This article was originally published in a sponsored newsletter.

In the world of myopia control, rebound is a frequent topic of discussion. J.Lo even released a song about it recently! There have been several recent reviews on the topic.^1-3 While they make for interesting reading, it is not convincing that they all correctly calculate rebound. So, what are people saying?

One study noted that rebound should be assumed until contrary treatment-specific evidence is obtained.⁴ The study also detailed a dramatic rebound following cessation of 1% atropine,⁵ along with the apparent lack of rebound with spectacles and soft contact lenses,^6,7 while acknowledging the modest treatment effects in the latter studies.⁴

A 2019 report from the International Myopia Institute (IMI) noted that “continuous long-term exposure to pharmacological antagonists is well known to cause upregulation of receptors.” This results in a loss of efficacy to the applied drug over time and can lead to exaggerated symptoms when treatment is ceased.8 A more recent IMI report concluded that “rebound effects as observed with higher concentration of atropine appear to be avoided with lower concentrations and optical strategies.”⁹

The U.S. Food and Drug Administration (FDA) workshop, co-sponsored by multiple professional organizations, stated that rebound effects weren’t evident when using optical myopia control treatments.¹⁰ However, the FDA still appears to require evaluation of rebound in clinical trials.

Additionally, the Atropine for the Prevention of Myopia Progression in Children report¹¹ concluded that because of the myopic rebound that happens with all doses of atropine, it will be crucial for practitioners to determine the optimal duration of treatment as well the best way to discontinue or taper treatment safely and to minimize regression.

Just when we seem to be getting some clarity, two recent studies offer conflicting results regarding the rebound following two years of treatment with 0.01% atropine.^12,13 There are often questions about tapering atropine, but there are few data to support any strategies. Clearly, the final chapters on rebound have yet to be written.

References

1. Chiu YC, Tsai PC, Lee SH, Wang JH, Chiu CJ. Systematic Review of Myopia Progression after Cessation of Optical Interventions for Myopia Control. J Clin Med. 2023 Dec 21;13:53.
2. Lee SH, Tsai PC, Chiu YC, Wang JH, Chiu CJ. Myopia progression after cessation of atropine in children: a systematic review and meta-analysis. Front Pharmacol. 2024 Jan22;15:1343698.
3. Sanchez-Tena MA, Ballesteros-Sanchez A, Martinez-Perez C, et al. Assessing the rebound phenomenon in different myopia control treatments: A systematic review. Ophthalmic Physiol Opt. 2024 Mar;44:270-279.
4. Brennan NA, Toubouti YM, Cheng X, Bullimore MA. Efficacy in myopia control. Prog Retin Eye Res. 2021 Jul;83:100923.
5. Tong L, Huang XL, Koh AL, Zhang X Tan DTH, Chua WH. Atropine for the treatment of childhood myopia: effect on myopia progression after cessation of atropine. Ophthalmology. 2009 Mar;116:572-579.
6. Berntsen DA, Sinnott LT, Mutti DO, Zadnik K. A randomized trial using progressive addition lenses to evaluate theories of myopia progression in children with a high lag of accommodation. Invest Ophthalmol Vis Sci. 2012 Feb 13;53:640-649.
7. Cheng X, Xu J, Chehab K, Exford J, Brennan N. Soft Contact Lenses with Positive Spherical Aberration for Myopia Control. Optom Vis Sci. 2016 Apr;93:353-366.
8. Wildsoet CF, Chia A, Cho P, et al. IMI - Interventions Myopia Institute: Interventions for Controlling Myopia Onset and Progression Report. Invest Ophthalmol Vis Sci. 2019 Feb 28;60:M106-M31.
9. Sankaridurg P, Berntsen DA, Bullimore MA, et al. IMI 2023 Digest. Invest Ophthalmol Vis Sci. 2023 May 1;64:7.
10. Walline JJ, Robboy MW, Hilmantel G, et al. Food and Drug Administration, American Academy of Ophthalmology, American Academy of Optometry, American Association for Pediatric Ophthalmology and Strabismus, American Optometric Association, American Society of Cataract and Refractive Surgery, and Contact Lens Association of Ophthalmologists Co-Sponsored Workshop: Controlling the Progression of Myopia: Contact Lenses and Future Medical Devices. Eye Contact Lens. 2018 Jul;44:205-211.
11. Pineles SL, Kraker RT, VanderVeen DK, et al. Atropine for the Prevention of Myopia Progression in Children: A Report by the American Academy of Ophthalmology. Ophthalmology. 2017 Dec;124:1857-1866.
12. Yam JC, Zhang XJ, Zhang Y, et al. Three-Year Clinical Trial of Low-Concentration Atropine for Myopia Progression (LAMP) Study: Continued Versus Washout: Phase 3 Report. Ophthalmology. 2022 Mar;129:308-321.
13. Lee SS, Nilagiri VK, Lingham G, et al. Myopia progression following 0.01% atropine cessation in Australian children: Findings from the Western Australia - Atropine for the Treatment of Myopia (WA-ATOM) study. Clin Exp Ophthalmol. 2024 Feb 23. [Online ahead of print]