Optic Nerve Head Changes over 15 Years—From the Atropine Treatment Long-Term Assessment Study

Purpose

To investigate optic nerve head (ONH) changes over 15 years from childhood to adulthood.

Design

A longitudinal study.

Participants

The Atropine Treatment Long-Term Assessment Study (ATLAS) included 148 myopic participants from the Atropine for the Treatment of Myopia 2 (ATOM2) trial.

Methods

During ATOM2, all participants were treated with daily atropine eye drops in concentrations of 0.01%, 0.1%, or 0.5%. The ATLAS recall visit was conducted in 2021–2022. At 3 study visits—ATOM2 baseline, last ATOM2 (5-year), and ATLAS recall (15-year)—participants underwent cycloplegic autorefractometry, biometry, and fundus photography. At recall, OCT centered on the optic disc was additionally performed. Fundus photographs were morphometrically examined for ONH ovality, torsion, parapapillary atrophy (PPA), disc–fovea distance, position of the central retinal vascular trunk (CRVT), angle kappa, and vertical distance between the arterial arcade. OCT images were analyzed for Bruch membrane opening distance, gamma zone, and Bruch membrane overhang.

Main Outcome Measures

Optic nerve head changes from childhood to young adulthood and associated factors.

Results

Optic nerve head characteristics were similar across atropine treatment groups. Myopic refractive error increased from –4.54 ± 1.64 diopters (D) at baseline to –6.35 ± 2.02 D at 5 years to –6.88 ± 2.4 D at 15 years (P < 0.0001). Axial length (AL) increased from a mean of 25.08 ± 0.89 mm to 26.31 ± 1.01 mm (P < 0.0001). Significant ONH changes after 15 years included PPA (beta zone/maximal disc diameter) increasing from 0.19 ± 0.11 to 0.31 ± 0.15 (P < 0.0001), and CRVT position ratio increasing from 1.62 ± 0.22 to 2.23 ± 0.5 (P < 0.0001). Multivariable mixed-effect models confirmed the association of age, AL, and spherical equivalent refraction (SER) with optic disc changes (P < 0.0001). Axial length, SER, and PPA were associated with the Bruch membrane opening distance area and the gamma zone (P values <0.0001). Additionally, age (P < 0.0001), PPA ratio (P = 0.002), and disc–fovea distance ratio (P = 0.030) were found to be associated with myopic progression greater than –2D over a 15-years period.

Conclusions

This long-term study suggests that myopic subjects showed increased PPA and nasal CRVT shift from childhood into young adulthood.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.