The document discusses practical patterns for myopia control, highlighting the effectiveness of atropine eye drops and behavioral modifications such as increased outdoor activities and reduced screen time. It emphasizes the impact of the COVID-19 pandemic on myopia progression in children, with a systematic review demonstrating a correlation between reduced outdoor time and increased myopia. Various dosages of atropine are examined, with recommendations for further clinical trials to establish optimal concentrations for myopia management.

1. Practical Patterns in
Myopia Control
Alvina Pauline Dy Santiago, MD
June 9, 2023
Philippines
Financial Disclosure: Lecturer for STADA Philippines (Naabak, Hyabak)

2. Affiliations

3. Practical Patterns in Myopia Control.ph
Atropine
(LAMP)
And other
behavioral
modifications
WSPOS, 2023
Outdoors
PH
COVID-19
Pandemic
What
works
2023 2019-2023
https://www.nationaljewish.org
https://
images.squarespace-
cdn.com/

4. 1 Outdoors
2
Decrease
gadget time
3
Decrease
near work
4
Atropine
0.01-0.1%
ATOM 2:
● 0.5%>0.1%>0.01%
LAMP:
● 0.05% > 0.025% >
0.01%
LAMP 2: 0.05%
5
Spectacles
● DIMS
● HAL
6
Contact Lenses
● Soft Multifocal Lenses
● Orthokeratology
“What appears to work” WSPOS 2023
BEHAVIORAL PHARMACOLOGIC OPTICAL

5. 1 Outdoors
2
Decrease
gadget time
3
Decrease
near work
4
Atropine
0.01-0.05%
5
Spectacles
● DIMS
● HAL
6
Contact Lenses
● Soft Multifocal Lenses
● Orthokeratology
“Practical Patterns” Philippines
BEHAVIORAL PHARMACOLOGIC OPTICAL

6. History of
Philippines
Outdoors
1

7. “Children, play under the sun for your eyes to stay clear.”
Slide from PSPOS deck

8. Outdoors
● Sensory pathways
From PSPOS fb page, 2019

9. Slide from PSPOS deck

10. Slide from PSPOS deck

11. From PSPOS 2019 https://fb.watch/kFmzamQD5C/

12. https://i.ytimg.com/vi/_XCsR_P7rD8/maxresdefault.jpg
Outdoor sports
○ Football

13. https://wingatchalian.com/wp-content/uploads/2019/05/IMG_5734.jpg
Outdoor sports
○ Swimming

16. History of
Philippines
Reduce Gadget Time
2

17. History of
Philippines
Reduce
Near Work
3

18. Slide from PSPOS deck

19. https://cdn.who.int/media/images/default-source/mca/mca-covid-19/coronavirus-2.tmb-479v.jpg?
sfvrsn=4dba955c_12%20479w

20. Longest enhanced community quarantine:
March 17 to May 15, 2020
Extend to May 31, 2020 in some
Children indoors
Children online instructions
Some children back to school only in 2021
Philippines COVID Response

21. The Impact of the COVID-19 Pandemic on Myopia
Progression in Children: A Systematic Review (2022)
Progression of Myopia
○ Reduced time spent outdoors
○ Increased Screen time
○ Use of electronic devices and tablets
Cyril Kurupp AR, Raju A, Luthra G, Shahbaz M, Almatooq H, Foucambert P, Esbrand FD, Zafar S, Panthangi V, Khan S. The Impact of the COVID-19
Pandemic on Myopia Progression in Children: A Systematic Review. Cureus. 2022 Aug 26;14(8):e28444. doi: 10.7759/cureus.28444. PMID:
36176879; PMCID: PMC9512310.

22. -
A fourth 20: viewing distance >20
cm?
Slide from PSPOS deck

24. Project Meetings on bigger screens
TV > Desktop > Tablets > Smartphones
https://airmore.com/wp-content/uploads/2022/01/zoom-cover.jpg
https://metro.co.uk/wp-content/uploads/2020/12/
PRI_177148634.jpg?quality=90&strip=all

25. Atropine
4

26. Sau SAS, Santiago APD, Peralta MDCT et al. Efficacy of atropine
eyedrops in reducing myopia progression and axial elongation in
myopic children: a meta-analysis. Asian J Ophthalmol. 2021;18:75-91,
https://doi.org/10.35119/asjoo.v18i1.593

29. Atropine 0.01% had equivocal results
Reducing myopia
Axial length elongation
Recommendation: Randomized Clinical Trial
0.01%, 0.02%, 0.05%
LAMP was born: 0.01%, 0.02%, 0.05%
(Low concentration atropine for myopia prevention)

30. Atropine 1%
● Available
● Supply chain woes

31. https://www.drnatashalim.com/wp-content/uploads/2018/02/Atropine-and-Myopine.jpg

32. Atropine 1% to 0.01%
1 ml A1% in 99 ml diluent (0.1 + 9.9; 0.05 + 4.95)
Subtract
0.05 ml
5 ml
Aspirate
0.05 ml

33. https://www.excel-medical.com/insulin-syringes-vs-tuberculin-syringes-key-differences/

34. 0.01%
1 ml + 99 ml
0.02%
2 ml + 98 ml
0.05%
5 ml + 95 ml
Low Dose Atropine
● 0.1 ml in 9.9 ml
● 0.05 ml in 4.95 ml
● 0.15 ml in 14.85 ml
● 0.2 ml in 9.8 ml
● 0.1 ml in 4.9 ml
● 0.3 ml in 14.7 ml
● 0.5 ml in 9.5 ml
● 0.25 ml in 4.75 ml
● 0.75 ml in 14.25 ml

35. Atropine Low Dose Ampule 1 mg/ml
(0.1%)
(ml)
Diluent
(ml)
0.01%
(1 mg/100ml)
1
0.10
0.05
99
9.9
4.95
0.02%
(2 mg/100 ml)
2
0.2
0.1
98 ml
9.8
4.9
0.05%
(5 mg/100 ml)
5
0.5
0.25
95 ml
9.5
4.75
Atropine Ampule is 1 mg/ml = 0.1%
https://ta-pharm.co.il/wp-content/uploads//tamc-old/products/190/Atropine%20sulfate%201_1600764166.jpg

36. Ortho K
complications
https://f6publishing.blob.core.windows.net/1f689fcb-4ec5-4d11-9242-b5cf24f88c54/WJO-4-63-g001.jpg

37. References
1. World Society of Pediatric Ophthalmology & Strabismus. Myopia Consensus Statement 2023. www.wspos.org
2. Philippine Society of Pediatric Ophthalmology and Strabismus. KLARO 2019. https://www.facebook.com/pspos1
3. Philippine Society of Pediatric Ophthalmology & Strabismus. Klaro (Video). From PSPOS 2019 https://
fb.watch/kFmzamQD5C/
4. Philippine Society of Pediatric OPhthalmology & Strabismus. Recommended screen time for kids. https://
www.facebook.com/pspos1
5. Sau SAS, Santiago APD, Peralta MDCT et al. Efficacy of atropine eyedrops in reducing myopia
progression and axial elongation in myopic children: a meta-analysis. Asian J Ophthalmol.
2021;18:75-91, https://doi.org/10.35119/asjoo.v18i1.593
6. Yam JC, Jiang Y, Tang SM, et al. Low-concentration atropine for myopia progression (LAMP) study: a randomized,
doubleblinded, placebo-controlled trial of 0.05%, 0.025%, and 0.01% atropine eye drops in myopia control.
Ophthalmology 2019; 126: 113–124.
7. Yam JC, Li FF, Zhang X, et al. Two-year clinical trial of the lowconcentration atropine for myopia progression
(LAMP) study: phase 2 report. Ophthalmology 2020; 127: 910–919.
8. T Yam JC, Zhang XJ, Zhang Y, et al. Three-Year Clinical Trial of Low-Concentration Atropine for Myopia
Progression (LAMP) Study: Continued Versus Washout.Ophthalmology. 2022 Mar;129(3): 308-321
9. Li FF, Zhang Y, Zhang X, et al. O Age Effect on Treatment Responses to 0.05%, 0.025%, and 0.01% Atropine:
Low-Concentration Atropine for Myopia Progression Study. Ophthalmology. 2021 Aug;128(8):1180-1187.

38. CREDITS: This presentation template was created
by Slidesgo, including icons by Flaticon and
infographics & images by Freepik
Thank you!
adsantiago1@up.edu.ph