Atropine Therapy for Myopia Management
Disclaimer – Atropine therapy is not our first choice in myopia management. While effective in myopia management, it can interfere with visual performance. We will only use atropine therapy when we have exhausted other options, or it is the patients preference.
Are you considering Atropine therapy or penalization therapy? If so, read on. If you haven’t heard about atropine therapy, then you should also read on. There are several things at the end that parents really need to be aware of.
What is Atropine therapy?
Atropine therapy is used to treat amblyopia, or what’s commonly called ‘lazy eye’. Amblyopia is when the eye is physically healthy, but has not developed proper vision. It’s as though the hardware is there, but the software is not. This can be caused by the eye being turned, obstructed, or not receiving a clear image during development.
The principal behind atropine therapy has been used for years with patching. If you cover the ‘good eye’, then the brain is forced to use the bad eye, which leads to better development than when it’s completely ignored. Patching has it’s limitations because it does not teach the brain to use the eyes together, and often it’s difficult to get a child to wear a patch outside of Halloween.
What does atropine do?
Atropine affects the eye by dilating the pupil and totally relaxing the focusing mechanism, preventing the eye from getting a clear image. In essence, it is a way of patching without the patch.
Exactly what is atropine?
Atropine belongs to a class of drugs called anti-cholinergics. It is also given to treat bradycardia (too slow of a heart rate). This means that in some cases a person can have adverse reactions to atropine administered in the eye due to it draining into the nasal passage and being ingested.
What is the upside of atropine therapy?
Atropine therapy gets rid of the debate about wearing a patch, as once it is administered, the eye is blurry until the drop wears off. This is seen as helpful in cases where children will not wear a patch.
What is the downside of atropine therapy?
In many cases of atropine therapy, a child may have visual acuity in the amblyopic (‘bad’) eye of 20/200 or greater. This is considered to be legally blind in most places. In some cases by penalizing the good eye full time, a child will be operating in the world with the same vision as a person we consider legally blind. Often that child is in school, trying to read and learn, play on a playground, and develop, all with severely compromised vision. Many of these children already struggle with hand-eye coordination or reading, due to visual problems that are unrelated to what atropine is treating, but often co-exist. This doesn’t even speak to the potential for a reaction to the atropine, which I have seen too many times.
Are there alternatives?
The downside of both patching and atropine is that it never teaches the brain to use the eyes together. Dichoptic training has been shown to be more effective than patching. This is where red-blue or red-green glasses are worn and a person plays games that require the use of both eyes at the same time.
In most cases of amblyopia, the child is lacking more than just clear vision. By patching or using atropine and making the ‘bad eye’ have better clarity, it still does not address problems with depth perception, hand-eye coordination, eye tracking when reading or other visual skills.
This is where optometric vision therapy comes in. An individualized program is created to treat and develop all these visual areas. The major downside to vision therapy is that it requires a lot of work. It can require months of 20 minutes of effort per day, although it achieves lasting results. Many parents report that the time invested is reclaimed in multiples by the time saved from having to help with homework when the visual problems have been affecting academic performance.
I believe that atropine has it’s place in care as a last resort. It only treats the problem of clarity, not the other issues of depth perception and eye teaming problems that are most often present in amblyopia. It also comes with potential drug reactions, and can majorly hinder a child’s ability to function. Before a parent puts their child on atropine therapy, I highly recommend that they use the atropine themselves for a few days. At least that way it’s an educated decision.Our practice serves patients from Victoria, Nanaimo, Duncan, and Vancouver Island, British Columbia and surrounding communities.