National research into the correct dosage of eye drops for children

More and more children in the Netherlands are becoming myopic

Eye drops containing atropine can prevent severe myopia, but they also have side effects. Therefore, it is important not to give more than strictly necessary. Researchers at Erasmus MC are starting a national study of the correct dosage for children

More and more children in the Netherlands are becoming myopic, probably from reading, watching a lot of screens and not playing outside much. Children with nearsightedness or farsightedness need glasses or contact lenses to see far away clearly. In the Netherlands, it is estimated that more than 12,000 children each year are diagnosed with high myopia, which can experience serious problems in adulthood.

In the new Myopia Atropine Dose (MAD) study, children with progressive myopia (more than -0.5 diopters per year) are given atropine eye drops. Atropine as an eye drop causes a dilated pupil and temporary loss of the ability to focus. “It has previously been discovered that atropine inhibits the length growth of the eye when used daily. The idea is that it reduces the risk of severe myopia,’ says orthoptologist Jan Roelof Polling from Erasmus MC.

The purpose of the study is to determine the correct dose of the eye drops. Half of the children receive an atropine eye drop daily with a dose of 0.5% (high dose), and the other half receive 0.05% (low dose). The researchers compare the glasses’ strength, eye growth, compliance and side effects in these children and share them via a national online platform. The data form the basis of a guideline for the treatment of myopia in the Netherlands.

In the study, the researchers focus on children between 6 and 12 years of age with a lens strength of between -1.5 and -6 diopters. Poll: ‘Most children develop myopia during that period. And the younger they are myopic, the higher the prescription of glasses later on.’

Behind a seemingly small problem lies a big risk. ‘Parents might think: My child is 8 or 9 years old and has -1.5, it’s not so bad. But that is not true. Half of these children become very myopic and have a prescription of -6 or more by the time they turn 25. These are children who may become severely visually impaired later in life.’

In particular, high myopia, as doctors call the eye condition, a lens power of -6 or more, causes retinal detachment and eye diseases such as glaucoma and macular degeneration and increases the risk of blindness later in life. Myopia is increasing dramatically worldwide, including in the Netherlands, as previous research from the Erasmus MC showed. Experts expect myopia to become the leading cause of blindness in the Netherlands by 2050.

Polling regularly hears that parents or specialists want to look at the onset of myopia. ‘Incomprehensible. Because then it’s too late. You have to intervene with young children, otherwise they will have serious complications later in life. Other therapies are available. They work but are not as effective as atropine. We have no time to lose.’

In 2012, Erasmus MC started giving 0.5% atropine eye drops to 124 myopic children every day. The children were followed for 3 years by the researchers. Poll: ‘The most important finding from our research is that eye growth was stunted by up to 75% in these children. And by inhibiting the growth of the eye, the risk of severe myopia is also reduced.’

More light in the eye due to the atropine drops can be bothersome. Children suffer from bright daylight, and the drops prevent the function of the eye muscles needed to see clearly up close. This can lead to headaches and reading difficulties. ‘Children are now given self-tinted progressive lenses during treatment, so the side effects are reasonably tolerated.’

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