A higher atropine concentration may be more effective at preventing myopia from progressing, but it usually comes with more side effects. You could work with your doctor to reduce or mitigate the impact of these side effects on your kid.
My experience with atropine
Thirty years ago, my parents took me to an eye doctor to help me manage my myopia progression. Even though I was prescribed atropine, I was not a successful case – my myopia continued to progress to -9.5 D when I reached 18 years old.
Thinking back, there were a number of reasons why I was not successful in preventing my myopia from progressing – a lack of understanding of the importance of lifestyle modifications, the light-sensitivity (photophobia) side effect of the high concentration atropine, and treatment non-persistency.
When my son started his myopia control treatment, I was grateful at the advancement in the area. Not only were there more options, understanding of how to use these treatments to manage myopia also had advanced significantly.
My son’s positive experience with atropine
My son received Ortho-K and 0.05% atropine combination treatments from the beginning since we took a more aggressive treatment strategy.
The use of low concentration atropine was supported by a clinical study that reported it effectively reduced the risk of myopia progression. Moreover, the low concentration option had minimal side effects compared to higher concentrations.
Further, a more recent study indicated that 0.05% atropine was the most effective low concentration option – among 0.01%, 0.025%, and 0.05% – without increasing the risk of side effects that may impact the vision-related quality of life.
It had been four weeks since my son started his atropine – once nightly before bed. The 0.05% atropine was well-tolerated with temporary blurred vision. Further, the side effect never bothered him because he always went to bed soon after.
My son's experience with atropine was good. It was just like having another eye drop. (We later found out that there were also the blurry near vision side effect -- can't read texts of font sizes less than 11 --but have migrated its impact by adjusting the dosing frequency -- more detail here in the link)
A not-so-good case with atropine
My son had a nanny when he was a toddler. The nanny’s granddaughter also developed myopia but had a negative experience with atropine.
The granddaughter was diagnosed with myopia and treated with a higher atropine concentration – 0.3%. After one month of treatment, she refused to continue.
She complained that she could taste the bitterness of atropine, and it caused her to gag. Furthermore, she had become extremely photophobic, which was disruptive as she was on her school’s basketball team.
She would complain that she couldn’t open her eyes. It was too bright. Even though we had only switched on the light in the room.”
My nanny didn’t understand what was going on. After several failed attempts to convince her to continue, she threw in the towel without realizing she could talk to the doctor and find a way to mitigate the side effect or even change to another treatment option.
So, what was happening?
Her eye drop drained down into the back of her nose and throat through the tear duct. Since the atropine she was using had a terrible taste, she threw up. (I think the atropine she had, like many eye drops, were developed without considering its taste)
Furthermore, the concentration of the atropine didn’t seem to be appropriate for her lifestyle. The higher concentration of atropine might be more effective, it intolerably increased her sensitivity to light, which also lasted too long into the second day, impacting her everyday life.
How to address these atropine-related side effects
As with any prescription drug, if your kid experiences any side effects, you should contact and see your doctor as soon as possible. Some questions to discuss with your doctor include,
- My kid is experiencing [side effect descriptions]. What may be the cause? Could we avoid or mitigate it?
- Are there other alternatives or different treatments if we want to continue his myopia control?
- Can you help my kid and me better understand what may be the impact of not continuing treatment?
Furthermore, a common way to help resolve tasting eye drops is to pinch the tear ducts at the corners of your kid’s eyes nearest the nose. With the tear duct shut, have your kid’s eyes closed for one to two minutes. Then, wipe off any excess eye drops.
This ensures sufficient atropine is absorbed while excess doesn’t drain down into the back of the throat.
Final thoughts
Myopia progresses rapidly during the first few years of onset, then slows down as your kid grows. An aggressive treatment strategy is a promising approach for myopia control, but it should be tolerable.
When treated with atropine, communicate with the eye doctor closely, especially if your kid experiences any side effects.
After all, if in pursuing efficacy, a drug’s side effects lead to non-persistency. It is the same as not being treated at all.
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