1 Eye 2013 Vol: 27(3):418-424. DOI: 10.1038/eye.2012.279

Prescription of atropine eye drops among children diagnosed with myopia in Taiwan from 2000 to 2007: a nationwide study

Eye is the official journal of the Royal College of Ophthalmologists. It aims to provide the practising ophthalmologist with information on the latest clinical and laboratory-based research.

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Figures
Figure 1: Children who visited ophthalmologist (%) during the school years 2000, 2004, and 2007. For all 4- to 18-year-old children, the percentage of children who visited ophthalmologist had significantly increased from 12.7% in 2000 to 18.5% in 2004 and to 21.4% in 2007. For 10-year-old children, the percentage of children who visited ophthalmologist had significantly increased from 20.9% in 2000 to 30.7% in 2004 and to 36.1% in 2007. Figure 2: Atropine eye drop prescription (%) among children diagnosed with myopia. Figure 3: The trends of various concentrations of atropine eye drop prescription among 4–18-year-old children diagnosed with myopia (2000 to 2007).
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References
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    • . . . Myopia is an important health concern in many East Asian1, 2, 3 and Western countries.4, 5, 6 In Taiwan, the prevalence of myopia among 12- and 13-year-old children is among the highest in South-East Asia.1, 3, 7 A trend toward increasing myopia among 7–18-year-old Taiwanese children was observed between 1983 and 2000.8 A similar but less extreme trend was found for 12–17 year olds in the United States, depicting an increase from 25% in 1971–1972 to 41.6% in 1999–2004.5 Given the increasing prevalence and severity of myopia among children worldwide, a variety of interventions have been developed to retard the progression of myopia.9, 10 Most of the proposed interventions lack conclusive evidences to support their effectiveness.10 . . .
  2. Saw SM, Wu HM, Seet B, Wong TY, Yap E, Chia KS et al. Academic achievement, close up work parameters, and myopia in Singapore military conscripts. Br J Ophthalmol 2001; 85(7): 855-860 , .
    • . . . Myopia is an important health concern in many East Asian1, 2, 3 and Western countries.4, 5, 6 In Taiwan, the prevalence of myopia among 12- and 13-year-old children is among the highest in South-East Asia.1, 3, 7 A trend toward increasing myopia among 7–18-year-old Taiwanese children was observed between 1983 and 2000.8 A similar but less extreme trend was found for 12–17 year olds in the United States, depicting an increase from 25% in 1971–1972 to 41.6% in 1999–2004.5 Given the increasing prevalence and severity of myopia among children worldwide, a variety of interventions have been developed to retard the progression of myopia.9, 10 Most of the proposed interventions lack conclusive evidences to support their effectiveness.10 . . .
  3. Matsumura H, Hirai H. Prevalence of myopia and refractive changes in students from 3 to 17 years of age. Surv Ophthalmol 1999; 44(Suppl 1): S109-S115 , .
    • . . . Myopia is an important health concern in many East Asian1, 2, 3 and Western countries.4, 5, 6 In Taiwan, the prevalence of myopia among 12- and 13-year-old children is among the highest in South-East Asia.1 . . .
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    • . . . Myopia is an important health concern in many East Asian1, 2, 3 and Western countries.4, 5, 6 In Taiwan, the prevalence of myopia among 12- and 13-year-old children is among the highest in South-East Asia.1, 3, 7 A trend toward increasing myopia among 7–18-year-old Taiwanese children was observed between 1983 and 2000.8 A similar but less extreme trend was found for 12–17 year olds in the United States, depicting an increase from 25% in 1971–1972 to 41.6% in 1999–2004.5 Given the increasing prevalence and severity of myopia among children worldwide, a variety of interventions have been developed to retard the progression of myopia.9, 10 Most of the proposed interventions lack conclusive evidences to support their effectiveness.10 . . .
  5. Vitale S, Sperduto RD, Ferris FL. Increased prevalence of myopia in the United States between 1971-1972 and 1999-2004. Arch Ophthalmol 2009; 127(12): 1632-1639 , .
    • . . . Myopia is an important health concern in many East Asian1, 2, 3 and Western countries.4, 5, 6 In Taiwan, the prevalence of myopia among 12- and 13-year-old children is among the highest in South-East Asia.1, 3, 7 A trend toward increasing myopia among 7–18-year-old Taiwanese children was observed between 1983 and 2000.8 A similar but less extreme trend was found for 12–17 year olds in the United States, depicting an increase from 25% in 1971–1972 to 41.6% in 1999–2004.5 Given the increasing prevalence and severity of myopia among children worldwide, a variety of interventions have been developed to retard the progression of myopia.9, 10 Most of the proposed interventions lack conclusive evidences to support their effectiveness.10 . . .
  6. Villarreal MG, Ohlsson J, Abrahamsson M, Sjostrom A, Sjostrand J. Myopisation: the refractive tendency in teenagers. Prevalence of myopia among young teenagers in Sweden. Acta Ophthalmol Scand 2000; 78(2): 177-181 , .
    • . . . Myopia is an important health concern in many East Asian1, 2, 3 and Western countries.4, 5, 6 In Taiwan, the prevalence of myopia among 12- and 13-year-old children is among the highest in South-East Asia.1, 3, 7 A trend toward increasing myopia among 7–18-year-old Taiwanese children was observed between 1983 and 2000.8 A similar but less extreme trend was found for 12–17 year olds in the United States, depicting an increase from 25% in 1971–1972 to 41.6% in 1999–2004.5 Given the increasing prevalence and severity of myopia among children worldwide, a variety of interventions have been developed to retard the progression of myopia.9, 10 Most of the proposed interventions lack conclusive evidences to support their effectiveness.10 . . .
  7. He M, Zeng J, Liu Y, Xu J, Pokharel GP, Ellwein LB. Refractive error and visual impairment in urban children in Southern China. Invest Ophthalmol Vis Sci 2004; 45(3): 793-799 , .
    • . . . Myopia is an important health concern in many East Asian1, 2, 3 and Western countries.4, 5, 6 In Taiwan, the prevalence of myopia among 12- and 13-year-old children is among the highest in South-East Asia.1, 3, 7 A trend toward increasing myopia among 7–18-year-old Taiwanese children was observed between 1983 and 2000.8 A similar but less extreme trend was found for 12–17 year olds in the United States, depicting an increase from 25% in 1971–1972 to 41.6% in 1999–2004.5 Given the increasing prevalence and severity of myopia among children worldwide, a variety of interventions have been developed to retard the progression of myopia.9, 10 Most of the proposed interventions lack conclusive evidences to support their effectiveness.10 . . .
  8. Lin LL, Shih YF, Hsiao CK, Chen CJ. Prevalence of myopia in Taiwanese schoolchildren: 1983 to 2000. Ann Acad Med Singapore 2004; 33(1): 27-33 , .
    • . . . Myopia is an important health concern in many East Asian1, 2, 3 and Western countries.4, 5, 6 In Taiwan, the prevalence of myopia among 12- and 13-year-old children is among the highest in South-East Asia.1, 3, 7 A trend toward increasing myopia among 7–18-year-old Taiwanese children was observed between 1983 and 2000.8 A similar but less extreme trend was found for 12–17 year olds in the United States, depicting an increase from 25% in 1971–1972 to 41.6% in 1999–2004.5 Given the increasing prevalence and severity of myopia among children worldwide, a variety of interventions have been developed to retard the progression of myopia.9, 10 Most of the proposed interventions lack conclusive evidences to support their effectiveness.10 . . .
    • . . . If our results are linked to previous epidemiological studies, the prevalence of myopia (cycloplegic refraction of less than −0.25D),8, 21 remained relatively unchanged from 2000 to 2006 among 7-year-old students (20% in 2000 and 2006), among 12-year-old students (61% in 2000 and 62% in 2006) and among junior and senior high school students (~76 and 85%, respectively) . . .
    • . . . Prior studies in Taiwan indicate that higher degree of urbanization is associated with the higher prevalence,8, 24 and higher progression rate of myopia.18 In the same token, myopia is highly associated with atropine prescription . . .
  9. Saw SM, Gazzard G, Au Eong KG, Tan DT. Myopia: attempts to arrest progression. Br J Ophthalmol 2002; 86(11): 1306-1311 , .
    • . . . Myopia is an important health concern in many East Asian1, 2, 3 and Western countries.4, 5, 6 In Taiwan, the prevalence of myopia among 12- and 13-year-old children is among the highest in South-East Asia.1, 3, 7 A trend toward increasing myopia among 7–18-year-old Taiwanese children was observed between 1983 and 2000.8 A similar but less extreme trend was found for 12–17 year olds in the United States, depicting an increase from 25% in 1971–1972 to 41.6% in 1999–2004.5 Given the increasing prevalence and severity of myopia among children worldwide, a variety of interventions have been developed to retard the progression of myopia.9, 10 Most of the proposed interventions lack conclusive evidences to support their effectiveness.10 . . .
    • . . . Although evidences from many clinical trials on the use of atropine eye drops support a statistically significant reduction in myopia progression between experimental and control groups,9, 10, 11, 12, 13, 14, 15, 16 the clinical significance of the results of these trials are controversial . . .
  10. Saw SM, Shih-Yen EC, Koh A, Tan D. Interventions to retard myopia progression in children: an evidence-based update. Ophthalmology 2002; 109(3): 415-421 discussion 422-4; quiz 425-6, 443 , .
  11. Yen MY, Liu JH, Kao SC, Shiao CH. Comparison of the effect of atropine and cyclopentolate on myopia. Ann Ophthalmol 1989; 21(5): 180-182 187 , .
    • . . . Although evidences from many clinical trials on the use of atropine eye drops support a statistically significant reduction in myopia progression between experimental and control groups,9, 10, 11, 12, 13, 14, 15, 16 the clinical significance of the results of these trials are controversial . . .
    • . . . Although in most clinical studies atropine is used to treat 6–13-year-old children,11, 12, 13, 14, 15 in Taiwan, 41.6% of 13–15-year-old children (junior high school students) and 28.5% of 16–18-year-old children (senior high school students) were still being prescribed atropine during 2007 . . .
  12. Shih YF, Chen CH, Chou AC, Ho TC, Lin LL, Hung PT. Effects of different concentrations of atropine on controlling myopia in myopic children. J Ocul Pharmacol Ther 1999; 15(1): 85-90 , .
  13. Shih YF, Hsiao CK, Chen CJ, Chang CW, Hung PT, Lin LL. An intervention trial on efficacy of atropine and multi-focal glasses in controlling myopic progression. Acta Ophthalmol Scand 2001; 79(3): 233-236 , .
    • . . . Although evidences from many clinical trials on the use of atropine eye drops support a statistically significant reduction in myopia progression between experimental and control groups,9, 10, 11, 12, 13, 14, 15, 16 the clinical significance of the results of these trials are controversial . . .
    • . . . Although in most clinical studies atropine is used to treat 6–13-year-old children,11, 12, 13, 14, 15 in Taiwan, 41.6% of 13–15-year-old children (junior high school students) and 28.5% of 16–18-year-old children (senior high school students) were still being prescribed atropine during 2007 . . .
  14. Chua WH, Balakrishnan V, Chan YH, Tong L, Ling Y, Quah BL et al. Atropine for the treatment of childhood myopia. Ophthalmology 2006; 113(12): 2285-2291 , .
    • . . . Although evidences from many clinical trials on the use of atropine eye drops support a statistically significant reduction in myopia progression between experimental and control groups,9, 10, 11, 12, 13, 14, 15, 16 the clinical significance of the results of these trials are controversial . . .
    • . . . Although in most clinical studies atropine is used to treat 6–13-year-old children,11, 12, 13, 14, 15 in Taiwan, 41.6% of 13–15-year-old children (junior high school students) and 28.5% of 16–18-year-old children (senior high school students) were still being prescribed atropine during 2007 . . .
  15. Fan DS, Lam DS, Chan CK, Fan AH, Cheung EY, Rao SK. Topical atropine in retarding myopic progression and axial length growth in children with moderate to severe myopia: a pilot study. Jpn J Ophthalmol 2007; 51(1): 27-33 , .
    • . . . Although evidences from many clinical trials on the use of atropine eye drops support a statistically significant reduction in myopia progression between experimental and control groups,9, 10, 11, 12, 13, 14, 15, 16 the clinical significance of the results of these trials are controversial . . .
    • . . . Although in most clinical studies atropine is used to treat 6–13-year-old children,11, 12, 13, 14, 15 in Taiwan, 41.6% of 13–15-year-old children (junior high school students) and 28.5% of 16–18-year-old children (senior high school students) were still being prescribed atropine during 2007 . . .
  16. Tong L, Huang XL, Koh AL, Zhang X, Tan DT, Chua WH. Atropine for the treatment of childhood myopia: effect on myopia progression after cessation of atropine. Ophthalmology 2009; 116(3): 572-579 , .
    • . . . Although evidences from many clinical trials on the use of atropine eye drops support a statistically significant reduction in myopia progression between experimental and control groups,9, 10, 11, 12, 13, 14, 15, 16 the clinical significance of the results of these trials are controversial . . .
  17. Chia A, Chua WH, Cheung YB, Wong WL, Lingham A, Fong 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; 119(2): 347-354 , .
  18. Shih YF, Chiang TH, Hsiao CK, Chen CJ, Hung PT, Lin LL. Comparing myopic progression of urban and rural Taiwanese schoolchildren. Jpn J Ophthalmol 2010; 54(5): 446-451 , .
    • . . . This is because not only do they face one of the highest percentages of children with myopia, but they also serve a population with a high progression rate.18 This study does not intend to discuss whether atropine should be prescribed to retard the progression of myopia . . .
    • . . . Different from studies in Hong Kong and Singapore school children that showed highest myopic progression in primary school students,22, 23 Shih et al18 reported that junior high school students had a higher progression rate than primary school students and senior high school students in Taiwan . . .
    • . . . Prior studies in Taiwan indicate that higher degree of urbanization is associated with the higher prevalence,8, 24 and higher progression rate of myopia.18 In the same token, myopia is highly associated with atropine prescription . . .
    • . . . It is possible that this is not only associated with the progression rate of myopia,18 but also with the severity of myopia, and/or the medical resources available in the various areas with different urbanization levels. . . .
  19. Shen HN, Lu CL, Yang HH. Epidemiological trend of severe sepsis in Taiwan from 1997 through 2006. Chest 2010; 138(2): 298-304 , .
    • . . . A detailed description of the sampling method can be found elsewhere.19, 20 The National Health Research Institutes scrambles the individual IDs before providing the data to scientists in Taiwan for research purposes to ensure patient privacy . . .
  20. Wu CY, Hu HY, Huang N, Pu CY, Shen HC, Chou YJ. Do the health-care workers gain protection against herpes zoster infection? A 6-year population-based study in Taiwan. J Dermatol 2010; 37(5): 463-470 , .
    • . . . A detailed description of the sampling method can be found elsewhere.19, 20 The National Health Research Institutes scrambles the individual IDs before providing the data to scientists in Taiwan for research purposes to ensure patient privacy . . .
  21. Bureau of Health Promotion, Department of Health, R.O.C. Epidemiology of myopia among 6 to 18 year old children in Taiwan [in Chinese]. Technical Report 2008 , .
    • . . . If our results are linked to previous epidemiological studies, the prevalence of myopia (cycloplegic refraction of less than −0.25D),8, 21 remained relatively unchanged from 2000 to 2006 among 7-year-old students (20% in 2000 and 2006), among 12-year-old students (61% in 2000 and 62% in 2006) and among junior and senior high school students (~76 and 85%, respectively) . . .
  22. Lam CS, Edwards M, Millodot M, Goh WS. A 2-year longitudinal study of myopia progression and optical component changes among Hong Kong schoolchildren. Optom Vis Sci 1999; 76(6): 370-380 , .
    • . . . Different from studies in Hong Kong and Singapore school children that showed highest myopic progression in primary school students,22, 23 Shih et al18 reported that junior high school students had a higher progression rate than primary school students and senior high school students in Taiwan . . .
  23. Saw SM, Tong L, Chua WH, Chia KS, Koh D, Tan DT et al. Incidence and progression of myopia in Singaporean school children. Invest Ophthalmol Vis Sci 2005; 46(1): 51-57 , .
    • . . . Different from studies in Hong Kong and Singapore school children that showed highest myopic progression in primary school students,22, 23 Shih et al18 reported that junior high school students had a higher progression rate than primary school students and senior high school students in Taiwan . . .
  24. Guo YH, Lin HY, Lin LL, Cheng CY. Self-reported myopia in Taiwan: 2005 Taiwan National Health Interview Survey. Eye (Lond) 2012; 26(5): 684-689 , .
    • . . . Prior studies in Taiwan indicate that higher degree of urbanization is associated with the higher prevalence,8, 24 and higher progression rate of myopia.18 In the same token, myopia is highly associated with atropine prescription . . .
  25. Wong TY, Foster PJ, Johnson GJ, Seah SK. Education, socioeconomic status, and ocular dimensions in Chinese adults: the Tanjong Pagar Survey. Br J Ophthalmol 2002; 86(9): 963-968 , .
    • . . . Studies have shown that adults with a high SES tend to be associated with a higher myopic refraction.25 It is well known that the refractive status of parents influences their children’s myopia26 through either hereditary or environmental factors.27, 28, 29 A strong parental history of myopia is associated with faster eye growth and a myopic shift.30 Therefore, children from a high socioeconomic background may have a higher prevalence of myopia and faster myopic progression, which justifies a higher level of prescription of atropine . . .
  26. Goss DA, Jackson TW. Clinical findings before the onset of myopia in youth: 4. Parental history of myopia. Optom Vis Sci 1996; 73(4): 279-282 , .
    • . . . Studies have shown that adults with a high SES tend to be associated with a higher myopic refraction.25 It is well known that the refractive status of parents influences their children’s myopia26 through either hereditary or environmental factors.27, 28, 29 A strong parental history of myopia is associated with faster eye growth and a myopic shift.30 Therefore, children from a high socioeconomic background may have a higher prevalence of myopia and faster myopic progression, which justifies a higher level of prescription of atropine . . .
  27. Wu MM, Edwards MH. The effect of having myopic parents: an analysis of myopia in three generations. Optom Vis Sci 1999; 76(6): 387-392 , .
    • . . . Studies have shown that adults with a high SES tend to be associated with a higher myopic refraction.25 It is well known that the refractive status of parents influences their children’s myopia26 through either hereditary or environmental factors.27, 28, 29 A strong parental history of myopia is associated with faster eye growth and a myopic shift.30 Therefore, children from a high socioeconomic background may have a higher prevalence of myopia and faster myopic progression, which justifies a higher level of prescription of atropine . . .
  28. Mutti DO, Mitchell GL, Moeschberger ML, Jones LA, Zadnik K. Parental myopia, near work, school achievement, and children's refractive error. Invest Ophthalmol Vis Sci 2002; 43(12): 3633-3640 , .
    • . . . Studies have shown that adults with a high SES tend to be associated with a higher myopic refraction.25 It is well known that the refractive status of parents influences their children’s myopia26 through either hereditary or environmental factors.27, 28, 29 A strong parental history of myopia is associated with faster eye growth and a myopic shift.30 Therefore, children from a high socioeconomic background may have a higher prevalence of myopia and faster myopic progression, which justifies a higher level of prescription of atropine . . .
  29. Zadnik K, Satariano WA, Mutti DO, Sholtz RI, Adams AJ. The effect of parental history of myopia on children’s eye size. JAMA 1994; 271(17): 1323-1327 , .
    • . . . Studies have shown that adults with a high SES tend to be associated with a higher myopic refraction.25 It is well known that the refractive status of parents influences their children’s myopia26 through either hereditary or environmental factors.27, 28, 29 A strong parental history of myopia is associated with faster eye growth and a myopic shift.30 Therefore, children from a high socioeconomic background may have a higher prevalence of myopia and faster myopic progression, which justifies a higher level of prescription of atropine . . .
  30. Lam DS, Fan DS, Lam RF, Rao SK, Chong KS, Lau JT et al. The effect of parental history of myopia on children’s eye size and growth: results of a longitudinal study. Invest Ophthalmol Vis Sci 2008; 49(3): 873-876 , .
    • . . . Studies have shown that adults with a high SES tend to be associated with a higher myopic refraction.25 It is well known that the refractive status of parents influences their children’s myopia26 through either hereditary or environmental factors.27, 28, 29 A strong parental history of myopia is associated with faster eye growth and a myopic shift.30 Therefore, children from a high socioeconomic background may have a higher prevalence of myopia and faster myopic progression, which justifies a higher level of prescription of atropine . . .
  31. Lee JJ, Fang PC, Yang IH, Chen CH, Lin PW, Lin SA et al. Prevention of myopia progression with 0.05% atropine solution. J Ocul Pharmacol Ther 2006; 22(1): 41-46 , .
    • . . . Lee et al31 pointed out that using 0.05% atropine eye drops is still effective in retarding the rate of myopia progression . . .
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