This article was originally published in a sponsored newsletter.
It’s clear that for low-concentration atropine drops to be effective in myopia management the drops have to actually get into the patient’s eyes. Unfortunately, this proves difficult in children who find the discomfort of administration unbearable. The purpose of this study was to determine modifications that can improve the comfort of low-concentration atropine eye drop administration.1
Clinicians have employed many modifications to atropine drops to improve their comfort; the authors tested a change in concentration, temperature, and source pharmacy. To test which modification would have a positive influence on comfort, they used the following drops: 0.01% room temperature Lab A, 0.05% room temperature Lab A, 0.05% refrigerated Lab A, and 0.05% room temperature Lab B. A program was created in MatLab to dynamically record the discomfort each participant felt for each drop over a 25-second period (0 to 10 = baseline comfort to severe discomfort). The drop order was randomized and each participant was masked.
A secondary measure of the study was to determine whether a person’s excitability was correlated to discomfort. To do so, the authors used a study-verified need for drama survey that measures a person’s interpersonal manipulation, impulsive outspokenness, persistent perceived victimhood, and need for drama.2
There was a statistically significant correlation between the participants’ need for drama and overall comfort of drops (R2 = 0.18, p = 0.02). In general, the researchers found that maximum discomfort was reached around 10 seconds, many participants had some residual discomfort lasting through 25 seconds, and each of the four drops had a mean maximum discomfort value under 3 of 10.
They also determined that changing the concentration and temperature of the drops had no significant effect on reported discomfort. Changing the source pharmacy of the drops was the only modification that improved the comfort of the drops; the drop from Lab B (0.05% room temperature) was significantly more comfortable than the 0.05% room temperature from Lab A. At timepoints 5, 10 15, and 20 seconds, p = < 0.001; at 25 seconds, p = 0.02.
There was a difference between how each lab prepared the drops, but the composition of the drops was not tested. More research is needed to determine what is causing the discomfort of administration.
As clinicians, these data can be used to judge whether a patient would be able to tolerate the discomfort of the drops and how to adjust the drops to improve their comfort to hopefully improve compliance.
1. Bayer A, Walline J. Response to atropine drops (RAD) study - a comfort comparison of low concentration atropine eye drops. Presented at the 2023 American Academy of Optometry meeting, New Orleans. 2023 Oct 11-14.
2. Frankowski S, Lupo AK, Smith BA, Dane’El M, Ramos C, Morera OF. Developing and Testing a Scale to Measure Need for Drama. Personality and Individual Differences. 2016 Jan;89:192-201.
