All children in that study were offered photochromatic spectacle lenses - either single vision or progressive addition depending on near vision symptoms. The pupil size exceeded 7.5mm, on average, for both photopic and mesopic conditions with 0.5% atropine, was around 7mm for 0.1% and 5 to 5.5mm for 0.01%. The ATOM-2 Study, which compared 0.5%, 0.1% and 0.01% concentrations, 5 found an increase of around 3mm in pupil size for the stronger concentrations but only 1mm for 0.01%. There is a concentration-dependent response seen with atropine and myopia control efficacy, and the same is true for the side effect of pupil dilation. Studies are either very small, 2 have found no difference between myopic and control groups 3 or have contradictory findings on whether emmetropes have the larger pupils or not. While the IMI acknowledged a potential relationship between depth of focus, accommodative lag, retinal image blur and higher order aberrations in progressing myopes, they reported inconclusive data from published studies. 2 The IMI paper published in 2021 on Accommodation and Binocular Vision in Myopia Development and Progression concluded that the role of pupils in the development and progression of myopia is unclear. 1 Another small study in 2009 concluded there was no relationship linking pupils, myopia and accommodation. There is, however, still a lot to learn.Ī 2020 study on university students in Nigeria found that there was a statistically significant relationship between pupil size and myopia however they only reviewed 100 myopes aged 18-25 years. It seems reasonable to conclude that as the pupil controls the light input to the retina, and we now understand the strong link between focus, light and myopia risks, that the pupil might potentially hold the answers to many of our myopia mysteries. Pupils may be connected to myopia management more than we realize. How does this influence your clinical practice?.
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