Myopia Control with Atropine for Kids with Myopia

Hey Good optometry morning. Dr. Michael Nelson, your youtube eye doctor here and welcome to Sunday Studies where I summarize an eye research study.

Today I am summarizing an important study if you are using atropine for myopia control. It is the LAMP study. I am putting a link to this study in the description below if you prefer to read it yourself, but I am going to make it super easy for you because I am going to tell you everything you need to know about the LAMP study.

And I’m going to do that in less than 8, 9, 10 minutes. I will also give you the 5 PEARLS that you should take home from this study…but time is ticking so lets go.

This study is a called Low-Concentration Atropine for Myopia Progression (LAMP) Study and sometimes it is referred to as the LAMP Study. There are 4 phases to this study phase 1 was published in ophthalmology in January 2019 and phase 2 in July 2020. I’m talking about phase 1 and phase 2 in this study.

An important precursor to the LAMP study are the ATOM studies…and I have a link to them up here.

ATOM studies showed that low dosages of atropine are effective in slowing myopia but 2 problems with the ATOM 2 study

There was not a placebo group in the ATOM 2 study and
0.01% didn’t seem to have an effect on axial length

Goal of LAMP study are to find out 3 things:

Does low dose atropine prevent progression compared to a placebo?
It there a concentration dependant response effect of low dose atropine?
What is the best concentration of low dose atropine?

LAMP is a randomized, placebo control double masked study with 4 phases over 5 years

Phase 1 : year 1 : looking at placebo, 0.05, 0.025 and 0.01 atropine

Phase 2 : year 2: placebo group crosses over the group that proves most effective in phase 1

Phase 3: year 3 washout for 12 months for all but the crossover group

Phase 4: years 4-5. Extended 2 years phases where atropine will be continued again in those that have progressed in in phase 3

Results of phase 1: over 400 kids kids 4-12 received one drop in each eye of either placebo, 0.05, 0.025 or 0.1 atropine.

Results of this study showed a clear concentration based response….basically the higher the dose of atropine more effective it was in myopia control. This also seemed to apply to axial length

PEARL 1: THERE IS A CONCENTRATION DEPENDENT EFFECT ON MYOPIA CONTROL WITH LOW DOSE ATROPINE.

….one note: there was no significant difference in axial length for the 0.01 % and the placebo group

PEARL 2: 0.01% DOESN’T SEEM TO HAVE ANY EFFECT ON AXIAL LENGTH COMPARED TO PLACEBO

….and since atropine has side effects the question is which dosage gives the best balance

Pearl 3: 0.05% is the most effective in controlling myopia and axial length with minimal symptoms over 1 year

Alright let’s talke about the phase 2…this is where they continued treatment for the 2^ndyear ….you may recall in the ATOM 2 study…that they found that 0.01 was more effective int the 2^nd year than the first year..

Phase 2 of the LAMP study did not show this effect…so this tells us that

In the ATOM 2 study there seemed to be a concentration dependant effect in year 1 but that did not hold in year 2. The LAMP study did not show this. The LAMP study shows that low doses of atropine remain concentration dependant over 2 years.

PEARL 4: CONCENTRATION DEPENDENT EFFECTS REMAIN IN FIRST 2 YEARS.

Alright before I get to the final and most important PEARL, if you have learned anything new from this study please hit the LIKE button below to help alert youtube of the value of this video.

The main summary of phase 1 & 2 of the LAMP study is that while 0.05, 0.025 and 0.01 are all effective in treating myopia progression with little symptoms 0.05% seems to be twice as effective as 0.01% in treating myopia.

PEARL 5: LAMP STUDY PHASE 1 & 2 SHOW THAT 0.05% IS 2X MORE EFFECITVE THAN 0.01% OVER 2 YEARS

=So the ATOM 2 study results resulted in an increase in optometrists using 0.01% atropine for myopia management, but the results of the LAMP study have indicated that eye doctors should be using 0.05% atropine one drop in each eye every evening for myopia control

I’m looking forward to the results of phases 3 and 4 of the LAMP study so make sure you hit subscribe so you get alerted when those come out and have a great optometry day.