Classification-Based Approaches to Myopia Control in a Taiwanese Cohort

Meng-Wei Hsieh; Hsu-Chieh Chang; Yi-Hao Chen; Ke-Hung Chien

doi:10.3389/fmed.2022.879210

Classification-Based Approaches to Myopia Control in a Taiwanese Cohort

Front Med (Lausanne). 2022 Jun 10:9:879210. doi: 10.3389/fmed.2022.879210. eCollection 2022.

Authors

Meng-Wei Hsieh^{1

2}, Hsu-Chieh Chang^{3

4}, Yi-Hao Chen^{2

5}, Ke-Hung Chien^{2

5}

Affiliations

¹ Department of Ophthalmology, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan.
² National Defense Medical Center, Taipei, Taiwan.
³ Department of Nursing, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan.
⁴ Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
⁵ Department of Ophthalmology, Tri-Service General Hospital, Taipei, Taiwan.

Abstract

Purpose: Myopia is a disorder of growing prevalence in school-aged children worldwide, especially in Asia. Although low-dose atropine is recognized as an effective treatment to slow myopia progression, different studies have reported varying efficacies of treatment, and the optimal concentration of low-dose atropine remains an open question.

Methods: A two-stage approach was conducted in this study. First, an observational study was conducted to plot the axial length growth curve for Taiwanese children. Second, an interventional 2-year study was performed in which different concentrations of low-dose atropine were applied based upon the risk-level status from the first stage.

Results: A total of 4,091 subjects, consisting of 2,105 boys (51.5%) and 1,986 girls (48.5%), were enrolled in the first stage to plot the axial growth curve for Taiwanese children aged between 3 and 16 years. The percentage of children with myopia increased from 2.3% in 4-year-olds to 88.0% in 16-year-olds. At the second stage, a total of 886 subjects [307 (34.65%) at low risk, 358 (40.41%) at moderate risk and 221 (24.94%) at high risk] were enrolled to receive low-dose atropine based upon the risk level (0.02, 0.03, and 0.05%, respectively). With this approach, the mean annual myopia progression was -0.33, -0.57, and -0.82 D in the low-risk, moderate-risk and high-risk groups, respectively. Applying annual myopic progression < -1.0 D as a criterion for responder, the responder rates were 95.77, 83.52, and 70.59% in the low-risk, moderate-risk, and high-risk groups, respectively.

Conclusions: We proposed a classification-based approach involving different concentrations of low-dose atropine based upon an individual's risk-level status. With this approach, myopic progression can be effectively controlled in patients without exposure to atropine side effects due to exposure to a higher dose than actually needed.

Keywords: atropine; low-dose atropine; myopia; myopic control; pediatric ophthalmology.