Buy Atropine Drops
Click Here --->>> https://urlgoal.com/2tkyFW
We compound and ship atropine eye drops every Wednesday. It is shipped cold via FedEx Next Day Air directly to your patient at no additional cost. We will reach out to your patient every 6 weeks to confirm their refill and schedule their shipment.
To make caring for children's vision simpler, OSRX offers three low-dose Atropine+ drops. We compound 0.01%, 0.025% and 0.05% concentrations, allowing you to customize myopia treatment by patient. Our OMNI Atropine+ eye drops ship directly to your patients or practice (your choice) at no added cost.
Donders (1864) was the first to recommend atropine as a treatment for myopia when he suggested it for suspected spasms of accommodation in myopic patients (11). One hundred years ago, Pollock was the first to employ prolonged use of atropine for the treatment of myopia (for a duration of several months to almost a year); the therapy also required affected children to avoid reading and writing (13, 83, 84). However, in the following decades of the 20th century, pharmacological treatment of myopia was not pursued. Few researchers from the 1930s to the 1990s conducted new studies (85-97). As previously mentioned, several of those studies completely disproved the hypothesis of convergence as the main cause of myopia, as children in those studies continued to read with both eyes, and therefore converge, with no signs of worsening myopia. In spite the evidence of the effectiveness of atropine treatment, it was not popular among ophthalmologists and had notable detractors (98-101).
A compelling body of evidence has recently emerged from several well-designed studies, including large groups of children, mainly from Asia. Shih et al. (1999) studied the daily use of different concentrations of atropine in 186 schoolchildren followed for up to two years (102). They found that the mean progression of myopia was 0.04 0.63 diopter (D) per year in the group receiving a solution of 0.5% atropine; 0.45 0.55 D per year in the group that received 0.25% atropine; 0.47 0.91 D per year in the 0.1% atropine group, and 1.06 0.61 D per year in the control group who received 0.5% tropicamide. They concluded that although all three concentrations of atropine had a significant protective effect with regard to slowing myopia progression, 0.5% atropine was the most effective (102). In 2001, the same researchers reported the results of another clinical trial that evaluated the effects of atropine with multifocal lenses to decrease the progression rate of myopia in 188 children assigned to three treatment groups. The first group was treated with daily 0.5% atropine concomitantly with use of multi-focal eyeglasses, the second group used only multi-focal eyeglasses, and the third group used single vision eyeglasses. The study had a follow-up time of at least 18 months. The researchers found that over 18 months, the mean progression of myopia in the group treated with atropine and multi-focal eyeglasses (0.42 D) was significantly less than the multi-focal (1.19 D) and single-vision groups (1.40 D) (103). The study Atropine in the Treatment of Myopia (ATOM 1) by Chua et al. (2006) was a randomized, double-blind, placebo-controlled trial including 400 children. It showed that 1.0% atropine eye drops applied daily in one eye over a period of 24 months reduced the progression of myopia by 77% compared with the untreated eye (1.2 D in the control group compared to 0.28 D in eyes treated with atropine) (104). The primary effect of atropine appeared to be by slowing the growth of vitreous chamber depth, which in turn decelerate axial length increase (105).
In 2012, we suggested that applying one eye drop every week, in comparison with one per day, would facilitate compliance among young patients. Our study used 1.0% atropine once per week in conjunction with photochromatic progressive addition lenses (PAL) and ocular hypotensive eye drops, was well tolerated by the patients, and was very effective at stopping myopia progression (113). In a group of 33 patients (66 eyes) aged 6 to 16 years (mean, 11.9 years) treated with ocular hypotensive drops, the baseline spherical equivalent was -4.52 D. At the one-year follow-up, the spherical equivalent was -4.46 D (P = 0.015). This slight reduction of the magnitude of myopia was attributed to the hyperopic shift secondary to the cycloplegic effect of atropine. Progression was essentially zero (113).
As lower concentrations of atropine have been shown to be effective, and considering that the effect can last for up to 2 weeks, we suggest that a future study should investigate a course of treatment that uses 0.5% atropine therapy once or twice per week for one year, which is then changed to 0.01% atropine administered daily (112).
Several meta-analyses have been performed on this topic in the past six years. Walline et al. (2011) concluded that the most probable effective treatment to diminish myopia progression was anti-muscarinic eye drops. However, side effects and unavailability limited clinical use (115). Song et al. (2011) published a meta-analysis of six randomized clinical trials that analyzed the annual rate of myopia progression after daily atropine application over one year. They concluded that lower concentrations (0.05%, 0.1%, and 0.25%) of atropine were not effective because myopia may still progress during use. However, when higher concentrations were used (0.5% and 1%), the progression was controlled for between 6 and 24 months in the diverse studies (116). Another meta-analysis by Li et al. (2014) concluded that atropine could significantly slow myopia progression in children, but showed greater effects in Asian than in Caucasian children. The weighted mean differences in myopia progression between treated and control groups in cohort studies and clinical trials including Asian children were 0.54 D per year and 0.55 D per year, respectively. Progression was smaller (0.35 D per year) in cohort studies including Caucasian children (117). In 2016, Huang et al. published their network meta-analysis of interventions for myopia treatment. They included 30 clinical trials in the analysis (5422 eyes) and performed a random effects network meta-analysis combining direct and indirect evidence. When comparing mean annual change in refraction (diopters/year) and mean annual change in axial length (millimeters/year) with placebo or single-vision eyeglasses, they found that 1.0% and 0.5% atropine (refraction change: 0.68 D; axial length change: -0.21 mm); 0.1% atropine (refraction change: 0.53 D; axial length change: -0.21 mm) and 0.01% atropine (refraction change: 0.53 D; axial length change: -0.15 mm) markedly slowed myopia progression. However, on direct comparison, 1.0% and 0.5% atropine had slightly higher effects compared to 0.01% atropine (refraction change: 0.10 D; axial length change: -0.07 mm) (118).
A clear advantage of very low atropine concentration is tolerance. Several studies have shown that side effects of low-concentration atropine are very uncommon. In 2011 Wu et al. published the results of a retrospective, case-control study including 117 children who received 0.05% atropine, and if progression of more than -0.5 D during a 6-month follow-up was observed, were changed to 0.1% atropine and were followed for at least 3 years. No side effects were reported (107). The ATOM 2 study reported that upon restarting 0.01% atropine in children who showed progression after a 12-month atropine washout (n = 192), there was a mean increase in photopic pupil size of approximately 1 mm and a loss of accommodation of 2.00 to 3.00 D, which were similar to the changes observed when the children were initially assigned to 0.01% atropine during phase 1. These ocular side effects were considered clinically insignificant. Children were offered progressive addition or photochromatic (tinted) glasses if they had problems with near vision when using the single vision eyeglasses, or experienced glare. During phase 1, 7% of children receiving 0.01% atropine requested such glasses, but no child who had restarted 0.01% atropine requested glasses. Pupil size and accommodation returned to levels similar to those in untreated children when examined two months after cessation of 0.01% atropine (111). In 2013 Cooper et al. performed a phase I clinical trial including 12 children with brown irises (one eye included in the study group and the fellow eye used as control), and found that 0.02% atropine was the maximum concentration that could be administered daily without a clinical effect, having defined the target toxicity level as an accommodative amplitude below 5 D, a difference in pupillary diameter equal to or greater than 3 mm, and/or a failure to read very small print (J1) while wearing distance correction (119). Nishiyama et al. found that although accommodation decreased by a mean of 1.5 D and the pupil diameter increased in size by mean 0.7 mm, the subjective symptoms of a group of 16 children receiving 0.01% atropine eye drops daily were minimal after two weeks (120). Recently, Loughman and Flitcroft performed a tolerance study on 14 young Caucasian adults in Ireland, who received one drop of 0.01% atropine in both eyes every day for five days. Photopic pupil size increased between 1.08 and 1.31 mm and amplitude of accommodation decreased slightly; however, there were no negative effects on visual acuity or reading speed. Although there was a slight increase in glare, there was no significant negative impact on quality of life, which was associated with low-dose topical atropine (0.01%) (121).
Additionally, low-concentration atropine has demonstrated some effect in the prevention of myopia onset in children who do not yet present it (pre-myopic). Atropine (0.025%) was administered to children aged 6 to 12 years with a spherical equivalent between +1.00 and -1.00 D, who were followed for at least 12 months. Twenty-one percent of the children receiving atropine became myopic, compared to 54% of those in a control group (123). 59ce067264