Progressive Addition Lenses Beneficial in Children Receiving Atropine for Myopia Control

Visual complaints during atropine therapy may be reduced by using progressive addition lenses.

Progressive addition lenses (PAL) may be helpful for children undergoing topical atropine treatment for myopia control, including those receiving medium to high doses, indicated new findings.

The research supported the use of comprehensive eye examination during the myopia development period in children receiving topical atropine to control progression and in addition, the use of a customized near prescription for their Harmon distance if an abnormal accommodative lag was observed.

“Visual complaints during atropine therapy can be reduced by using PAL, and this may also contribute to a decrease in the dropout rate,” wrote study author Hui-Ying Kuo, PhD, Department of Optometry, Chung Shan Medical University. “However, further studies are required to examine the effect of this combination treatment, the long-term impact of atropine therapy and public strategies for myopia control in children.”

Recent years have shown the increasing effects of myopia in younger generations, with nearly 1.95 billion individuals worldwide and 0.28 billion suffering from high myopia. The most widely studied non selective muscarinic antagonist is atropine and it is used extensively in children to slow myopia progression, particularly in Asia.

Clinicians have raised concerns on the application of higher doses of atropine and their subsequent strong side effects. However, the 1% atropine ophthalmic solution can effectively increase the thickness of the choroid and prevent further axial elongation in myopic children, while the 0.01% showed the opposite outcome, according to investigators. To strike a balance between its efficacy and its side effects, a comprehensive eye examination is required for children undergoing atropine treatment.

The aim of the current study is to assess the changes in visual function before and after prescribing near-addition lenses in children receiving topical atropine. Investigators also studied the adaptation to these lenses and the method of determining the optical near prescription.

The study recruited a total of 40 children aged 7 to 12 years, including 23 males and 17 females, from two public elementary schools in Taiwan. All participants were undergoing atropine treatment for at least 6 months before the baseline examination and continued receiving the therapy during the following year.

At both the baseline and the final examination (1-year follow-up), a series of visual function assessments were performed. This included distance best-corrected visual acuity (BCVA) for each eye, high and low contrast visual acuity at near, accommodative lag, horizontal heterophoria, stereopsis, near points of convergence (NPC), and a questionnaire of daily visual complaints. The Harmon distance was considered the optimal viewing distance for reading and other close work.

The study data report a significantly positive correlation between the atropine concentration and the lag of accommodation (r = .41; P = .0001). 80% of the children had an accommodative lag >2.00 D at their Harmon distances.

Moreover, statistically significant differences in visual acuity were observed with and without the PAL. Distance visual acuity without and with the distance prescription was 0.41 ± 0.33 and 0.06 ± 0.06 logMAR, respectively (P <.0001). Significant differences in both high and low contrast near visual acuity were observed with the PAL (P <.0001), according to investigators.

Additionally, the PAL produced a significantly longer mean NPC break (12.68 ± 7.00 vs. 10.98 ± 6.26 cm) and recovery (17.97 ± 7.10 vs. 16.13 ± 6.68 cm; P = 0.05). Similarly, investigators observed a significant difference in near heterophoria (−1.20 ± 4.77 vs. −3.90 ± 4.91; P < .0001).

The mean corrected distance heterophoria was 2.91 ±5.62 Δ and 45% of the participants showed improved stereoacuity with the near correction. Daily visual complaints were compared both with and without the PAL. Lower scores showed fewer complaints and/or higher satisfaction with the lenses and no significant differences were found regarding the use of the computer, writing homework, and reading.

The study, “The use of progressive addition lenses to improve the daily visual function of children receiving topical atropine treatment,” was published in Ophthalmic & Physiological Optics (OPO).

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