Child Patient Story with Focus on Early Mitigation

Axial length is definitely the best way to measure progression of myopia. In an ideal world, I would like to have both. If I have the choice between axial length and spherical equivalent, definitely axial length, however, acknowledging that not everyone has access to axial length measurement equipment, I would say that having some sort of progression tracking, such as spherical equivalent, is better than nothing.

Until only a few years ago, I used to start all patients on 0.01% atropine eye drops; but now, I access the patient and the dosage depends on their profile e.g. if the patient is a 10 year-old hyperope or a very low myope or so, I might very well start them on 0.01%, however, if that same patient profile is already at -3.00 diopter, the question is: can we really afford to start with 0.01% and wait and see what happens? In such a case, I would say that the benefits of a higher dosage outweigh any risks.

In the past, we used to think that there is a time limit on how long you can use atropine drops in children, however, in my opinion there really isn’t any time limit and as long as their myopia is progressing, I would continue; it is not until the progress halts or minimises that I would consider tapering them off atropine. I would caution against suddenly stopping treatment because you risk a sudden rebound and all the years of treatment are then wasted.

First of all, I would caution against suddenly stopping treatment because you risk a sudden rebound and all the years of treatment are then wasted. I would taper the patient off instead and how this is done depends very much on whether the patient is on a high or lower dosage of atropine.

For high dosage patients, it will take longer becuase the risk of a rebound is higher.

For a patient on 0.01% how uses atropine everyone night, you could for example reduce it to six days per week for three months; then 5 days per week for three months and so on.

If the child’s myopia has stablised for one to one and a half year; but it also really depends on age, the older the child is, the more likely we are to stop treatment, whereas with a young child, we are more likely to taper off the treatment more slowly, for example, with atropine drops, we may reduce the treatment every six months as opposed to every three months for an older child.