低剂量阿托品会导致视力模糊吗？

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Low dose atropine is often used for myopia control in children. How commonly will patients complain of side effects, such as photophobia, allergy or blurry vision at near?bl呈现病人who experienced blurry vision after using 0.01% atropine once, and subsequently refused to use it. This led to significant fear and misconception on the part of the parent. How should a case like this be managed?

模糊视觉阿托品

社区建议的这些影响的可能原因是：

  • 阿托品的不准确稀释：阿托品滴是手动复杂的，活动成分效力和稳定性的变化是可能的。1查看我们的博客Complications in Atropine Compounding有关更多细节。
  • Instilling excessive number of drops of atropine
  • 对阿托品的超敏反应导致过度反应

Investigating these potential causes are important in successfully managing this patient.

研究怎么说？

低浓度阿托品对学生尺寸的影响

  • 这ATOM22and LAMP3研究主要由东南亚和东亚儿童组成，分别报道了少数瞳孔扩张，分别为0.01％的阿托宾为0.8mm和0.5mm。
  • 使用0.01％阿托品后，一群德国学童平均经历了1毫米的学生扩张。4
  • 梁和威廉姆斯5报道说，当学生大（> 7.3mm）时，视觉性能和视网膜上图像的分辨率会受到影响。

因此，这表明，如果一个孩子有大的学生一开始，低剂量阿托品滴注后的小瞳孔扩张可能会因图像分辨率的变化而潜在地影响距离和近视。

Effect of low-concentration atropine on accommodation

  • 在灯研究中，30.01% atropine only reduced accommodative amplitude by 0.3D, while 0.025% and 0.05% reduced amplitude (amps) by 2D.
  • 在Atom2研究中，20.01％的阿托品将AMP降低了约4-5D，但0.1％和0.5％的AMP大幅度降低了两年后的AMP从基线的16D左右降低到4-6D，这会影响接近敏锐度。
  • Accommodation amps decreased by 1.5D in Japanese children using 0.01% atropine.6但是，未报告主观症状。
  • Another study on Chinese children using 0.01% atropine found it did not affect monocular or binocular amps, or accommodative facility tested with +/-2.00 lenses.7

儿童通常有良好的住宿，因此，适应幅度的较小降低通常不会影响他们的近视。但是，在某些儿童中，阿托品的副作用可能足以引起双眼视力的问题，因此应在儿童的阿托品治疗中对其进行全面评估，尤其是当他们遇到近视问题时。根据其BV状态所确定的，可能需要光学支持，例如接近添加的眼镜。

还应该考虑什么？

虹膜颜色。Many atropine studies involve children of East Asian heritage; it is expected that side effects may be more pronounced in Caucasian children withlighter iris pigmentation。尽管Gong等人对疗效与低剂量阿托品的副作用的荟萃分析，但对于个人来说可能是正确的8suggests that difference in response between Asian and Caucasian children was minimal. Instead, increase side effects were linked to higher concentrations of atropine.

分配不正确。A key consideration is a pharmacy dispensing error. In Australia, a案件数量在2018年和2019年报告1%阿托品的儿童在哪里0.01% atropine had been prescribed. In response, Optometry Australia recommended that atropine prescriptions include the specific note 'MUST BE COMPOUNDED' to avoid this dispensing error.

使用的滴数量。临床建议是在每晚在阿托品治疗中灌输每只眼睛的一滴。有趣的是，原子22and LAMP3studies do not mention if children were told to instill one or two drops. Generally, the pre-corneal ocular volume is only around 20 uL while dropper bottles can deliver 25-70 uL per drop,9so one drop should be enough to deliver the medication. Multiple drops could increase the concentration of the medication absorbing into the eye.

Take home messages:

  • Ensure your prescription is written clearly and legibly to reduce the potential for dispensing error. It is also prudent to write 'MUST BE COMPOUNDED' on the prescription to ensure the non-commercially available, low concentrations of atropine are correctly compounded.
  • 当患者使用0.01％阿托品使用不良影响时，第一个呼叫端口是确保已正确分配并灌输正确的剂量。只需要一滴一滴，但是应咨询患者和父母的眼睑上的某些“溢出”到眼睑上，并可能由于体积下降而发生皮肤，这并不意味着需要多滴才能实现治疗剂量。
  • 阿托品的副作用是浓度和剂量依赖性，因此重要的是要告知患者及其父母潜在症状，并确保在管理的初始阶段进行定期跟进，尤其是在处方较高浓度时。这国际近视研究所Clinical Management Guidelines建议在4-7天的阿托品开始后进行随访，然后在1个月，3个月和6个月的时间内再次进行随访。
Kimberley 120x120

关于Kimberley

Kimberley Nguis a clinical optometrist from Perth, Australia, with experience in patient education programs, having practiced in both Australia and Singapore.

Connie headshot 120x120

关于Connie

康妮·甘is a clinical optometrist from Kedah, Malaysia, who provides comprehensive vision care for children and runs the myopia management service in her clinical practice.

参考

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