Atropine for their myopia. How bad should be myopia be before atropine is started? Can atropine be started when myopia has just been first recognized? What are the criteria for initiating the atropine treatment for myopia? Because there is a lot of different opinions on atropine, especially about using atropine in children. The second part of the question is this. Is atropine for myopia used only during the night? So that because it affects their accommodation. How is atropine being used in ophthalmology to prevent and treat myopia? Well, it was the age of the child with myopia. It also depends on the history of myopia in the family. Because when you have a family with high myopia in the parents, you know that the child has a high risk of having the same severe myopia. So in these cases, you can just begin to use the atropine treatment very early. For the atropine treatment, it could be in the morning rather than in the evening because it doesn't have a real effect on the accommodation. Because it's a very low dose of atropine. You know, standard atropine drops are usually 1%. Or atropine is 0.3%. And in this case, for nearsightedness treatment, atropine is 0.01% and 0.05%. So it's very low. And usually, there is no impact on the accommodation. If there is an impact on the accommodation, we use atropine in the evening, because it's better. And we can also combine atropine and some eyeglasses. For instance, we can just begin with eyeglasses, and after that, add atropine. So it is tailored for the child or the parents. I cannot say exactly when to begin the atropine treatment. But for sure, if there is a new evolution of myopia, if nearsightedness is rapidly growing, we can start therapy with atropine very early. What would be the mechanism of action of atropine at such very low concentrations? That's a very interesting question because I think we do not know everything about that. Atropine is supposed to act on the muscarinic receptors and inhibit them. So there are two mechanisms of action of atropine to slow down myopia progression. Its first action is to fight the defocus on the middle periphery of the retina. There is the signal there that says, "okay, just grow the eye." So that's the defocus system on the glasses and the contact lenses with the defocus system. Or it can be reshaping the cornea with orthokeratology. Or it can be activated with myopia or with atropine on muscarinic receptors. But I'm not sure we know everything about atropine. Well, this is very interesting. And you also mentioned that there are some corrective contact lenses that reshape the cornea in a child with developing myopia. How does that work? Is that something recent? What is the name of the particular technology? Because that's something new, I have not heard about it before. So the orthokeratology is not a new system. It's been a very well-known system for quite a long time. But I think orthokeratology is interesting for older children. Because in younger children, it's very difficult to make them wear this semi-rigid contact lens during the night. Of course, orthokeratology is very interesting for older children who go to sports activities. Menicon Ortho-k orthokeratology lenses are doing very nice shaping of the cornea. But there are also all the other laboratories that can do orthokeratology lenses. Because orthokeratology is not a new system, it works. But the problem of orthokeratology is that it's difficult to make a clinical study. So there are no reference clinical trial studies with large numbers of patients because it's quite difficult to do them. That's why orthokeratology was used a long time ago. But it's not very easy to demonstrate exactly the action of orthokeratology lenses. Also, it is because when you act on the shape of the cornea, you don't get exactly the actual lens in the shape of the eye. Because you just go and flatten the cornea. And so, this is very difficult also to understand the process of myopia correction. So that's a very interesting system of myopia therapy. But I would say that I will go to new innovating systems [first], or atropine therapy. Atropine is probably the most efficient system to slow myopia progression. While this is very interesting - addressing myopia with the new technologies, obviously but also with some pharmacological means. Hopefully, it will lead to a decrease in myopia, especially in younger children. 20% is a very large percentage of young children, you know, millions of children around the world. Exactly!
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