The most difficult question that remains unaddressed is when to stop the treatment, Professor Morad noted. In the ATOM studies, treatment was given for 2 years and then stopped. If the patient continued to progress by >0.5 D per year, treatment could be reinitiated.
“This seems like a sensible approach but there are other possibilities,” Professor Morad said. “Perhaps treatment should be continued until around 13 years of age, when myopia usually stops progressing.”
Another important consideration is cost. Atropine is not yet commercially available as 0.01% drops, so the treatment has to be prepared in a pharmacy—in Israel the cost varies from $20 to $80 per bottle, which could place a high burden on the parents.
Lastly, the long-term side effects are unknown. The studies from the 1970s that looked at 1% atropine showed no significant side effects except for difficulties in accommodation after prolonged treatment.
Professor Morad pointed out that the dose used in these children is much lower and no side effects were reported, which is “hopeful”.