after stopping treatment. When a child stops treatment, “the ini-tial follow-up is at 6 months, then again at 12 months,” Dr. Epley said. “If there is no change in this period, then the child follows up in 1 year. If the child changes, we restart the drops and recheck in 6 months.” Thus far, in his practice, the only kids whose myopia began to increase rapidly after discontinuing atropine are those who stopped before completing at least 2 years of treatment.
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