Managing Atropine Dosage for Myopia Control in Children

Q: Managing Atropine Dosage for Myopia Control in Children

Hello： You can give it a try, but after using it for a month, it's best to check your prescription again. <br>If there isn't much change, you can continue using it. <br>I believe the concentration is quite low, so you can make the adjustment directly. <br>Thank you for your messa

The concentration of the mydriatic agent atropine is reduced?

Dear Director Gao,
Thank you for your continued enthusiasm in responding to online inquiries; I have greatly benefited from reading your posts.
My daughter, who is over 7 years old, was diagnosed with 50 degrees of myopia in her right eye.
The doctor prescribed 0.01% atropine for one month, but during the follow-up examination with dilation, her myopia remained at 50 degrees.
The doctor then switched to 0.05% atropine, and after another month of treatment, her myopia decreased to 25 degrees, and her vision improved to 1.0.
She is currently still using the 0.05% solution.
I am considering that since she is in second grade and her academic workload is not heavy, along with concerns about potential drug resistance, I worry that prolonged use of 0.05% may necessitate increasing the concentration in the future.
Therefore, I would like to reduce the concentration back to 0.01% to see if it can be controlled.
If her academic workload increases later, I can reconsider using 0.05%.
Since there is still some time before her next follow-up appointment, I would like to consult your advice on the following:
1.
Is it advisable to switch directly from 0.05% to 0.01%? Will a direct decrease in concentration cause a rebound effect?
2.
Regarding point 1, if considering the rebound effect, what dosing regimen would you recommend for transitioning from 0.05% to 0.01%?
Thank you for taking the time to respond.

Hu Yan Ba, 40~49 year old female. Ask Date: 2024/02/01

Dr. Gao Pilin reply Ophthalmology

Hello: You can give it a try, but after using it for a month, it's best to check your prescription again.
If there isn't much change, you can continue using it.
I believe the concentration is quite low, so you can make the adjustment directly.
Thank you for your message.

Reply Date: 2024/02/01

More Info

Managing myopia in children, particularly through the use of atropine, is a nuanced process that requires careful consideration of dosage and potential effects. In your case, your daughter has shown a positive response to the 0.05% atropine solution, reducing her myopia from -50 diopters to -25 diopters, which is a significant improvement. However, your concerns about long-term use and potential resistance to the medication are valid and warrant discussion.

1. Switching from 0.05% to 0.01% Atropine: It is generally acceptable to reduce the concentration of atropine from 0.05% to 0.01%. However, it is important to note that this change may not yield the same degree of myopia control. The higher concentration (0.05%) has been shown to be more effective in slowing the progression of myopia compared to the lower concentration (0.01%). Therefore, while you can make the switch, it is crucial to monitor your daughter's myopia closely after the change.
Regarding the concern of a "rebound effect," where myopia could potentially worsen after reducing the dosage, this is a possibility. Some studies suggest that a sudden decrease in atropine concentration may lead to a temporary increase in myopia progression. To mitigate this risk, a gradual tapering approach could be beneficial.
2. Tapering Dosage: If you are concerned about the rebound effect, consider a tapering schedule. For instance, you might reduce the frequency of the 0.05% atropine before switching to 0.01%. For example, you could administer 0.05% atropine every other day for a week or two before switching to 0.01% daily. This gradual reduction may help your daughter’s eyes adjust to the lower concentration without a significant rebound in myopia.

Additionally, it is essential to maintain regular follow-ups with your ophthalmologist. They can provide tailored advice based on your daughter's specific condition and response to treatment. Regular eye exams will help track any changes in her vision and allow for timely adjustments to her treatment plan.

In summary, while it is possible to switch from 0.05% to 0.01% atropine, doing so may affect the efficacy of myopia control. A gradual tapering approach may help minimize the risk of rebound myopia. Always consult with your eye care professional before making any changes to medication regimens, as they can provide the most personalized and informed guidance based on your daughter's unique situation.

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