- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03865160
Low-dose Atropine for Myopia Control in Children (AIM)
October 4, 2022 updated by: University Eye Hospital, Freiburg
Low-dose Atropine for Myopia Control in Children, a Prospective, Double-blind, Placebo-controlled, Multicentric, Randomized Clinical Trial
Myopia (nearsightedness) is the most common eye disorder.
Only second to age, it is the main risk factor for major degenerative eye diseases such as glaucoma, macular degeneration or retinal detachment.
Their risk increases with the degree of myopia.
Hence, prevention of myopia and slowing its progression is of high relevance.
Almost all clinical studies, including two large randomised clinical trials (RCT) were performed in Asia with Asian study participants.
The results indicate that atropine eye drops can attenuate myopic progression in children, even in low concentrations thus minimizing unwanted side effects.
However, the cumulative evidence is yet not strong enough to recommend their unrestricted use, especially in a Non-Asian population.
We therefore intend to set up an adequately powered RCT comparing atropine 0.02% eye drops with placebo to validate previous findings and to test whether this therapeutic concept holds its promise in a European population.
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Detailed Description
Myopia (nearsightedness) is the most common developmental eye disorder in the first decades of life.
It is the biggest risk factor for sight threatening degenerative eye diseases later in life, second only to age.
Its prevalence is increasing worldwide in pandemic dimensions affecting now > 80% in Asian and > 40% in Caucasian populations.
Myopia is one of the five eye diseases identified as immediate priorities by the WHO's global initiative for the elimination of avoidable blindness.
It usually develops during primary school and its onset and progression are related to environmental factors such as near work and lack of day light exposure, to a lesser degree to genetic factors.
Therefore, retardation of myopia progression is a major therapeutic goal.
Clinical trials from Asia have shown that 0.01% atropine eye drops can attenuate progression of myopia while inducing only little side effects such as light sensitivity and reduced accommodation.
Subsequent data also from Asia have suggested that a concentration of 0.05% atropine is slightly more effective with a still acceptable level of adverse effects.
However, it is unclear whether this therapy is equally and sufficiently efficacious in a Caucasian population.
It is also unclear which concentration of atropine represents the best compromise between efficacy and safety.
Our own uncontrolled pilot data suggest that 0.01% delays progression by about 50% with negligible side effects, but that 0.05% induces a pupil dilation of > 3 mm, which is considered unacceptable.
Due to the increasing prevalence also in Europe and an increasing demand from parents for means to retard myopia progression, the trial is the first European large scale randomized clinical trial investigating the safety and efficacy of 0.01% and 0.02% atropine eye drops in comparison to placebo drops.
Such a trial is mandatory to substantiate the increasing off-label prescriptions of low-dose atropine in children and to develop clinical guidelines.
Study Type
Interventional
Enrollment (Anticipated)
300
Phase
- Phase 2
- Phase 3
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Wolf Lagrèze, Prof.
- Phone Number: 40110 +49 (0) 761 270
- Email: wolf.lagreze@uniklinik-freiburg.de
Study Contact Backup
- Name: Daniel Böhringer, Prof.
- Phone Number: 40010 +49 (0) 761 270
- Email: daniel.boehringer@uniklinik-freiburg.de
Study Locations
-
-
-
Ahaus, Germany, 48683
- Recruiting
- Augen-Zentrum-Nordwest, Augenpraxis Ahaus
-
Contact:
- Stefanie Schmickler, Dr.
-
Bonn, Germany, 53127
- Recruiting
- Universitats-Augenklinik Bonn
-
Contact:
- Bettina Wabbels, Prof. Dr.
-
Erlangen, Germany, 91054
- Recruiting
- Universitätsklinikum Erlangen, Augenklinik
-
Contact:
- Gabriele Gusek-Schneider, Prof. Dr.
-
Essen, Germany, 45147
- Recruiting
- Universitätsklinikum Essen, Klinik für Augenheilkunde
-
Contact:
- Anja Eckstein, Prof. Dr.
-
Freiburg, Germany, 79106
- Recruiting
- Medical Center - University of Freiburg, Eye Hospital
-
Contact:
- Wolf A. Lagrèze, Prof.
- Phone Number: 40110 +49 761 270
- Email: wolf.lagreze@uniklinik-freiburg.de
-
Göttingen, Germany, 37075
- Recruiting
- Universitätsmedizin Göttingen, Augenklinik
-
Contact:
- Michael Schittkowski, Prof. Dr.
-
Hamburg, Germany, 20246
- Not yet recruiting
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Augenheilkunde
-
Contact:
- Martin Spitzer, Prof. Dr.
-
Hannover, Germany, 30625
- Recruiting
- Medizinische Hochschule Hannover, Klinik für Augenheilkunde
-
Contact:
- Karsten Hufendiek, Dr.
-
Heidelberg, Germany, 69120
- Not yet recruiting
- Universitätsklinikum Heidelberg, Augenklinik
-
Contact:
- Christina Beisse, Dr.
-
Köln, Germany, 50937
- Recruiting
- Uniklinik Köln, Zentrum für Augenheilkunde
-
Contact:
- Andrea Hedergott, Dr.
-
Leipzig, Germany, 04103
- Not yet recruiting
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Augenheilkunde
-
Contact:
- Ina Sterker, Prof. Dr.
-
Magdeburg, Germany, 39120
- Recruiting
- Universitätsklinikum Magdeburg A.ö.R., Universitätsaugenklinik
-
Contact:
- Claudia Schuart, Dr.
-
Mainz, Germany, 55131
- Not yet recruiting
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Augenklinik und Poliklinik
-
Contact:
- Karin Lorenz, PD Dr.
-
München, Germany, 80336
- Recruiting
- Ludwig-Maximilians-Universität München, Augenklinik und Poliklinik
-
Contact:
- Theresia Ring-Mangold, Dr.
-
Münster, Germany, 48149
- Recruiting
- Klinik für Augenheilkunde des UKM, Gebäude D15
-
Contact:
- Julia Biermann, Prof. Dr.
-
Oldenburg, Germany, 26121
- Recruiting
- Pius-Hospital Oldenburg, Medizinischer Campus Universität Oldenburg, Universitätsklinik für Augenheilkunde
-
Contact:
- Thomas Lischka, Dr.
-
Rosenheim, Germany, 83022
- Recruiting
- AugenCentrum Rosenheim
-
Contact:
- Philipp Eberwein, Prof. Dr.
-
Ulm, Germany, 89075
- Recruiting
- Universitätsklinikum Ulm, Klinik für Augenheilkunde
-
Contact:
- Armin Wolf, Prof. Dr.
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
8 years to 12 years (Child)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Male or female patients aged 8 to 12 years (up to the day before the 13th birthday)
- Myopia of -1 D to -6 D with reported or documented annual progression ≥ 0.5 D of myopia
- Written informed consent obtained from patient (if applicable) and parents or legal guardians according to international guidelines and local laws
- Ability to understand the nature of the trial and the trial related procedures and to comply with them
Exclusion Criteria:
- Asian or African origin
- Abnormal binocularity
- Strabismus
- Astigmatism >1.5 D
- Anisometropia >1.5 D
- History of amblyopia
- Corrected visual acuity in any eye <0.63
- Any acquired or developmental organic eye disease
- Premature birth
- Any known systemic metabolic disease or chromosomal anomaly
- Previous use of any kind of contact lenses
- Previous use of atropine eye drops
- Epilepsy
- Known hypersensitivity to the active substances or any of the excipients
- Participation in any other interventional clinical trial within the last 30 days before the start of this trial
- Simultaneous participation in other interventional trials which could interfere with this trial; simultaneous participation in registries and diagnostic trials is allowed
- Contraindications according to the Summary of Product Characteristics (SmPC): Increased intraocular pressure (primary forms of glaucoma or narrow angle glaucoma), chronic rhinitis sicca
- Caution and pediatric counselling shall be assured if any of the following conditions are present according to the Summary of Product Characteristics (SmPC): Cardiac insufficiency, arrhythmia, coronary stenosis, hyperthyroidism, stomach or bowel stenosis, bowel paralysis, megacolon, muscle weakness, lung edema, hypersensitivity to atropine, spastic paralysis
- Parents or children with poor understanding of the German language
- Person who is in a relationship of dependence/employment with the sponsor or the investigator
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Arm A, Interventional group
Treatment period 1: Atropine eye drops, 0.02%, 1 drop/eye, daily for 12 months Treatment period 2: Atropine eye drops, 0.02%, 1 drop/eye, daily for 12 months Treatment period 3: Placebo (NaCl 0.9%) eye drops, 1 drop/eye, daily for 12 months
|
One drop of the above mentioned drug will be installed into each eye daily at bedtime.
One drop of the above mentioned drug will be installed into each eye daily at bedtime.
|
Experimental: Arm B, Control group
Treatment period 1: Placebo (NaCl 0.9%) eye drops, 1 drop/eye, daily for 12 months Treatment period 2: Atropine eye drops, 0.01%, 1 drop/eye, daily for 12 months Treatment period 3: Atropine eye drops, 0.01%, 1 drop/eye, daily for 12 months
|
One drop of the above mentioned drug will be installed into each eye daily at bedtime.
One drop of the above mentioned drug will be installed into each eye daily at bedtime.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Demonstration of superiority of low-dose atropine 0.02% eye drops compared to placebo for myopia control
Time Frame: Baseline - 12 months
|
Change in cycloplegic refraction [dioptre (D)/year] after one year will be performed using an analysis of covariance (ANCOVA) model with the annual change in refraction as the dependent variable.
The mean value of both eyes is analysed.
|
Baseline - 12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Assessment of axial eye length growth under low-dose atropine 0.02% in comparison to placebo
Time Frame: Baseline - 12 months
|
Change in axial length [mm/year].
The mean value of both eyes is analysed.
Analyses will be performed in a regression model.
|
Baseline - 12 months
|
Assessment of the categorized rate of change in refraction of low-dose atropine 0.02% compared to placebo
Time Frame: Baseline - 12 months
|
The primary endpoint change in cycloplegic refraction after one year will be categorized (patients progressing < 0.25D (dioptre), 0.25D - 0.75D and > 0.75D after one year of treatment) and will be analysed descriptively, giving absolute and relative frequencies of these categories as a supportive analysis.
|
Baseline - 12 months
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Assessment of rebound of myopia progression (refraction) after cessation of atropine 0.02% treatment
Time Frame: 24-months - 36-months
|
Change in refraction [D/year] in year 3, to be determined only in the intervention group.
|
24-months - 36-months
|
Assessment of rebound of myopia progression (axial length) after cessation of atropine 0.02% treatment
Time Frame: 24-months - 36-months
|
Change in axial length [mm/year] in year 3, to be determined only in the intervention group.
|
24-months - 36-months
|
Change in refraction [D/year]
Time Frame: intervention group: baseline - 24-months, control group: 12-months - 36-months
|
Change in refraction [D/year] after two years of treatment with low-dose atropine 0.02% eye drops (after year 2 in the interventional group) compared to low-dose atropine 0.01% eye drops (after year 3 in the control group).
|
intervention group: baseline - 24-months, control group: 12-months - 36-months
|
Change in axial length [mm/year]
Time Frame: intervention group: baseline - 24-months, control group: 12-months - 36-months
|
Change in axial length [mm/year] after two years of treatment with low-dose atropine 0.02% eye drops (after year 2 in the interventional group) compared to low-dose atropine 0.01% eye drops (after year 3 in the control group).
|
intervention group: baseline - 24-months, control group: 12-months - 36-months
|
Assessment of safety of topical preservative free atropine in comparison to placebo with regard to pupil size
Time Frame: Baseline - 36-months
|
Pupil diameter in mm using the IOL Master 500 or 700 or a PlusoptiX device (preferred) at 200 - 300 lux room illumination.
Parameter will be listed by site and patient and displayed in summary tables.
|
Baseline - 36-months
|
Assessment of safety of topical preservative free atropine in comparison to placebo with regard to near vision
Time Frame: Baseline - 36-months
|
Visual acuity at near (40 cm distance) using Landolt-C near vision charts (non-crowded version) as decimal acuity.
Parameter will be listed by site and patient and displayed in summary tables.
|
Baseline - 36-months
|
Assessment of safety of topical preservative free atropine in comparison to placebo with regard to accomodation
Time Frame: Baseline - 36-months
|
Accommodation in D as the near point by the Royal air force near point rule (RAF) or by the Accommodation Convergence Rule (VISUS GmbH) (mean of three measurements of both eyes).
Parameter will be listed by site and patient and displayed in summary tables.
|
Baseline - 36-months
|
Assessment of safety of topical preservative free atropine in comparison to placebo with regard to pulse rate
Time Frame: Baseline - 36-months
|
Pulse rate (per minute): parameter will be listed by site and patient and displayed in summary tables.
|
Baseline - 36-months
|
Number of participants with treatment-related adverse events as assessed by the current CTCAE v4.0
Time Frame: Baseline - 36-months
|
The adverse events are displayed in summary tables by treatment. |
Baseline - 36-months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Wolf Lagrèze, Prof., Eye Center, Medical Center, University Hospital Freiburg
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Helpful Links
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
October 19, 2021
Primary Completion (Anticipated)
October 1, 2025
Study Completion (Anticipated)
April 1, 2026
Study Registration Dates
First Submitted
March 3, 2019
First Submitted That Met QC Criteria
March 5, 2019
First Posted (Actual)
March 6, 2019
Study Record Updates
Last Update Posted (Actual)
October 7, 2022
Last Update Submitted That Met QC Criteria
October 4, 2022
Last Verified
October 1, 2022
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Eye Diseases
- Refractive Errors
- Myopia
- Myopia, Degenerative
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Anti-Arrhythmia Agents
- Parasympatholytics
- Autonomic Agents
- Peripheral Nervous System Agents
- Muscarinic Antagonists
- Cholinergic Antagonists
- Cholinergic Agents
- Adjuvants, Anesthesia
- Bronchodilator Agents
- Anti-Asthmatic Agents
- Respiratory System Agents
- Pharmaceutical Solutions
- Mydriatics
- Ophthalmic Solutions
- Atropine
Other Study ID Numbers
- P001307
- DRKS00023337 (Registry Identifier: German Clinical Trials Register (DRKS))
- 2020-001575-33 (EudraCT Number)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
No
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Myopia, Progressive
-
He Eye HospitalNot yet recruiting
-
University of BradfordCoopervision, Inc.; University of HuddersfieldNot yet recruiting
-
Visioneering Technologies, IncRecruitingMyopiaUnited States, Canada, Hong Kong, Singapore
-
Shanghai 10th People's HospitalCompletedMyopia | Myopia, ProgressiveChina
-
Tianjin Eye HospitalActive, not recruiting
-
Tianjin Eye HospitalCompleted
-
Sultan Qaboos UniversityChristian Medical College, Vellore, IndiaUnknown
-
Peking University People's HospitalUnknownProgressive MyopiaChina
-
Shanghai Eye Disease Prevention and Treatment CenterRecruiting
-
Shanghai Eye Disease Prevention and Treatment CenterShanghai General Hospital, Shanghai Jiao Tong University School of MedicineNot yet recruiting
Clinical Trials on Atropine eye drops, 0.02%
-
Hai Yen Eye CareBrien Holden VisionCompleted
-
Hai Yen Eye CareBrien Holden VisionCompleted
-
Zhaoke (Guangzhou) Ophthalmology Pharmaceutical...Active, not recruiting
-
Eye & ENT Hospital of Fudan UniversityShandong Provincial Hospital; Children's Hospital of Fudan University; Xinhua... and other collaboratorsRecruiting
-
Hai Yen Eye CareBrien Holden Vision InstituteCompleted
-
Zhaoke (Guangzhou) Ophthalmology Pharmaceutical...Recruiting
-
Medical University of ViennaCompleted
-
Alcon ResearchCompleted
-
AllerganCompletedDry Eye SyndromesUnited States