Atropine eyedrops for the control of shortsightedness

Shortsightedness is a huge problem in Singapore and many big cities around the world. More than half of Singapore schoolchildren are already wearing glasses for shortsightedness by the age of 12 years. What is worrying is that the earlier one starts out becoming shortsighted, the higher the final spectacle degree tends to be. Very highly shortsighted people are at increased risk of eye problems like cataract and retinal problems at a younger than average age.

It is important therefore that we try to slow down the increase of shortsightedness as much as possible. Ensure that a child spends 1-2 hours outdoors in sunlight each day. Take regular breaks from near work when reading or with computer use. Apart from these, using Atropine eyedrops is the only method proven in big studies (randomised controlled trials) to slow down the rate at which shortsightedness increases.

What is Atropine?

This is a chemical obtained from plants in the same family as the nightshade plant. Owing to the presence of extremely high levels of atropine and other chemicals, the berries and leaves of the plant are poisonous. 

Interestingly, the nightshade plant is also called ‘belladonna’ (meaning beautiful woman in Italian) as people in the past used atropine to dilate the eyes for a cosmetic effect! It achieves its effects in the body by blocking a special receptor molecule that among other things controls the action of muscles as well as the growth of the eyeball.

Atropine is available in many forms, but for eye conditions it is used as an eyedrop. Various concentrations have been tried but the commonly available concentrations are 1%, 0.125% and 0.01%.

Traditional treatment (Atropine 1%)

Traditionally, to reduce the rate at which shortsightedness increases, 1% Atropine eyedrops were used once a day or even once a week. In a study at the Singapore National Eye Centre, 1% eyedrops used once a day reduced the progression of shortsightedness from an average of 100 degrees a year to less than 25 degrees a year. Our experience suggests that using it even once a week has a very similar effect.

Side effects of traditional Atropine treatment

Atropine 1% dilates the pupil and relaxes the muscle used for near focusing inside the eye. As a result patients feel very sensitive to bright lights and with normal glasses on have difficulty with close up work such as reading. If this concentration is used, special glasses which turn dark outdoors (‘Transitions’ lenses) and which have progressive lenses (having a near section below for near focus) are required. All of these side effects are temporary and disappear when the patient stops using the drops.

Newer treatments (Atropine 0.125% and 0.01%)

In an effort to do away with the side effects of Atropine, lower concentrations of Atropine were tried. When used once every day, 61% of those using 0.1% and only 6% of those using 0.01% Atropine felt a need for special ‘Transitions’ and progressive lenses. Therefore, normal glasses or contact lenses can usually be worn while the 0.01% Atropine concentration is used.

However, the lower concentrations are not as effective as the 1% concentration at slowing progression of shortsightedness. On average, the myopia progression over 2 years for 1% Atropine was 28 degrees, for 0.1% 38 degrees, and for 0.01% 49 degrees. This was still better than the 120 degree increase seen in those who were not using the Atropine eyedrops.

General pointers about using Atropine for shortsightedness

Whether 1% or 0.01% Atropine is used, the eyedrops must be used for a long period of time. Although the shortsightedness increases at a slower rate while Atropine is used, the rate increases again when it is stopped. The idea is therefore to use the Atropine during the period of time when the shortsightedness is increasing fastest. Usually by about 18 years of age, the rate of increase of shortsightedness would have already slowed down naturally.

This means that on average, most children who use the eyedrops would be using them for several years. The longer the eyedrop is used, the bigger its potential effect. For example, if a child had shortsightedness that was increasing by 100 degrees every year, using the 1% eyedrop for 3 years would reduce the final power by 300 degrees. This might mean that instead of having 500 degrees of shortsightedness as an adult, he/she would only have 200 degrees of shortsightedness finally.

In trying to slow the progression of shortsightedness, a number of decisions have to be made. Should Atropine be used or not? Should the 1%, 0.125% or 0.01% concentration be used? How long should the child continue with the eyedrops?

These decisions should be made after a discussion of the pros and cons of each decision with your eye doctor. For example, if the shortsightedness is increasing very fast and is already of a high degree, one would favour using the 1% eyedrop despite the side effects. On the other hand, if the side effects cannot be tolerated and one is willing to give up some of the stabilizing effect of the 1% eyedrop, then the 0.01% concentration is a good option.

EDIT 7 MAY 2018
Please note that I do not run an online pharmacy, and these are illegal in many parts of the world. Do not request Atropine from myself, or any other doctor, unless you or your child have seen the particular doctor and it has been determined after a proper consultation that Atropine is necessary. Requests for Atropine will be deleted in the future to avoid cluttering up the comments section in this post.

P/S.
Have you ever seen pinhole glasses? I heard that they are available at Watsons. Do NOT waste your money on these gimmicks. They do nothing to help the eyes or vision. Have a look at this link: Case Watch report on settlement of charges of misleading claims