A Randomized Controlled Trial of Gradual (Slow Versus Very Slow) Versus Sudden Cessation of Atropine Therapy and Monitored Lifestyle Changes in the Incidence and Magnitude of Rebound Myopia.

Atropine eye drop therapy has emerged as a globally accepted and effective intervention for slowing down myopia progression. Numerous studies highlight the efficacy of atropine therapy in mitigating myopia progression, often complemented by increased outdoor daylight activities and reduced screen time. However, the recent ATOM2 study(phase 2- washout period) revealed a concerning phenomenon known as rebound myopia, characterized by a worsening of myopia (progression of >0.5D) after the cessation of atropine therapy.

Remarkably, despite the growing significance of atropine therapy in myopia management, there is a notable lack of published guidance on strategically ceasing atropine treatment to minimize the incidence and magnitude of rebound myopia. Additionally, the role of monitored lifestyle changes, such as outdoor activities and screen time reduction, in addressing rebound myopia remains largely unexplored.

This study aims to fill this critical gap by assessing the efficacy of two atropine cessation regimes- gradual (slow vs very slow) versus sudden cessation of atropine therapy. Simultaneously, the research seeks to delineate the impact of monitored lifestyle changes on the incidence and magnitude of rebound myopia.

Methods;

The study will involve the randomization of patients into two groups, namely Group A and Group B. the group of children, the higher myopic eye will undergo a gradual tapering of atropine eye drops over 7 months, while the low myopic eye will undergo sudden cessation of atropine therapy. Lifestyle modification advice will be provided in this group. in group B children, the high myopic eye will undergo gradual tapering of atropine eye drop therapy over 3 months and the lower myopic eye will undergo sudden cessation of atropine eye drop. lifestyle modification including over 45 minutes of daily outdoor daylight activity and less than 1 hour of screen time, will be monitored using monitoring charts.

Patients will be followed up every three months, during which refractive power and axial length will be measured. The recruitment period for this comprehensive study is expected to span 13 months, aiming to provide  insight into the evolving landscape of rebound myopia management strategies