Zhu Qin, Chen Li, Liang Jia-Rui, Hu Min, Xue Li-Ping, Zhou Guang-Long, Zhou Yuan, Zhang Jie-Ying, Fernandez-Hazoury David, Helman Allison, Zhu Ying-Ting, Zhang Xiao-Fan
Department of Pediatric Ophthalmology, Affiliated Hospital of Yunnan University, Kunming 650021, Yunnan Province, China.
BioTissue (Tissue Tech Inc), Miami, Florida 33032, USA.
Int J Ophthalmol. 2024 Nov 18;17(11):2129-2140. doi: 10.18240/ijo.2024.11.20. eCollection 2024.
Myopia is a huge health problem due to its high frequency, vision losses and public health cost. According to the World Health Organization, at least 2.2 billion people have vision impairment. Although myopia can be controlled at its early and middle stages, unfortunately, no cure can be achieved so far. Among the methods to control myopia, atropine, a muscarinic receptor antagonist, is the oldest but still the most effective for retardation of myopia progression. Despite such a fact, standard protocols have not been established for clinicians to use atropine for treatment of myopia. In this article, a concise and up to date summary of myopia epidemiology and pathogenesis and summarized therapeutic effects and side effects, possible mechanisms and application methods of atropine were provided in hope for clinical doctors to effectively control this problematic disease. At present, the protocol is recommend: use higher dose (1%) of atropine intermittently to effectively slowdown myopia progression in schoolchildren for 2y, and to significantly reduce side effects of atropine by decrease of atropine frequency for 1y and inhibit myopic rebound by withdrawal of topical atropine gradually for 1y. Application of a lower dose (0.05%) atropine regime should also be considered due to its effectiveness and application at regular basis.
近视是一个严重的健康问题,因其高发病率、视力损害以及公共卫生成本。据世界卫生组织统计,至少有22亿人存在视力障碍。尽管近视在早期和中期可以得到控制,但遗憾的是,目前尚无治愈方法。在控制近视的方法中,毒蕈碱受体拮抗剂阿托品是最古老但仍然是延缓近视进展最有效的药物。尽管如此,临床医生使用阿托品治疗近视尚未建立标准方案。本文对近视的流行病学、发病机制进行了简要且最新的总结,并概述了阿托品的治疗效果、副作用、可能的作用机制及应用方法,以期临床医生能有效控制这一疑难病症。目前推荐的方案是:间歇性使用高剂量(1%)阿托品,可有效减缓学龄儿童近视进展2年,并通过减少阿托品使用频率1年显著降低其副作用,通过逐渐停用局部阿托品1年抑制近视反弹。由于低剂量(0.05%)阿托品方案有效且可定期应用,也应予以考虑。