Effects of Cycloplegic Agents on Children's Myopia Progression

Q: Effects of Cycloplegic Agents on Children's Myopia Progression

Hello Sophia： "Pseudomyopia," also known as "accommodative myopia," is a type of myopia caused by the eye's focusing mechanism. <br>Children have a stronger accommodative ability than adults, making them more susceptible to pseudomyopia. <br>If the eyes can be given appropriate r

Effects of Mydriatic Agents?

Dear Doctor, my child was diagnosed with myopia of 150 degrees on May 21 of this year.
After using a cycloplegic agent for one week, the prescription increased to 175 degrees.
The clinic physician then increased the concentration of the cycloplegic agent, and after another week of treatment, the prescription changed to 200 degrees.
Due to certain reasons, the medication was stopped until today when we returned for a check-up, and the prescription remains at 200 degrees.
I have a few questions:
1.
My child just turned three years old on August 4.
Will the use of cycloplegic agents affect eye development?
2.
Can the use of cycloplegic agents cause glaucoma?
3.
It has been two months since the last treatment, and my child's prescription has not increased.
Does this indicate true myopia rather than pseudomyopia, and is the use of cycloplegic agents still effective?
4.
Besides using cycloplegic agents, are there other treatment options available?

sophia, 30~39 year old female. Ask Date: 2005/08/29

Dr. Liu Jingxian reply Ophthalmology

Hello Sophia: "Pseudomyopia," also known as "accommodative myopia," is a type of myopia caused by the eye's focusing mechanism.
Children have a stronger accommodative ability than adults, making them more susceptible to pseudomyopia.
If the eyes can be given appropriate rest or treated with "cycloplegic agents" to relieve ciliary muscle tension, this type of pseudomyopia can often return to normal.
However, if the ciliary muscle remains tense over time, it can lead to structural changes in the lens, resulting in true myopia.
If a child has undergone complete relaxation of the ciliary muscle with "cycloplegic agents" and still shows myopia upon refraction testing, this portion of myopia is considered true myopia.
"Cycloplegic agents" typically also cause pupil dilation, which is why some refer to them as "mydriatics," but not all mydriatics have the effect of relaxing the ciliary muscle.
Generally, we use short-acting cycloplegic agents (such as Tropicamide), which are applied once before bedtime, with effects lasting about six hours, allowing normal activities upon waking.
Others may use long-acting cycloplegic agents (such as Atropine: 0.1%, 0.25%, 0.5%, 1.0%), which can last up to two weeks and provide better relaxation of the ciliary muscle compared to short-acting agents.
Atropine is an anticholinergic medication, and if accidentally overdosed, it can cause systemic effects, including dry mouth, constipation, palpitations, tachycardia, and flushing (therefore, after applying the medication, it is best to press the inner lower eyelid or close the eyes for a few minutes to prevent absorption through the nasolacrimal duct, which could lead to systemic effects).
Current clinical results indicate that "local use of Atropine" can slow the progression of myopia in school-aged children, but it may also bring inconveniences and lifestyle impacts (the higher the concentration, the stronger the effect [0.1%, 0.25%, 0.5%, 1.0%]): (1) Accommodation dysfunction caused by ciliary muscle paralysis may require the use of bifocal or multifocal glasses to reduce inconveniences in daily life or while reading and writing.
(2) Due to pupil dilation, more light (including ultraviolet light) enters the eye; it remains unknown whether long-term use could adversely affect the lens or retina; it is recommended to wear UV-protective sunglasses during outdoor activities while using Atropine.
(3) After long-term use of Atropine, there may still be a reduction in accommodative ability after discontinuation.
(4) It is best to avoid using Atropine too early before a child's visual function is fully developed.
(5) The dosage of atropine eye drops may be too strong for young children.
If necessary, it should be advised to apply gentle pressure to the inner canthus for a few minutes after instillation to prevent systemic effects.
(6) "Very few" patients may experience allergic reactions to atropine eye drops.
(7) "Very few" patients may experience increased intraocular pressure from using Atropine.
Wishing you good health.
Taiwan e-Learning Academy, Department of Ophthalmology, Taipei City Hospital, Zhongxing Branch, Dr.
Liu Jing-Hsi.

Reply Date: 2005/08/29

More Info

The use of cycloplegic agents in children, particularly for the management of myopia (nearsightedness), is a topic of considerable interest and research. Cycloplegic agents, such as atropine, are often used to temporarily paralyze the ciliary muscle of the eye, which can help in accurately measuring refractive errors and managing conditions like myopia. However, there are several concerns and considerations regarding their effects on children's eye development and myopia progression.

1. Impact on Eye Development: The concern that cycloplegic agents might affect eye development in young children is valid. However, studies have shown that when used appropriately, cycloplegic agents do not have a detrimental effect on the normal development of the eye. The primary purpose of these agents is to provide a clearer assessment of refractive error by preventing accommodation (the eye's ability to focus on near objects). In your child's case, the use of cycloplegic agents for a short duration, as prescribed by the physician, is generally considered safe and should not hinder normal eye development.

2. Risk of Glaucoma: The concern about cycloplegic agents causing glaucoma is also noteworthy. While certain medications can increase intraocular pressure, the risk is minimal with the commonly used cycloplegics in children when administered in appropriate doses. However, it is crucial to monitor intraocular pressure, especially in children with a family history of glaucoma or other risk factors. Regular follow-ups with an eye care professional can help ensure that any potential issues are identified early.

3. Myopia vs. Pseudomyopia: The distinction between true myopia and pseudomyopia (a temporary condition often due to excessive near work) is essential. If your child's myopia has stabilized at 200 degrees after the cycloplegic treatment, it suggests that the condition may be more permanent rather than a temporary refractive error. Cycloplegic agents can help in determining the true refractive state of the eye, and if the degree of myopia remains unchanged, it indicates that the child has developed true myopia. Continuing treatment with cycloplegic agents may still be beneficial, especially if the goal is to slow the progression of myopia.

4. Alternative Treatment Options: Besides cycloplegic agents, there are several other strategies to manage myopia progression in children. These include:
- Orthokeratology (Ortho-K): This involves the use of specially designed contact lenses worn overnight to reshape the cornea temporarily, which can help reduce myopia progression during the day.

- Multifocal Contact Lenses: These lenses are designed to provide different focal points and can help in managing myopia progression.

- Atropine Eye Drops: Low-dose atropine drops have been shown in studies to effectively slow the progression of myopia in children.

- Environmental Modifications: Encouraging outdoor activities and reducing screen time can also play a role in managing myopia progression. Studies suggest that increased time spent outdoors may help in reducing the incidence and progression of myopia.

In conclusion, while the use of cycloplegic agents is generally safe and can provide valuable information regarding your child's refractive status, it is essential to have ongoing discussions with your eye care provider about the best management strategies for your child's myopia. Regular check-ups and monitoring will help ensure that any changes in vision are addressed promptly, and appropriate interventions can be implemented to manage myopia effectively.

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