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)To read this article in full you will need to make a payment
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Article Info
Publication History
Accepted:
December 31,
2020
Received in revised form:
December 23,
2020
Received:
September 24,
2020
Publication stage
In Press Journal Pre-ProofFootnotes
Conflict of Interest Disclosures: no conflicting relationship exists for any author.
Sources of funding: This study was supported in part by the CUHK Jockey Club Children Eye Care Programme; the General Research Fund (GRF), Research Grants Council, Hong Kong (14111515 and 14103419 [JCY]); the Health and Medical Research Fund (HMRF), Hong Kong (5160836 [LJC]); direct grants from the Chinese University of Hong Kong (4054197 [CPP], 4054193 [LJC], and 4054121 & 4054199 [JCY]); the UBS Optimus Foundation Grant 8984 [JCY]; and the Centaline Myopia Fund [JCY].
Human subjects: Written informed consents were obtained from parents or guardians, and verbal consent from the study subjects. The study is registered with the Chinese Clinical Trial Registry (identifier; ChiCTR-TRC-13004032) and the Clinical Trials Registry of the Centre for Clinical Research and Biostatistics (CCRB), The Chinese University of Hong Kong (identifier: CUHK_CCT00383). It was approved by the Ethics Committee of Hong Kong Eye Hospital. All procedures were conducted according to the tenets of the Declaration of Helsinki. No animal subjects were used in this study.
Identification
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© 2021 Published by Elsevier Inc. on behalf of the American Academy of Ophthalmology
