Hospital.Help

Berlin, September 2024 – Children who wear glasses because of short-sightedness are no longer an unusual sight. One important reason is the fact that many children today spend very little time outdoors and are therefore rarely exposed to sunlight. How can we counteract this? Professor Dr. med. Wolf Lagrèze from the German Ophthalmological Society (DOG) will discuss common myopia treatment approaches, new applications, international study results on the promising drug atropine and the effect of sunlight at the hybrid press conference on October 10, 2024 on the occasion of the annual congress.

The trend towards “normal short-sightedness” that we know from Asia has not yet been repeated to the same extent in Europe: while 80 to 90 percent of young people in Southeast Asian cities are short-sighted, on our continent this proportion is currently 30 to 40 percent. “One in ten of them, i.e. around five percent of all people of this age, develop what is known as high myopia,” says Professor Dr. med. Wolf Lagrèze, head of the Neuro-ophthalmology, Pediatric Ophthalmology and Strabismus Treatment Section of the Department of Ophthalmology at the University Hospital Freiburg. Doctors define this as short-sightedness of more than -6 diopters. From this value, the risk of long-term retinal damage increases. “Values ​​of -10 diopters and above are considered particularly critical,” explains Lagrèze. “The risk of later visual impairment due to macular degeneration or retinal detachment is then over 50 percent.”

Contradictory results on the active ingredient atropine

Myopia is therefore not just a cosmetic problem. In order to counteract serious consequential damage, including loss of vision in old age, a whole range of different remedies have been devised and scientifically studied. A few years ago, treatment with highly diluted atropine-containing eye drops, which were supposed to slow the lengthening of the eyeball, became particularly well-known. “Studies from Asia have produced good results with this,” reports Lagrèze.¹ This has led to the worldwide use of low-dose atropine therapy. “Unfortunately, comparable successes have not yet been achieved in Europe and the USA,” emphasises the DOG expert.

For example, the Irish MOSAIC study, which used a formulation from Nevakar, found that two years of use of 0.01 percent atropine drops reduced the progression of myopia by only 0.1 dioptres compared to placebo.² The American-European CHAMP study, which used the same formulation, compared placebo with 0.01 percent and 0.02 percent atropine. The result: After three years of treatment, the progression of myopia was 0.25 diopters lower in the 0.01 percent group than in the placebo group.³ “Although this effect was statistically significant, it seems exaggerated to consider it as truly clinically significant for those affected,” explains Lagrèze. The results of the German AIM study, which examines the effect of 0.02 percent atropine drops in the formulation of a German contract manufacturer, are now eagerly awaited.

Wait for longer-term studies – and interpret them carefully

Against the background of these results, the so-called myopia boom⁴ is now being viewed in a more differentiated manner. “We take regional and ethnic differences into account more,” emphasises the Freiburg doctor. Due to the sobering experiences with atropine, new approaches to treating myopia are now being assessed more cautiously and questioned more critically in terms of safety and reproducibility. “This applies to the new red light therapy, in which the eyes are irradiated with red laser light, but also to multifocal optics such as multi-segment glasses and special contact lenses,” says Lagrèze. Although these are already widespread, they still need to be examined in longer-term studies. “Caution when interpreting possible effects is also advisable because the influence of new everyday trends such as increasing smartphone use on eye development cannot yet be reliably estimated,” adds the DOG expert.

Because myopia affects such a large group of the population, its treatment can place a significant burden on health systems. “It is all the more gratifying that we have an effective and even free preventive measure in the form of sunlight,” says Lagrèze. Extensive studies – also conducted in Asia – have already shown that the risk of myopia decreases with increasing exposure to sunlight. A recently published study even provides information on what the optimal dosage should be: According to this, a stay outdoors must last at least 15 minutes at a time for sunlight to have its preventive effect.⁵ The study also showed that 2000 lux of daylight is enough to produce a measurable effect. “That is a light intensity that can even be achieved on an overcast winter day,” says Lagrèze happily.

Sources:

1. Chia A et al. Atropine for the treatment of childhood myopia: safety and efficacy of 0.5%, 0.1%, and 0.01% doses (Atropine for the Treatment of Myopia 2). Ophthalmology 2012 Feb;119(2):347-54.
   doi: 10.1016/j.ophtha.2011.07.031. Epub 2011 Oct 2.
2. Loughman J et al. Acta Ophthalmol 2024; 102:245.
3. Zadnik K et al. JAMA Ophthalmol 2023; 141: 99.
4. Dolgin E. The myopia boom. Nature 2015 Mar 19;519(7543):276-8.
   doi:10.1038/519276a.
5. Chen J et al. Smartwatch Measures of Outdoor Exposure and Myopia in Children. JAMA Network Open. 2024;7(8):e2424595. doi:10.1001/jamanetworkopen.2024.24595 (Reprint

Proof requested upon publication.