The prevalence of myopia is increasing globally. Complications of myopia are associated with huge economic and social costs. It is believed that high myopia in adulthood can be traced back to school age onset myopia. Therefore, it is crucial and urgent to implement effective measures of myopia control, which may include preventing myopia onset as well as retarding myopia progression in school age children. The mechanism of myopia is still poorly understood. There are some evidences to suggest excessive expansion of Bruch's membrane, possibly in response to peripheral hyperopic defocus, and it may be one of the mechanisms leading to the uncontrolled axial elongation of the globe. Atropine is currently the most effective therapy for myopia control. Recent clinical trials demonstrated low-dose atropine eye drops such as 0.01% resulted in retardation of myopia progression, with significantly less side effects compared to higher concentration preparation. However, there remain a proportion of patients who are poor responders, in whom the optimal management remains unclear. Proposed strategies include stepwise increase of atropine dosing, and a combination of low-dose atropine with increase outdoor time. This review will focus on the current understanding of epidemiology, pathophysiology in myopia and highlight recent clinical trials using atropine in the school-aged children, as well as the treatment strategy in clinical implementation in hyperopic, pre-myopic and myopic children.
摘要: 全球近视的患病率正在急剧上升, 且近视的并发症消耗巨大的社会和财政支出。人们认为, 成年后的高度近视由学龄期发生的近视而来。因此, 实施近视控制的有效措施至关重要, 措施包括预防近视产生以及延缓学龄儿童的近视发展。目前, 然而关于近视的致病机制仍然知之甚少。一些证据表明Bruch膜的过度扩张, 可能引起了周边远视离焦, 并且它可能是导致眼球发生不可控制的眼轴伸长的机制之一。阿托品是目前控制近视最有效的方法。最近的临床试验表明, 与高浓度制剂相比, 低剂量阿托品滴眼液如0.01% 可以延缓近视发展, 副作用明显减少。然而, 仍然有一部分患者的反应较差, 其中最佳处理仍不明确。已提出的临床策略包括逐步增加阿托品给药频率, 以及低剂量阿托品结合增加室外活动时间。本综述将重点介绍目前近视在流行病学、病理生理学中的研究, 以及最近在学龄儿童中使用阿托品的临床试验和临床实施的远视、近视、近视儿童的治疗策略。.