Age effect on treatment responses to 0.05%, 0.025%, and 0.01% atropine: Low-concentration Atropine for Myopia Progression (LAMP) Study

  • Fen Fen Li
    Affiliations
    Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong
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  • Yuzhou Zhang
    Affiliations
    Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong
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  • Xiujuan Zhang
    Affiliations
    Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong
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  • Benjamin Hon Kei Yip
    Affiliations
    Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong
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  • Shu Min Tang
    Affiliations
    Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong

    Department of Ophthalmology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
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  • Ka Wai Kam
    Affiliations
    Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong

    Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
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  • Alvin L. Young
    Affiliations
    Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong

    Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
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  • Li Jia Chen
    Affiliations
    Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong

    Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China

    Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong
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  • Clement C. Tham
    Affiliations
    Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong

    Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China

    Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong

    Hong Kong Eye Hospital, Hong Kong SAR, China
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  • Chi Pui Pang
    Affiliations
    Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong

    Hong Kong Eye Hospital, Hong Kong SAR, China
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  • Jason C. Yam
    Correspondence
    Correspondence: Jason C. Yam Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong;
    Affiliations
    Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong

    Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China

    Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong

    Hong Kong Eye Hospital, Hong Kong SAR, China

    Department of Ophthalmology, Hong Kong Children’s Hospital, Hong Kong SAR, China
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Published:January 07, 2021DOI:https://doi.org/10.1016/j.ophtha.2020.12.036

      Abstract

      Purpose

      To investigate the effect of age at treatment and other factors on the treatment response to atropine in the Low-concentration Atropine for Myopia Progression (LAMP) study.

      Design

      Secondary analysis from a randomized trial.

      Participants

      350 children, aged 4 to 12 years, randomization stratified by age and gender, originally assigned to receive 0.05%, 0.025%, 0.01% atropine, or placebo once daily in both eyes who completed 2 years of the LAMP study were included in this study. In the second year, the placebo group was switched to 0.05% atropine group.

      Methods

      Potential predictive factors for treatment response, that is, change in spherical equivalent (SE) and axial length (AL) over two years, were evaluated by generalized estimating equations in each of treatment group separately. The factors evaluated included age at treatment, gender, baseline refraction, parental myopia, time outdoors, diopter hours of near work, and treatment compliance. Estimated mean values and 95% CIs of change in SE and AL over two years were also generated.

      Main outcome measures

      Factors associated with SE change and AL change over two years were the primary outcome measures. The associated factors during the first year were secondary outcome measures.

      Results

      In 0.05%, 0.025%, and 0.01% atropine group, younger age was the only factor associated with SE progression (coefficient=0.14, 0.15, and 0.20, respectively) and AL elongation (coefficient=-0.10, -0.11, and -0.12, respectively) over two years; the younger age, the poorer response. At each year of age from 4 to 12 across the treatment groups, higher-concentration atropine showed a better treatment response, following a concentration-dependent effect (P-trend for each age group <0.05). In addition, the mean SE progression in 6-years-old children in 0.05% atropine (-0.90D, 95%CI: -0.99, -0.82) was similar to that of 8-years-old in 0.025% atropine (-0.89D, 95%CI: -0.94, -0.83), and 10-years-old in 0.01% atropine (-0.92D, 95%CI: -0.99, -0.85). All concentrations were well tolerated at all age groups.

      Conclusions

      Younger age is associated with poor treatment outcomes to low-concentration atropine at 0.05%, 0.025%, and 0.01%. Among atropine concentrations studied, younger children required the highest 0.05% concentration to achieve similar reduction in myopic progression as older children on lower concentrations.

      Abbreviations and acronyms:

      LAMP ( Low-concentration Atropine for Myopia Progression study), D ( diopters), SE ( spherical equivalent), AL ( axial length), HRs ( hazard ratios), CIs ( confidence intervals), VFQ ( Visual Function Questionnaire)
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