Normal pupil size child9/21/2023 The asterisks for the ATOM2 study efficacy outcomes are because these comparisons were made to an historical control group at a later time, 6 not to a concurrent control group as for the rest. The table below, from our Atropine for Myopia Management online course, provides a summary of the outcomes and side effects of key atropine studies including the ATOM1, ATOM2 and LAMP studies, as well as a placebo-controlled study on 0.02% and 0.01% (without a nifty acronym!). However over one-third of participants were issued photochromic glasses, which were offered to parents concerned about side effects or pupil dilation - the authors note that these may have been taken up for protection against potential instead of realized side effects. Only 2% of the LAMP participants needed progressive addition spectacles and 5% reported photophobia, that didn't require intervention. Some 60-70% of the children treated with 0.1% or 0.5% requested progressive addition spectacles, compared to 6% in the 0.01% group.īy comparison, the LAMP Study showed less than 1mm increase in pupil size for all concentrations, being 0.05%, 0.025% and 0.01%. All children in that study were offered photochromatic spectacle lenses - either single vision or progressive addition depending on near vision symptoms. The pupil size exceeded 7.5mm, on average, for both photopic and mesopic conditions with 0.5% atropine, was around 7mm for 0.1% and 5 to 5.5mm for 0.01%. The ATOM-2 Study, which compared 0.5%, 0.1% and 0.01% concentrations, 5 found an increase of around 3mm in pupil size for the stronger concentrations but only 1mm for 0.01%. There is a concentration-dependent response seen with atropine and myopia control efficacy, and the same is true for the side effect of pupil dilation. Studies are either very small, 2 have found no difference between myopic and control groups 3 or have contradictory findings on whether emmetropes have the larger pupils or not. While the IMI acknowledged a potential relationship between depth of focus, accommodative lag, retinal image blur and higher order aberrations in progressing myopes, they reported inconclusive data from published studies. 2 The IMI paper published in 2021 on Accommodation and Binocular Vision in Myopia Development and Progression concluded that the role of pupils in the development and progression of myopia is unclear. 1 Another small study in 2009 concluded there was no relationship linking pupils, myopia and accommodation. There is, however, still a lot to learn.Ī 2020 study on university students in Nigeria found that there was a statistically significant relationship between pupil size and myopia however they only reviewed 100 myopes aged 18-25 years. It seems reasonable to conclude that as the pupil controls the light input to the retina, and we now understand the strong link between focus, light and myopia risks, that the pupil might potentially hold the answers to many of our myopia mysteries. Pupils may be connected to myopia management more than we realize. How does this influence your clinical practice?.
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