近視控制的功效：低濃度阿托品對近視進展的LAMP研究

Ophthalmology Volume 130, Number 7, July 2023

中文摘要

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。

該研究還研究了停藥對近視進展的影響。在第三年開始時，接受兩年治療的兒童中，有一半被隨機分配繼續治療或進行洗藥。停藥組近視進展和軸向伸長速度更快。在第三年中，相較於接受較低濃度阿托品治療的組別，先前接受較高濃度阿托品治療的組別軸向伸長稍微更大。然而，除了0.05%和0.01%阿托品的比較外，不同濃度阿托品之間的近視進展差異並不具有統計學上的顯著性。

由於研究中的第一年對照組在後續年份轉為治療組，因此無法直接計算低濃度阿托品在第一年以後的長期療效。然而，基於其他研究的荟萃分析(metaanalysis)，估計近視進展平均每年減緩15%。根據這個估計，計算了每個阿托品濃度在三年內的預期軸向伸長累計減少量。

與其他高濃度阿托品和光學療法的數據相比，低濃度阿托品在三年的治療療效，特別是0.05%，是令人滿意的。該研究還強調了低濃度阿托品在長期療效方面相對於光學療法和高濃度阿托品的潛在優勢。需要注意的是，該研究存在一些限制，例如在三年期間群體規模的變化以及無法對估計值計算置信區間。

除了LAMP研究的結果，本文還討論了美國兒童中視護存取和視力損害方面的社會經濟和種族不平等問題。由於醫療保健資源分配的不公平性，導致健康差異，影響了特定人群的結果。該研究利用了全國兒童健康調查(NSCH)來探討兒童的未滿足視護需求和報告的視力損害之間的差異，並考慮了不同年齡組和社經類別。研究強調了需要解決與健康有關的社會決定因素，並回應由此產生的健康不平等，涉及醫療保健的所有領域。

總的來說，LAMP研究為低濃度阿托品在近視控制方面的療效提供了寶貴的洞察，而關於社會經濟和種族不平等的討論則強調了解決兒童視護中的健康不平等的重要性。

English Abstract

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.