The Association of Choroidal Thickening by Atropine With Treatment Effects for Myopia: Two-Year Clinical Trial of the Low-concentration Atropine for Myopia Progression (LAMP) Study

To evaluate longitudinal changes in subfoveal choroidal thickness (SFChT) among children receiving atropine 0.05%, 0.025%, or 0.01% over 2 years and their associations with treatment outcomes in myopia control. Double-blinded randomized controlled trial. SFChT was measured at 4-month intervals using...

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Bibliographic Details
Published in:American journal of ophthalmology 2022-05, Vol.237, p.130-138
Main Authors: Yam, Jason C., Jiang, Yuning, Lee, Jackie, Li, Sherie, Zhang, Yuzhou, Sun, Wen, Yuan, Nan, Wang, Yu Meng, Yip, Benjamin Hon Kei, Kam, Ka Wai, Chan, Hei-Nga, Zhang, Xiu Juan, Young, Alvin L., Tham, Clement C., Cheung, Carol Y., Chu, Wai Kit, Pang, Chi Pui, Chen, Li Jia
Format: Article
Language:English
Subjects:
Atropine - therapeutic use
Axial Length, Eye
Biomarkers
Child
Choroid
Clinical outcomes
Compliance
Humans
Myopia - diagnosis
Myopia - drug therapy
Ophthalmology
Outdoor activities
Questionnaires
Refraction, Ocular
Software
Tomography, Optical Coherence
Variance analysis
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Summary:To evaluate longitudinal changes in subfoveal choroidal thickness (SFChT) among children receiving atropine 0.05%, 0.025%, or 0.01% over 2 years and their associations with treatment outcomes in myopia control. Double-blinded randomized controlled trial. SFChT was measured at 4-month intervals using spectral domain optical coherence tomography. Cycloplegic spherical equivalent (SE), axial length (AL), best-corrected visual acuity, parental SE, outdoor time, near work diopter hours, and treatment compliance were also measured. 314 children were included with qualified choroidal data. The 2-year changes in SFChT from baseline were 21.15 ± 32.99 µm, 3.34 ± 25.30 µm, and −0.30 ± 27.15 µm for the atropine 0.05%, 0.025%, and 0.01% groups, respectively (P < .001). A concentration-dependent response was observed, with thicker choroids at higher atropine concentrations (β = 0.89, P < .001). Mean SFChT thickness significantly increased at 4 months in the atropine 0.025% (P = .001) and 0.05% groups (P < .001) and then remained stable until the end of the second year (P > .05 for all groups). Over 2 years, an increase in SFChT was associated with slower SE progression (β = 0.074, P < .001) and reduced AL elongation (β = −0.045, P < .001). In the mediation analysis, 18.45% of the effect on SE progression from atropine 0.05% was mediated via its choroidal thickening. Low concentration atropine induced a choroidal thickening effect along a concentration-dependent response throughout the treatment period. The choroidal thickening was associated with a slower SE progression and AL elongation among all the treatment groups. Choroidal response can be used for assessment of long-term treatment outcomes and as a guide for concentration titrations of atropine.
ISSN:0002-9394
1879-1891
DOI:10.1016/j.ajo.2021.12.014