Ophthalmology Volume 130, Number 7, July 2023
低濃度阿托品對近視進展的LAMP(The Low-Concentration Atropine for Myopia Progression)研究在三年的時間內顯著提升了我們對低濃度阿托品在控制近視方面的理解。在研究的第一年，研究將兒童隨機分配到接受不同濃度阿托品或安慰劑的組別。結果顯示，與安慰劑組相比，接受0.05%、0.025%和0.01%阿托品治療的組別近視進展較慢，軸向伸長也較少。
Title : Efficacy in Myopia Control: The Low-Concentration Atropine for Myopia Progression (LAMP) Study
The Low-Concentration Atropine for Myopia Progression (LAMP) study, conducted over a period of three years, has significantly advanced our understanding of the effectiveness of low-concentration atropine in controlling myopia. In the first year of the study, children were randomly assigned to receive different concentrations of atropine or a placebo. The results showed that compared to the placebo group, the groups receiving 0.05%, 0.025%, and 0.01% atropine experienced a slower progression of myopia, as indicated by reduced axial elongation.
The study also examined the impact of treatment cessation on myopia progression. At the start of the third year, half of the children who had received two years of treatment were randomized to continue treatment or undergo a washout. Those who discontinued treatment showed faster myopia progression and axial elongation. During the third year, there was a slightly larger axial elongation among those previously treated with higher concentrations of atropine compared to those treated with lower concentrations. However, the differences in myopia progression between the various atropine concentrations were not statistically significant, except for the comparison between 0.05% and 0.01% atropine.
Since the year 1 control group in the study switched to treatment in the subsequent years, the long-term efficacy of low-concentration atropine beyond year 1 could not be directly calculated. However, based on a meta-analysis of other studies, it was estimated that myopia slows down by an average of 15% per year. Applying this estimation, the projected cumulative reduction in axial elongation over three years was calculated for each atropine concentration.
Comparisons with other data on higher atropine concentrations and optical therapies show that the 3-year treatment efficacy of low-concentration atropine, particularly at 0.05%, is favorable. The study also highlighted the potential long-term efficacy of low-concentration atropine compared to optical therapies and higher atropine concentrations. It is important to note that the study had some limitations, such as variations in cohort size over the three-year period and the inability to calculate confidence intervals for the estimates.
In addition to the LAMP study findings, the article also discusses the socioeconomic and racial disparities in vision care access and impairment among children in the United States. Health disparities resulting from inequitable distribution of resources within healthcare contribute to worse outcomes for certain populations. The study utilized the National Survey of Children’s Health to explore differences in unmet vision care needs and reported vision impairment among children, considering age groups and socioeconomic categories. The study emphasizes the need to address relevant social determinants of health and respond to resulting health inequities in all domains of healthcare.
Overall, the LAMP study provides valuable insights into the efficacy of low-concentration atropine for myopia control, while the discussion on socioeconomic and racial disparities underscores the importance of addressing health inequities in vision care among children.