What is the function of 0.01% concentration of atropine sulfate eye drops?

0.01% Atropine Sulfate Eye Drops (EIKANCE) is a low-concentration atropine preparation that has received great attention in the global ophthalmology field in recent years. It is mainly used to delay the progression of myopia in children. Unlike high-concentration atropine sulfate (such as 1% or 0.5%), which is commonly used to treat iridocyclitis or to dilate mydriasis for examination, EIKANCE (0.01%) is designed for long-term use and has the advantage of significantly reducing the risk of side effects, especially for children and adolescents. EIKANCE was approved for marketing in Australia in 2023. It is the world's first atropine sulfate eye drop approved by regulatory agencies for controlling the progression of myopia, marking an important breakthrough in the field of ophthalmic drugs.

From a pharmacological mechanism, atropine is an anticholinergic drug that can block the M-type choline receptors in the ciliary muscle and iris sphincter, reducing the eyeball's response to close visual stimulation. Although the exact mechanism by which atropine delays myopia is not fully understood in the scientific community, a large number of studies have shown that it may slow down the progression of myopia by affecting the biochemical signals of the eyeball wall, inhibiting scleral stretching and axial lengthening. Especially at low concentrations, atropine does not obviously cause mydriasis or accommodation paralysis, but it can effectively interfere with the progression of myopia, indicating that its mechanism may involve more retinal signal regulation than simple ciliary muscle relaxation.

EIKANCE is mainly intended for children aged 6 to 14 years old who have been diagnosed with progressive myopia, that is, patients whose refractive error increases by at least 0.5D per year. Studies have shown that continuous use of 0.01% atropine can reduce the progression rate of myopia by about 50% or more, and has shown good efficacy and safety in multiple large-scale clinical trials in Asian and Western countries. For example, in long-term clinical studies in Singapore, Taiwan and Australia, children treated with EIKANCE significantly slowed the progression of myopia within two to three years, and the axial growth of the eye was also significantly lower than that of the untreated group, suggesting that the drug can not only control refractive changes, but also regulate eyeball growth.

Compared with high-concentration atropine eye drops, EIKANCE has significant advantages in safety. High-concentration preparations often cause adverse reactions such as obvious photophobia, difficulty in near vision, accommodation dysfunction, and conjunctival irritation, and are not suitable for long-term daily use. Due to its extremely low concentration, EIKANCE will hardly affect daily visual function. Most children will have no obvious subjective discomfort after using it, and it will rarely cause pupil dilation or blurred vision. In addition, long-term compliance is significantly higher than that of high-concentration preparations, which is particularly critical for myopia management that requires many years of use.

In terms of usage,EIKANCE is usually instilled into each eye every night before going to bed. Due to its preservative-free formula and mildness, it is suitable for long-term use without causing cumulative damage to the eyes. However, this drug still needs to be used under the guidance of an ophthalmologist, and changes in axial length and refraction should be reviewed regularly to judge the efficacy and decide whether to continue treatment. In addition, once the drug is stopped, some patients may experience a "rebound" phenomenon, that is, the rate of myopia progression rebounds in a short period of time. Therefore, the drug withdrawal plan also requires professional evaluation and monitoring.

Reference materials:https://www.medsafe.govt.nz/profs/datasheet/e/EikanceEyeDrops.pdf