Low concentration atropine for myopia control affects accommodative function, but not near acuity: a real-world prospective case series.

INTRODUCTION: The prevalence of myopia is increasing in children around the world. Optical (glasses, contact lenses) and medical (low-concentration atropine - LCA) management options to slow progression are gaining popularity in the UK; the launch of commercial formulations of LCA is anticipated for 2025. It therefore seems timely to report our experience with the impact of LCA on accommodation and near visual acuity (NVA). METHODS: In this service evaluation - registration number 1582, we retrospectively reviewed the electronic records of 76 children and young people (CYP) using LCA (August 2020-August 2022). Demographic and clinical data - strabismus, near point of accommodation (NPA) and NVA were collected at baseline and 6 months later. RESULTS: We included 47 CYP (23 female), mean age 9.02 years (range 4.7-18.8 years). Thirty-nine had no strabismus, n = 6 exophoria and n = 2 intermittent exotropia. The median (IQR) for NPA before starting LCA was R:6 cm (2 cm) and L:6 cm (2 cm) and the median for NVA was N5 in both eyes. Treatment following initial visit, n = 10 started atropine 0.01%, n = 2 maintained atropine 0.01% usage and n = 2 started atropine 0.01% in addition to optical treatment. Twenty-three children started atropine 0.05% as a first line treatment, n = 7 started atropine 0.05% in conjunction with their previous management and n = 3 stayed on current treatment. At 6 months, the median (IQR) for NPA was R:8 cm (5 cm) L:8 cm (5 cm) and the median of the NVA was N5 in both eyes. Wilcoxon signed-Rank test showed a statistical worsening in NPA following LCA in the right eye Z = -3.358, p < .001 and left eye Z = -3.326, p < .001. Both 0.01% and 0.05% atropine produced impairments to NPA with no change in NVA, and the 6-month change in NPA did not differ significantly between concentrations (U = 175.50, p = .291). No CYP complained of asthenopic symptoms. CONCLUSION: Low-concentration atropine reduces near point of accommodation but does not affect near visual acuity.