2023-06-12 16:00:00
Taiwanese children are too prone to myopia!according toIn 2016, a survey on myopia among domestic schoolchildren in Taiwan showed that 15.36% of 15-year-old children were highly myopic (the degree of myopia was not less than 600 degrees).this is in the internationalIs a very high prevalence of high myopia.This is also subject toRace, genetics, eye habits, education orientation, environmentwaitInfluenced by many factors,andOn the road of myopia control,I believe you must alsoHeard of “mydriatic agent”,But what does the mydriatic do?What side effects of mydriatics should be paid attention to? Ophthalmologist Dr. Zheng Yuting will share the instructions with you.
What are mydriatics?
The main pharmacological effect of mydriatic agent is antimuscarinic agent. Acting on the eyes, it will paralyze and relax the two muscles inside the eyeball: “ciliary muscle (adjusting muscle)” and “pupil constrictor muscle”. This has two effects:
1. The ciliary muscle loses its ability to adjust, so that the eyes cannot focus on close distances and can only see distance.
2. The pupil dilates, allowing more light to enter the eye.
Human eyes can see far and near, because the ciliary muscle of the eyeball (regulatory muscle) is working. When looking far away, the muscles relax, and when looking close, the muscles need to contract. When the eyes are used at close range for a long time, the eyeball adjustment muscles will be overly tense, and mydriatics can temporarily relax the muscles and reduce the degree of pseudomyopia. When optometry, if there is a little mydriatic agent, the interference of the accommodation muscles can be removed, and the true degree of myopia of the eye can be measured.
It should be noted that during the effect of the mydriatic agent, because the regulating muscles are relaxed, it will be more difficult to focus on close things, resulting in temporary near-distance vision blurring.
Mydriatics dilate the pupils mainly to assist ophthalmologists in performing retinal examinations.For ordinary people, after dilation of pupils, photophobia and discomfort in bright environments are the most complained side effects of mydriatics, and this side effect is especially obvious outdoors in bright sunlightbut inAfter the effect of the medicine wears off, it will return to normal.
Can “long-acting mydriatic agent” slow down the progression of myopia?
It is very important to control the degree of myopia in childhood.andMydriatics are one of the ways to control myopia in children. “Long-acting mydriatic agent” has undergone many large-scale randomized controlled clinical trials and clinical observations of different groups of children in many countries. It has been rigorously confirmed that it can effectively “slow down” the progression of myopia. This is currently the highest level of evidence and the most effective way to prevent myopia. It is also the only eye drops that can effectively control myopia.butOnly long-acting mydriatics have this benefit, not short-acting mydriatics.
It is important to note that,The effect of long-acting mydriatics lies in “preventing the future” possible myopia, rather than “changing the past” myopia already formed. This is a very, very important concept.
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Four characteristics and myths of long-acting mydriatics
1.The myopia control effect of long-acting mydriatic agent, the higher the concentration, the better, and the myopia control effect of 0.5% long-acting mydriatic agent is significantly better than that of 0.01%.
2.Low concentrations of long-acting mydriatics have protective power, and some long-acting mydriatics are better than none. Although the low concentration of 0.01% is not as effective in controlling myopia as high-concentration syrup, compared with no mydriatic, the low concentration of 0.01% still shows the ability to slow down the progression of myopia (from an average increase of 120 degrees in two years to an average increase in two years 49 degrees).
3.The effect of long-acting mydriatics is to “slow down” the rate of increase in the degree of myopia, not “to stop increasing myopia at all”. Regardless of the concentration of long-acting mydriatics, after several years of follow-up, the degree of myopia and axial length of the eye may still increase, but the increase rate becomes less. None of the research groups had a significant reduction in the degree of myopia, and personal eye habits still need to be paid attention to.
4.Long-acting mydriatics cannot reduce the degree of true myopia that has already formed. That is to say, the effect of long-acting mydriatics is to prevent the degree of myopia that may occur in the future, but it is powerless for the degree of myopia that has formed in the past. What happened, has happened.
Long-acting mydriatic side effects
Long-acting mydriaticthe benefits oflet’s talk about its disadvantages again,according toA meta-analysis study in 2017 showed that the common side effects and average incidence rates of long-acting mydriatics are:
1. Photophobia caused by pupil dilation: 25.1%
2. Near-distance blurred vision caused by cycloplegia: 7.5%
3. Red and itchy eyes caused by drug allergy: 2.9%
The higher the concentration of long-acting mydriatics, although the ability to delay the progression of myopia is stronger, but the side effects will be more obvious, and children’s acceptance will be lower. Because mydriatics will “simultaneously” paralyze the accommodative muscles and pupil constrictor muscles in the eyeball.
Side effects 1. Photophobia
Photophobia is the most complained side effect of mydriatics. This is because the pupillary constrictor muscle is paralyzed. The indoor environment is fine, but in the outdoor environment with strong sunlight, children may feel dazzling and produce movements such as squinting, or even be unable to open their eyes. It is recommended to wear UV-resistant sunglasses and protect your eyes from the sun.
Studies have shown that the incidence of photophobia has a significant relationship with the concentration of mydriatic agents: 43.1% of high-concentration mydriatics, 17.8% of medium-concentration mydriatics, and only 6.3% of low-concentration mydriatics. If the child has severe photophobia, you can also consider switching to a lower concentration of mydriatics, or reducing the frequency of dosing of mydriatics. Although these two practices may reduce the power of myopia control,But a little is better than nothing。
Side Effect 2. Blurred near-distance vision
Difficulty focusing at close range is another side effect of mydriatics, as the accommodative muscles of the eyeball are paralyzed, preventing close-up images from being focused. As long as you hold the book farther away, you will see clearly. This virtually encourages schoolchildren to maintain a correct reading distance and keep their eyes from getting too close to the books. However, if schoolchildren really encounter difficulties when writing or doing homework, they can consider getting a pair of reading glasses for near use or multi-focal lenses to assist near-distance vision.
Side effects, whether photophobia or difficulty focusing at close range, are temporary. As long as the effect of the mydriatic agent wears off, it will return to normal.
Some people worry that mydriatics will allow excessive light to enter the eyeball, whether it will cause long-term damage to the lens, macula, glaucoma, etc. Mydriatics have been widely used for many years, and there are no large-scale case reports of this effect. Wearing sunglasses outdoors can effectively block light, prevent ultraviolet rays and strong light exposure. It is an eye protection measure that “any age group” should take, not just limited to children with mydriatics.
Some parents worry that mydriatics will increase intraocular pressure, but this side effect is very rare in children, and many studies do not even mention this side effect at all. Mydriatics do have the potential to increase intraocular pressure in “adults with narrow corner structures”. But it is not easy to have this situation in normal adults or children. So this should be regarded as a myth cracking, don’t believe in rumors anymore.
Side effect 3. Red and itchy eyes
Finally, if the child has an allergic reaction with red and itchy eyes after ordering the mydriatic, it means that the physique is not suitable, so do not continue to order.
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Reminders for healing days
Long-acting mydriatics can effectively slow down the progression of myopia, and are effective at low concentrations. The higher the concentration, the better the effect of myopia control; the lower the concentration, the less side effects. We need to strike a balance between the two. Even a low-concentration long-acting mydriatic is more effective than “no point”. Depending on the child’s condition, it is very important to discuss with the doctor the concentration of the mydriatic and the frequency of administration.
If children cannot accept the side effects of mydriatics, or simply do not want to order mydriatics, other myopia control methods can also be considered. Myopia is always prevention is better than cure, not Jiang Xin trap. Developing good eye habits, increasing time for outdoor activities, and seeing far away are all important daily maintenance. I hope that every child can have good eyesight when they grow up!
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This article is reproduced from:Zheng Yuting Ophthalmologist The original title is:Are mydriatics useful for nearsightedness? What are the side effects?Full disclosure of advantages and disadvantages
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