By Jamie Chang, Yong Loo Lin School of Medicine, National University of Singapore

Singapore is in a long-standing battle with myopia, a phenomenon that is extremely prevalent. Without slowing the progression of myopia, especially in children, many severe problems will arise in the future – pre-senile cataracts, glaucoma, retinal tears and myopic macular degeneration. But with the introduction of atropine therapy, the rate of myopia progression can be reduced.

During the Singapore Primary Eye Care Symposium (SPECS) 2019 held between 23-24 July 2019 at One Farrer Hotel, Singapore, Dr Foo Fong Yee, Senior Consultant and Head of Paediatric Ophthalmology & Strabismus with the National Healthcare Group Eye Institute at Tan Tock Seng Hospital, was invited to discuss the topic, “Changing paradigms in Myopia: Atropine Therapy”. She discussed commonly known ways to reduce the progression of myopia which include increasing the time spent outdoors and decreasing the amount of near work. Adding on to the non-exhaustive list, she introduced the use of atropine 0.01% eye drops which is consistently evidenced to be effective in slowing the rate of progression. Its benefits surpass other eye drops, being the only medication that not only slows down the myopia progression but stops muscularic receptors from stimulation by acetylcholine, has a growth suppressing influence on extra retinal tissue and does not affect the patient’s vision quality of life.

Although rare, atropine eye drops have side effects which were highlighted by Dr Foo, which include dry mouth, face flushes, headache, and in some instances, photophobia which has a positive correlation to the atropine concentrations. There may also be near vision disturbances which are completely recover 26 months after cessation.

She also advises that prior to commencing the atropine treatment, practitioners must confirm that there are no other treatable ocular problems, the refractive error and the patient’s baseline progression rate should be accurately measured. The patient must be reviewed at regular intervals to ensure no severe side effects, and to check the intraocular pressures.

In addition, studies have shown that increasing the atropine concentration has a higher rate of side effects and potentially higher rate of discontinuation. Hence, Dr Foo encourages that low dose atropine should also be combined with more outdoors time for an inexpensive, safe and effective way to retard myopia progression in myopic children.