Tuesday, April 22, 2014

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. 
The Atropa Belladonna plant
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.
Atropine 1% eyedrops

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.
Atropine 0.01% eyedrops
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.

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




66 comments:

  1. Very interesting. I am an American of Indian descent and both my girls have myopia. Let me see if their ophthalmologist will prescribe them atropine. is 0.125 % more potent than 0.1 % ?

    Thanks

    Manix Appunni
    Frisco TX USA

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  2. Hi Manix, 0.125% is slightly more concentrated than 0.1% atropine, but in terms of their effectiveness and side effects, they are more or less equivalent. Bear in mind that both 0.125% and 0.1% atropine dilate the pupils and can affect near reading somewhat while wearing glasses, so if your daughters use these concentrations they would need special transitions (photochromatic) glasses which are also progressives. That's part of the reason why we nowadays almost always start off with the 0.01% concentration of atropine.

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  3. Hi Dr Por, your blog has been very useful and provides me with additional info on atropine. My son was on 0.01% for 1 yr+ but his myopia is still increasing pretty fast. His power increases by 50 about every quarter. I have decided to switch him to 0.125% and to 0.1% if it still doesn't help. I am wondering if any eye supplements or food will help to slow the progression? Tks!

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    1. Thanks for your comments! If your son's myopia is still increasing at that rate, I agree that it would be worth considering a higher concentration like 0.125% or even 1%. You would then need the special transitions and progressive glasses. Do remember that these drops need to be used as consistently as possible, over a long time period. There is no evidence that any dietary changes or supplements help with myopia progression. Generally our recommendations are still to increase outdoor time, and to use atropine.

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  4. Hi Dr Por, yes, I meant 1% atropine if the 0.125% don't work for him but that would mean adapting to the progressive and transitions glasses. We are trying our best to increase his outdoor time but sometimes it's really difficult looking at our Singapore's education system.

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    1. Yes, it's not easy to increase outdoor time-I think it is a number of factors combined-including our Singapore weather (very hot a lot of the time, raining often), lack of an 'outdoor culture' (even PE in schools is often conducted indoors) and of course the many tuition classes/CCA taking up precious time.

      There are a number of forum commenters and websites or posts that try to get people to buy supplements, but they confer no benefit, as long as your child is eating a healthy balanced diet.

      Generally speaking, although lower is always better, myopia doesn't give too many serious issues until it gets very high. In most high myopes, contact lenses or even refractive surgery can give a quality of life very similar to those without shortsightedness, so not to worry too much also!:)

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  5. I M ROHIT, I am occuring from myopia -3.85 both, what should i used atropine 1% or .1%.

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    1. Hi, whether atropine would be useful to you would depend primarily on whether your myopia is still increasing or whether it has stabilised.

      So for example, if last year it was -3.75 and this year it is also -3.75, then atropine would do nothing for you. On the other hand, if last year it was -2.75 and this year it is -3.75, and you are in the age group where axial myopia can progress quickly (ie between about 7-17 years of age), then you can consider atropine treatment to slow down the rate at which the myopia increases. If atropine is suitable for you, then you should discuss with your doctor the pros and cons of the 1% vs 0.01% concentration. The 1% concentration can have a stronger stabilising effect, but has side effects and can be associated with a greater rebound phenomenon. Most new patients that I see start off with the 0.01% concentration nowadays.

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  6. Hello,

    My right eye has a diopter of -1.0, and my left eye has no degree. Will these drops help my right eye reduce its myopia? Also, it is my first month experiencing myopia in my right eye.

    Thank you!

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    1. Hi Constance, sorry for the delay. Atropine does not reduce spectacle power. Depending on your age, atropine might help but only in so far as reducing myopia progression-ie slowing down any future increase. This has mainly been tested in children. In an older adult eg 50s or 60s, especially if there is associated visual blurring, the eyes should be checked for other things like cataract if myopia is increasing.

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  7. Where can I buy the Atropine 0.01% in U.S? it is a prescription medicine here and my doctor said she does not believe it and can't provide me the prescription.

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    1. Hi there, atropine is a prescription medicine pretty much everywhere. The 0.01% concentration may not be commercially available in the US but any compounding pharmacy should be able to make it up if a doctor prescribes it.

      Recently an editorial was published in the prestigious journal Ophthalmology regarding low dose atropine: https://www.ncbi.nlm.nih.gov/pubmed/26802703

      I suppose that should help to convince more doctors regarding the effectiveness of this medication in myopia.

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  8. Hi Where can i get 0.01 in singapore

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  9. As previously mentioned, Atropine is a prescription only medicine so you need to see an eye doctor first. If he/she feels that your situation or your child's situation requires it, then he/she will prescribe (and dispense) that medicine to you.

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  10. Dear Dr. Por,

    We have been giving Atropine 0.01% to our 7 year old son for last six months. But, it has not shown any improvement (his number changed from -4.5 to -5.5 in six months). Since we don't have a higher concentration here in USA (like 0.1, 0.5), will it be beneficial to increase the frequency two times a day (currently we give every night before sleep) or use two drops (instead of one drop) every night.

    Thank you!

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    1. Hi Rakesh,
      Yes, Atropine 0.01% may not work so well for certain people. Using 2 drops at a time will not make any difference because the second drop just washes out from the eye-there isn't space in the eye to hold both drops. Using the drops 2 times a day might give a better effect, but we don't know if this is really the case as no study has been conducted administering the drops like this. I suspect it probably will not make much difference either, but would be the better option to try compared to using 2 drops at a time. (Disclaimer: Please note that this does not constitute medical advice and you should discuss all treatment changes with your regular eye doctor)

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    2. Dear Rakesh Where did you get this 0.01% Atropin Sulphate. I am Dheeraj From India

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  11. Dear Dr Por, do you know if someone is testing the possible benefits and risks of combining 0.01% atropine treatment and orthokeratology, and if there are practitioners who combine these two treatments? If yes, do you know when they administer atropine in relation to putting on the lenses? I am considering the combined treatment for my daughter in the UK, but it is difficult to find information on the subject. Many thanks, Guy Deutscher

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    1. Hi Guy, no, I am not aware of any studies done which look at the effects of combining atropine treatment with orthokeratology. In Singapore, orthokeratology is still often frowned upon by the medical community even though I would say it is slowly gaining wider acceptance. I don't know of any colleagues who combine the treatments. Theoretically I don't see any harm from combining 0.01% atropine with orthokeratology, but it would be good to do so under the care of an eye doctor in your area after you discuss the pros and cons with him/her. Combining the treatments like this probably should be considered 'experimental' for the time being, in the sense that we don't know the benefits it could add to existing treatments.

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    2. Many thanks for the information!

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  12. Dear Dr Por, My child is now around 500 deg. Can she start with 0.01% concentration? She is now wearing progressive lens. Her degree increased around 125 after 18mth of wearing the progressive lens (she still reads under unfavourable conditions when not unsupervision). Thanks.

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    1. Hi, yes, I would think your child could consider the 0.01% concentration of atropine. The atropine may not completely stop the myopia progression, but can slow it down. Do discuss it with your eye doctor.

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  13. Hi Sir

    I am Dheeraj from India I am in need of Atropine Sulphate 0.01% . Can you help me in this

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  14. Dear Dr Por,
    I'm 39, myopia person who suffers from severe cobweb floaters. The research showing atropine 0.01% is effective and with no or minimal side effect is interesting. Someone from our floaters community have tried atropine 0.01%. He reported no blurring of vision, very minimal glare at night. Other than that, he did not see his hundreds cobweb floaters for the next 30 hours. The drop does not cure floaters but it certainly help to provide relief. Would you be considering to do clinical trial ?

    Many thanks,
    Kenny from Sydney

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    1. Hi Kenny, sincere apologies for taking so long to reply. No, unfortunately I will not be conducting a trial in this regard. What is known about floaters is that they are generally less obvious when the surroundings are darker, and also when the pupils are dilated. It is possible that in some people atropine 0.01% dilates the pupils ever so slightly, so that while it does not cause obvious blurring, the slight dilation is enough to reduce the symptoms of floaters. In general, I would not expect any problems from trying atropine 0.01% to reduce your floaters, and you could ask your eye doctor about them. If your eyes are dark brown, there is a higher chance that the drops don't work so well in dilating the pupil. As such, the only problem I forsee is perhaps the lack of predictability of using atropine 0.01% for this purpose.

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  15. Thanks for getting back. My eyes are dark brown and you're right that the dilation is less than other people who tried it - any reason for this? It does help a bit but given it does not dilate my eyes much , I have to use many drops a day (and no side effect like blurring). I'm currently using 0.05%. Usually 3 drops a day but sometimes 6 drops when floaters are bad. So far I don't feel any side effect. I checked my eye pressure regularly (3 to 4 weeks) and they are normal.

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  16. The pigment in dark brown eyes tends to absorb some of the medicine and reduce its effect. To get the same effect as a lower concentration in light coloured eyes, a slightly higher concentration like the 0.05% that you are using is probably required. You should use this under a doctor's supervision as the medicine is prescription only in most countries.

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  17. My son in usa started .01 this week his number jump 4.5 to 6.75 in 8 month. I am very afraid what do you advise me and my next visit is in 2 month. I also like to know if his number keep on increasing can he go blind.

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    1. Hi there, since your son has already started on the eyedrops, I would just carry on and keep the appointment for a check up. Such a large jump is quite unusual but I cannot say more about that as the measurements were not done in my clinic and I have not seen your son before. Specific questions about your son are best answered by your doctor, but in general most shortsighted people do not go blind.

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  18. Hi Dr. Por, my son is now 8.5 years old from 20/20(March) and jumped to 20/70(Nov) in 8 months. Doctor prescribed 0.01% atronpine. But started using a few days, he complained about the eye itchiness, the doctor said it is the atropine caused the allergy and prescribed patanol. However, I feel that the patanol holds the dilation longer than usual, after using the patanol for two days once a day, he complained about the light and blurred vision. His pupils was dilation more, I had to stop both eye drops for 3 days. So what would be your suggestion to us? His doctor is one vacation. What else can be used to reduce the allergy besides patanol? Can I use the atropine in alternate days? if used the atronpine in alternate days, it is still effective in slowing down the myopia? please advise whatelse can we do or try?

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    1. Hi Ellen, in general, if patients are getting significant side effects from their medications, it would be advisable to stop the medicines in the first instance and then see their doctor as soon as is practicable. In your case, it is probably best to stop the atropine for now, and wait until your doctor comes back from vacation for further discussion regarding the options.

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    2. Hi Dr. Por, thanks for your prompt reply. Usually, kids in like my son's age and degrees, usually how many years they need to use the atropine daily? and what would be the rebound rate when they stop the atropine after that no. of years? thanks

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  19. Hi. We would like to start using atropine 0.01% . The issue that we face is atropine 0.01% is not found at gulf countries. We trying to found formulation recipes how we can prepare atropine 0.01% we couldn't find any reference
    Your help will be appreciated if you kindly share with us a reference that guide us how to prepare atropine 0.01%
    Thank you

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    1. Hi, there is no reference out there, I think because the dilution is relatively simple ie you can dilute eg 0.1ml of 1% to 10ml of 0.01% with sterile water for injection. But the thing to consider is how you are going to preserve that for the usual duration of use, and different places have different protocols or methods for that.

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  20. Hi Doctor Por, I've heard about Atropin Sulphate from a friend of mine.
    I'm currently 16 years old and I have really terrible eyesight, would this medicine still work for me?
    Thank you

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    1. Hi Ava, atropine is used to slow myopia progression, ie to avoid a rapid increase in shortsightedness. It does not improve the spectacle degree that is already there.

      Usually at 16 years of age, your shortsightedness is not increasing that fast anymore, so from that aspect, atropine is unlikely to be helpful for you.

      You can still consider using it if your shortsightedness is increasing very fast, eg about 100 degrees (or -1D) every year.

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  21. Hi Doc Por,

    I am based in Singapore and have a 7 year old daughter who has 6/9 vision. Can she get prescribed atropine as a prevention to myopia? Or only when she starts experiencing myopia?

    Thank you.
    Michael

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    1. Hi Michael, we don't usually recommend atropine as a preventive measure because we cannot predict whether the particular child is actually going to become myopic or how fast their myopia will progress if they get it. This is bearing in mind that the treatment requires a commitment of several years at least and does cost some amount of money. At the moment there is an ongoing study looking into this aspect and the results will hopefully shed extra light on the cost effectiveness of using atropine like this. In the meantime, it is really only on a case by case basis, eg if there is a high risk with both parents having very high myopia, and the patient is very motivated and willing to use the drops even without any overt problems.

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  22. Interestingly, atropine is a good antidote for nerve agent, the one that killed Kim Jong Nam. So we should carry some eyedrops with us when we go Malaysia.LOL.Anyway we can also get from Watson. Back to short-sightedness or myopia, the main problem is when we bring kids to opticians, they ask our kids to see far for the very small alphabets. So the spectacle is meant to see far. But 80% of the time, the kid will be seeing near, his books, laptop or even handphone. So his eye muscle will contract to make his eye bulge to counter his new glasses meant to see far. This problem is already known in the US and smart parents are getting their kids reading glasses to arrest the deteriorating myopic. Here in Singapore, our myopic approach to eyesight problem is a spectacle indeed since our prescription methodology is causing our kids not able to read for long duration or concentrate fully due to eye pain or wrongly used far distance lenses for reading. So we classified them as ADSD or other kind of syndrome.

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    1. Hi, in actual fact, kids have no problem focusing for near even if you give them the full distance glasses prescription. They only have a problem if they use stronger strengths of atropine like 0.1% and above ie there is no problem at all with focusing if you use 0.01% atropine. Our prescription methodology (prescribing for distance vision) most certainly does not cause problems with reading or concentrating for long durations. Think about it-when we prescribe for distance vision, we are only giving the child vision that they would get if they were not shortsighted-ie we are giving them vision that is normal for their age.

      In the US and elsewhere, there are people out to make money by advocating different kinds of glasses or eye exercises, all of which have not been proven in good studies (double blind randomized controlled studies) to have any significant benefit in slowing the progression of myopia. In fact there was a study -randomised controlled study (Vision Research
      Volume 42, Issue 22, October 2002, Pages 2555–2559) which showed that undercorrecting myopia caused it to progress faster.

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  23. hello. i had millions of floaters and i went viteiolisis with ultra q laser jag to vanish them. no luck they were many. So i went for full vitrecromy. 90% happy but now there are many tinny tiny mucroscopic cells falling down very anoying. they are less in number every day. but 9 months has passed feom vitrectomy. the waiting ia to much. so i tried ateopine and cells apear to disapear but pupils are so big. ao i reduced atropine to 0.5% still no cells but to much dilation also. so i keep lowering dosage. now i only use one drop of ateopine 0.5% on a sterul bottle of 10 ml. and i get no cells and only 2 mm bigger pupil. voilaaaaa. also my iop is normal because i have iol implanted and small iridectomys. my dou t now it is safe? also i ha e another problem y get many glares from my iol (i keep my original lens also) it is possible that with vitrectomy lens or eye got distorted and now i get more glare even without atropine? thanks

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    1. Hi, I am not sure what you mean by glare exactly, and I am not sure how you have an IOL and keep your original lens also. I think it's probably best that you ask your doctor about these experiences you are having.

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  24. Hi Doctor, would like to check the Atropine Eye Drop is produce at where? Where can we get this? Can we buy at normal pharmarcy?

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    1. Atropine eyedrops, like all medicines, can only be prescribed by a doctor. You need a doctor's supervision, to see if the medicine is effective, to monitor for side effects and so on. If your child has myopia and it is progressing quickly, do bring him/her to see an eye doctor and check if atropine might be helpful.

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  25. Dear Dr Por, my son who is 8 years old and has a degree of 425 on both eyes. For the past 3 years, the power has increased for about 100-125 per year). I think it can potentially reach a degree of about 1200 before it stabilizes if he don't go for treatment. In event if he needs to use Atropine concentration of more than 0.1%, it might result in difficulty with close work. He does not wish to have this side effect but has no resistance to wear the normal glasses. May I know is there any other eye problems (e.g. detach of retina, nerves/blood vessels injury etc.) which could result from the high degree. Thanks in advance.

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    1. Hi, using atropine 0.01% does not cause any significant visual side effects usually, especially in brown eyes, so your son can start with this if the myopia is progressing quickly. High degrees of myopia are associated with an increased risk of retinal detachment, and extremely high degrees above 1000 degrees are associated with an increased risk of macular degeneration later in life. Also, high degrees of myopia may limit the options for refractive surgery if your son ever wants to have that done when he is older.

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    2. Dear Dr Por, your advice is very much appreciated. Many thanks from the bottom of my heart! You are truly a good and helpful person.

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  26. Hi Dr. Por, My 7.5 year old son is going to start with 0.01 Atropine soon, here in the US. His myopia had been increasing by 0.75 D every year from the time he was 4 years old. But this year (actually in 14 months), it went up by 2.75 D in each eye. Astigmation went up by 0.25 in both eyes. His eyes are otherwise healthy. The doctor also did a corneal scan for Keratoconus and it was negative. Everyone who checked his eyes said there is a big jump but no one gave us any explanation as to why it jumped so much in such a short time. I would greatly appreciate your thoughts on this. I have -10 myself and my husband has only -2. My myopia's progression was never so rapid. No one else in my entire family has high myopia. We are terrified. We are of Asian Indian ethnicity. Is there any research on whether Atropine 0.01 works for Indians?

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    1. I forgot to mention that he is currently at -4.25 sph -2.75 cyl in both eyes. He was -1.50 sph -2.50 cyl during the last checkup 14 months back.

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    2. There are generally speaking only 2 possibilities for the power to increase, or seem to increase like this. Firstly, if the refraction was not done with a cycloplegic agent (dilating eyedrops) it is possible that he was 'accommodating' during the test, thus causing it to show a falsely high degree of myopia. If cycloplegic drops were used and the myopia was still shown to be -4.25 currently, then it would be due to excessive growth of the eyeball. This is caused by both environmental as well as genetic factors. Some things you can change, others are more difficult or impossible to do so. Also, there are still many unknown factors influencing eyeball growth and myopia progression-a big part of the reason why no one gave you an explanation is that much is still unknown. As far as I am aware the atropine drops should work. In fact some of the study patients in the Singapore study would have been Asian Indians, but regardless of this, I would expect at least some effect of Atropine across different racial groups on average.

      Don't be terrified. You are -10, and I am also -10 in one eye, and I think we can do most things just fine:) If cycloplegic refraction has not been done yet, get it done to reassure yourself that the myopia is real. If so, then it is a good idea to go ahead with 0.01% Atropine and then re-measure the myopia in about 6 months' time.

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    3. Thanks so much Dr. Por for your quick and detailed reply! The eye hospital that we went to is a top eye hospital. So I am assuming they must have done cycloplegic refraction but I am not sure. I remember the Tech doing the refraction first and then putting in the drops. Then, the Fellow checked his eyes and asked him to read the chart one time which he did without any issues. I don't know if she did cycloplegic refraction or not. Later, the main doctor came, looked at the readings and recommended the .01% atropine drops treatment. I will check with them. I hope the .01% atropine drops works for my son. Thanks so much Dr.Por. I truly appreciate your help.

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  27. This comment has been removed by the author.

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  28. Hi Dr Por ,
    My Daughter who is 5.5 years old , today just diagnosed with 1.50 n 1.75 myopia n astigmatism of 50 n 75.
    Can she start with the atropine 0.01 drop n if yes usually how Long will she need to use?
    Thank you!

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    1. Hi Sheryl, how was your daughter's spectacle power measured? At her age she should have a spectacle power measurement with eyedrops to dilate her pupils-this is called cyclorefraction and is usually done at a doctor's clinic. Without the eyedrops, sometimes the measurement is not accurate.

      I usually do not start a child on atropine straight away, because occasionally we have cases where the spectacle power is not rising so fast. If your daughter really has this amount of shortsightedness, I think you could remeasure this in about 6 months' time and then start the drops if it has increased by more than about -0.50D or 50 degrees.

      As mentioned above, children who use these eyedrops on average will use them for a few years, sometimes even longer. The longer the drops are used, up to a point, the bigger the stabilizing effect that is achieved.

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  29. Hi doc. My kids doctor has prescribed atropine 0.01% for my 6 year old daughter. But in UAE only atropine 1% is available. Can we dilute atropine 1% in tear plus to make it .01% or should we use sterile water for injection to dilute. Thanks.

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    1. I don't really advise you to dilute it yourself, but if you are going to do it I think normal saline would be better than sterile water for injection. Sterile water for injection has basically zero mosm/l, ie it is like distilled water. Putting that in the eye can sting somewhat.

      Artificial tears have different additives which can include thickening agents like guar gum, hyaluronic acid, various methylcelluloses etc, and it is possible these may affect the penetration of the atropine by binding to it, especially when it is in such a dilute form.

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  30. ı'm very appreciated for atropine information,
    ı wanna use my patients but the issue that we face is we only have 0,5 mg / 1ml atropine vial for injection.
    FROM THİS HOW CAN I PREAPARE %0.01 DROP.
    ID BE VERY GLDA WITH YOUR HELP :)

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    1. As above, I don't really recommend you dilute it yourself. Please see the comments above.

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  31. Dr. Por.

    Are you using preservative free 0.01% and is it approved in Singapore? Also do you think preservative will enhance the efficacy of the product.

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    1. Yes, we are using preservative free 0.01% atropine. I don't think the presence or absence of preservatives will have any effect on the product's efficacy. We just use it in this form as it is the one available to us. Either will be fine.

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  32. Hi Doctor, my kid has -1.75 for both eyes and has been using atropine 0
    01 for 6 months, we are going for a week vacation, will try to take the atropine with us (get ice from hotel each day and carry with us to other hotel), my question is just in case, the method does not work the atropine get overheated and cannot be used, my kid will be no atropine for a week, will her eyes' short sightedness will getting worse even faster then before during and after the vacation? what advice you will give me. Of course, after the vacation to home, we will continue the atropine. thanks

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    1. Hi, atropine does not need to be refrigerated or kept cold in storage so I think you will be fine. As long as it is at room temperature and it is not exposed to direct sunlight, it will remain active. Be careful not to leave it in a hot car-temperatures in a car exposed to the sun in the tropics or during summer can easily go above 40 degrees Celsius.

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    2. Thanks so much for your prompt reply. but any clinical tests were done to know if stop the use of atropine for a few days will accelerate the short sightedness?

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    4. In our country the 0.01 atropine is made by compound pharmacy, and I was told to keep it in refrigerator from day 1, that is why I am concern.

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