Inhibition of myopia by 0.01% atropine eye drops: minimal doses, visual function and possible biological mechanisms
Final Report Abstract
The progression of childhood myopia can be reduced by regular administration of atropine eye drops. Because of the possibility of disturbing side effects (restriction of near vision and glare due to pupil dilation), formulations of atropine concentrations diluted to different degrees (0.01 - 0.05%) have been studied for several years. The mechanisms of atropine on the inhibition of myopia progression are still incompletely known. A clinical trial (SAM IIT) showed good overall tolerability of a formulation containing 0.01% atropine without preservative for 13 months. The initial effect on pupil width subsided after a few days. Accommodation and contrast vision showed no relevant change. An increase in ciliary muscle over time showed a correlation with the increase in myopia. We have studied which other effects of atropine could explain the inhibition of myopia. We have found in the model of the chicken that atropine has a prominent stimulatory effect on dopamine release from the retina. That dopamine itself can inhibit axial eye growth is known since some time. We found that choroidal thickening and dopamine release follow a similar time course – it is in the range of hours which may suggest that regular application of atropine is necessary for an effect. The release of dopamine from the retina correlates with the thickening of the choroid, suggesting that dopamine may be one of the retinal signals for the choroid. Further, we found that binding of atropine to alpha2-Adrenoreceptors may also be important. Our report describes also how the initial application for funding to the DFG generated a number of new interesting ideas and projects. For instance, it merged into the observation that reading with inverted text contrast could inhibit myopia. In summary, we can say that atropine acts in the retina, releases dopamine, thickens the choroid and obviously acts in the tissue layers of the posterior globe.
Publications
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Studies on retinal mechanisms possibly related to myopia inhibition by atropine in the chicken. Graefe's Archive for Clinical and Experimental Ophthalmology, 258(2), 319-333.
Mathis, Ute; Feldkaemper, Marita; Wang, Min & Schaeffel, Frank
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Atropine-induced choroidal thickening in the chicken: interactions with light and dopamine. Poster #104, 15. International Myopia Conference, Rotterdam, September 2020
Mathis U., Feldkaemper M., Liu H. & Schaeffel F.
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A retrospective analysis of the therapeutic effects of 0.01% atropine on axial length growth in children in a real-life clinical setting. Graefe's Archive for Clinical and Experimental Ophthalmology, 259(10), 3083-3092.
Kaymak, Hakan; Graff, Birte; Schaeffel, Frank; Langenbucher, Achim; Seitz, Berthold & Schwahn, Hartmut
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Corneal Penetration of Low-Dose Atropine Eye Drops. Journal of Clinical Medicine, 10(4), 588.
Austermann, Henning; Schaeffel, Frank; Mathis, Ute; Hund, Verena; Mußhoff, Frank; Ziemssen, Focke & Schnichels, Sven
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Effects of Single and Repeated Intravitreal Applications of Atropine on Choroidal Thickness in Alert Chickens. Ophthalmic Research, 64(4), 664-674.
Mathis, Ute; Feldkaemper, Marita Pauline & Schaeffel, Frank
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Studies on the interactions of retinal dopamine with choroidal thickness in the chicken. Graefe's Archive for Clinical and Experimental Ophthalmology, 261(2), 409-425.
Mathis, Ute; Feldkaemper, Marita; Liu, Hong & Schaeffel, Frank
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Ciliary muscle morphology during 13-month 0.01% Atropine treatment of childhood myopia: Results of the SAM IIT trial. Invest. Ophthalmol. Vis. Sci. 2023;64(8):3404
Strasser T., Wagner S., Peters T. & Ziemssen F.
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Immunohistochemical studies on dopamine in the human choroid. Annals of Anatomy - Anatomischer Anzeiger, 260, 152533.
Konwar, Jahnobi; Kaser-Eichberger, Alexandra; Platzl, Christian; Heindl, Ludwig; Mathis, Ute & Schroedl, Falk
