New Study Compares Myopia Control Methods

HOT TOPIC

Myopia Control Showdown: Ortho-K vs. 0.04% Atropine vs. 0.01% Atropine

A new, randomized clinical trial published in JAMA Ophthalmology compared the efficacy of 0.01% and 0.04% atropine eye drops with orthokeratology (ortho-k) for controlling myopia in 209 children 8 to 15 years of age with refractive errors between -1.00 D and -4.00 D. Conducted in Shanghai, China, the study found that 0.04% atropine was the most effective in slowing axial length (AL) elongation over 2 years, with a mean difference of 0.18 mm less growth compared with 0.01% atropine and no significant difference between 0.01% atropine and ortho-k (0.08 mm).

Approximately 70% of participants completed the 2-year follow-up, with 48, 48, and 53 children in the 0.01% atropine, 0.04% atropine, and ortho-K groups, respectively. The 0.04% atropine group consistently showed the best treatment effect at all visits, followed by ortho-k and 0.01% atropine. Age was a factor, with younger children showing faster AL growth, particularly in the 0.01% atropine group. Adverse effects included photophobia, affecting 55.2% of the 0.04% atropine group and 25.3% of the 0.01% group at 3 months, declining to 22.9% and 2.1% by 2 years. Despite the study’s efficacy, critics highlighted limitations, including small subgroup sizes (16-18 per group) and insufficient statistical power, which hindered age-specific conclusions. The study, conducted during the COVID-19 lockdown, lacked data on behavioral confounders such as outdoor time and near work, which could have skewed the results.

An invited commentary in JAMA Ophthalmology questioned the claim that 0.04% atropine benefits older children, suggesting it outperforms ortho-k and 0.01% atropine across all ages studied. The findings advocate for 0.04% atropine as a promising option for myopia control, particularly in younger children with mild myopia; however, further validation is needed due to data limitations.

According to the study's authors, the findings suggest ortho-k should be used in younger children to maximize its advantage over 0.01% atropine; 0.04% atropine might benefit younger children with mild myopia, although further validation is needed.

My Two Cents

I interpreted these findings as another strike against 0.01% atropine drops—and another feather in the cap of 0.04 or 0.05% atropine drops. Meanwhile, ortho-k continues trudging along as old reliable. In my experience, as more studies continue to be released about the efficacy of atropine in managing myopia, it should, at some point, become the standard of care. However, something we must also keep in mind is that the standardization of atropine drops is lacking. All atropine drops must be obtained from a compounding pharmacy. But, as we all know, there is a vast difference between the efficacy of drops even if they have the same amount of active ingredient. A perfect example is that of cyclosporines from Harrow. Both Verkazia and Vevye are 0.1% cyclosporine; however, the feeling, comfort, and likely the efficacy are very different. They’re not even approved for the same disease state!

Fingers crossed we get an FDA-approved drop for myopia management sooner rather than later. Speaking of which, if you haven’t heard, the FDA set a target Prescription Drug User Fee Act date of October 23, 2025, for SYD-101 (Sydnexis), an eye solution designed to slow down the progression of myopia in children. Oh, and by the way Sydnexis: I noticed there’s not a single optometrist on your management team or board of directors. That’s like dedicating a new company solely to pediatric asthma and not having a pediatrician on your board. Not a good look.

OUTSIDE THE LANE

Study Finds Link Between Seasonal Conditions and Incidence of RRD

A systematic review published in Retina explored the seasonal incidence of rhegmatogenous retinal detachment (RRD), analyzing 18 studies with 384,723 cases across North America, Europe, Asia, and Australia. Two-thirds of the studies, covering 95% of cases, identified a seasonal pattern, with higher RRD incidence in spring and summer compared with fall and winter, in the Northern Hemisphere.

This trend was consistent in Asian and European studies, but less evident elsewhere due to limited data. The study authors suggest meteorological factors, such as low atmospheric pressure and high solar radiation, may contribute to RRD by inducing physiological changes in the vitreous, retinal vessels, vitreoretinal adhesion, and retinal pigment epithelium function. For instance, higher temperatures may accelerate posterior vitreous detachment by promoting vitreous liquefaction, potentially leading to retinal tears. Low atmospheric pressure might cause hypoxia, resulting in choroidal and vascular changes that compromise retinal function and promote subretinal fluid accumulation; however, the study could not establish causation, and alternative explanations were proposed. Warmer seasons may increase hospital visits due to trauma, a known RRD risk factor, and heighten atopic conditions, leading to eye rubbing, another risk factor. The authors also noted summer’s better weather may improve hospital access compared with winter, when harsh conditions could limit transportation. Due to methodological differences among studies, a formal meta-analysis was not feasible, but the findings suggest a link between seasonal conditions and RRD incidence.

The researchers recommend multimodal retinal imaging to investigate further subtle physiological changes related to solar radiation and atmospheric pressure. While the study highlights a compelling seasonal trend in RRD, the authors caution that these associations require further research to clarify underlying mechanisms and confirm contributing factors.

My Two Cents

What a weird factoid that seems to very much be true, given that out of 18 comprehensive RRD studies, 95% found a seasonal connection of higher RRD incidence in the spring and summer. It’s just an elegant piece of eyeball knowledge that’s cool to know.

CAN YOU RELATE

How great is technology? Sure, it’s often flawed, and for every great experience, there are times when it lets us down in a big way. In fact, just this past weekend, I experienced both its highs and lows. Let me explain.

Each summer, in addition to going up to my family’s favorite little vacation destination in northern Michigan, I also return to my roots in mid-Michigan and attend one of the area’s oldest and largest community festivals, the Munger Potato Festival. Munger is home to 1,453 people, and it’s in the middle of nowhere. There are no streetlights, and if you blink while driving, you might pass straight through town and miss it completely. Munger is where my mom was born and raised and, exactly 70 years ago, my grandpa Erv Witucki brought the Munger Potato Festival to life. It’s an event that continues to foster an unbelievable amount of community pride and draws people from all over for its demolition derby, car races, and large beer tent.

The technological high I experienced occurred on my way to and from Michigan. While waiting for the two flights it took to get me and my son to mid-Michigan, I was in constant contact with my team resolving different patient issues regarding medication, new problems that had popped up, things that patients had questions about, and various other clinical issues. Thanks to our excellent EMR system, Modernizing Medicine, I was easily able to view all my patients’ charts, prescriptions, and other pertinent information securely from my phone. We handled every issue—and there were plenty—with ease, making my life, my team’s life, and most importantly, my patients’ lives a whole lot easier. How many people can say they love their EMR system? Modernizing Medicine didn’t even pay me to say that!

As for the technological low I experienced, it seems United Airlines has an issue every time I fly. Due to multiple computer outages and seemingly poor organization, my son and I spent hours delayed. In fact, we were so delayed at one point on Sunday that I was back on Modernizing Medicine figuring out which patients were going to need to be moved from my schedule on Monday morning if I couldn’t make it to clinic and which ones could be seen by someone else in my practice and have testing done, so that I could review the results and call them later in the day to discuss the road forward with treatment. Again, technology gives and technology takes.