Taking aim at nearsightedness in kids before it’s diagnosed

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Taking aim at nearsightedness in kids before it's diagnosed

$25 million NIH grant funds study of preventive atropine drops

For the first time, researchers are leading a national study to see if the onset of nearsightedness can be delayed - and consequently reduced in magnitude over a lifetime - with the use of eyedrops in young children.

Scientists at The Ohio State University and the University of Houston have received two grants from the National Institutes of Health totaling $25 million to test daily drops of atropine as a nearsightedness preventive therapy in children age 6-11 years old.

"The more nearsightedness you have, the more at risk you are as an older adult of sight-threatening complications - retinal detachments, atrophy at the back of the eye, glaucoma and macular degeneration," said Jeffrey Walline, co-principal investigator on the grants and professor of optometry at The Ohio State University. "So anything we can do to reduce the amount of myopia reduces your risk of those complications. And that's our goal, ultimately."

Walline is co-leading the study with David Berntsen, Golden-Golden Professor and chair of clinical sciences at the University of Houston College of Optometry, and Lisa Jordan, director of the Data Coordination and Analysis Center at Ohio State.

Previous studies in the United States and Asia have suggested atropine can slow the progression of nearsightedness after its onset. This new study aims to administer the drug before diagnosis in children deemed at highest risk for myopia, or nearsightedness, based on their school vision screening outcomes.

People are born farsighted, and previous research has suggested that kids whose farsightedness has decreased to a specific measure by third grade are at the highest risk - with almost 90% accuracy - for developing nearsightedness by eighth grade. Those children will be recruited to join the study.

The clinical trial will be conducted at Ohio State, the University of Houston, and 12 additional centers across the United States. Researchers plan to enroll over 600 children who will be randomized to receive nightly drops of either 0.05% low-concentration atropine or a placebo for two years.

The timing of the onset of nearsightedness in children receiving the drug will be compared to those who receive the placebo. Any children in the placebo arm of the trial who are diagnosed with myopia during the study will begin receiving the atropine drops. All children who become nearsighted will also receive an annual voucher for corrective lenses, Walline said.

The eye grows fastest just before the onset of myopia, which tends to begin between the ages of 8 and 10 and progresses up to about age 16. After that, the eye might continue to grow but does not become more myopic in most people.

The researchers predict the atropine drops will reduce the proportion of children who become nearsighted from 20% in the placebo group to 10% in the treatment group, and that atropine will slow pre-myopic eye growth by 30% over the course of the study.

Myopia affects at least one-third of adults in the United States, and is becoming more prevalent - because, the scientific community believes, children are spending less time outdoors now than in the past.

In decades past, myopia hasn't been thought of so much as a disease than as a nuisance condition. But in the past 10 years, optometry research has advanced beyond alleviating symptoms to better understand and address the mechanisms of nearsightedness with an eye toward lowering the risk for vision loss in adulthood, Walline said.

Walline, Berntsen and Jordan previously co-led studies showing that contact lenses can effectively slow the progression of nearsightedness. The research team reported in 2020 that multifocal contact lenses with the strongest reading power dramatically slowed further progression of myopia in nearsighted kids as young as 7 years old, and in 2025, they reported that those benefits lasted after the treatment ended.

"We've shown that kids can handle treatments from a very young age, and so we're just applying a different treatment now," Walline said. "If they become nearsighted during our study, we will also give them the option of wearing contact lenses."

In addition to the health ramifications of myopia, correcting the condition is expensive, costing an estimated $4 billion to $7 billion annually in the United States. And high myopia not only threatens vision, but limits the options for refractive surgery, contact lenses and glasses - all factors that point to the importance of getting ahead of the diagnosis, Walline said.

"Myopia affects such a large number of people, and even if the effects for given individuals aren't particularly bad, if we can save the sight of just a few people, I think it's ultimately very important," he said. "This affects one out of every three people in the United States. We can make a big difference."

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