Managing Myopia and Monitoring Ocular Risks: Insights for Pediatric and Diabetic Care

Clinicians are increasingly balancing the promise of interventions that preserve vision—from childhood myopia control to metabolic therapies in diabetes—against the need for vigilant ocular monitoring.

Comparative efficacy—measured by axial length elongation and spherical equivalent progression—offers concrete guidance in pediatric eye care. Evidence from clinical studies indicates that atropine eye drops and orthokeratology can slow myopia progression, aligned with consensus frameworks from international expert groups rather than formal guideline mandates. Studies such as those noted in a JAMA Ophthalmology comparative study underscore these findings, suggesting a nuanced approach to myopia management. Both atropine and orthokeratology can be effective for myopia control, though results vary across studies; clear age‑ or severity‑based differences are not consistently demonstrated.

Safety remains paramount in pediatric treatments. Long-term use of low-dose atropine (approximately 0.01–0.05%) is generally well tolerated in children, with mild, dose-dependent side effects such as photophobia and near blur and a potential for rebound on cessation, warranting monitoring and thoughtful tapering. ATOM1 and ATOM2 demonstrated efficacy with dose-dependent adverse effects (for example, photophobia and near blur); more recent data such as the LAMP trial inform contemporary dose selection.

Such findings are crucial for reassuring both clinicians and parents regarding atropine’s role in myopia control, as detailed in a JAMA Ophthalmology analysis of long‑term low‑dose atropine.

Beyond childhood myopia, the same commitment to preserving vision across the lifespan applies in metabolic disease: turning to diabetes management, potential ocular risks associated with GLP‑1 receptor agonists have emerged as a concern. Observational signals have raised questions about a possible association with optic neuropathy that requires further study; this is distinct from the better-established phenomenon of early retinopathy worsening with rapid A1c reductions in high‑risk patients. As indicated by a JAMA Ophthalmology cohort study, clinicians should weigh the risks when prescribing GLP-1 RAs.

While signals regarding optic neuropathy remain uncertain, GLP‑1 receptor agonists confer substantial metabolic and cardiovascular benefits; clinicians should weigh individualized risks and consider co‑management with ophthalmology in higher‑risk patients.

Enhanced ophthalmic monitoring is prudent for patients at higher risk—such as those with pre‑existing moderate‑to‑severe diabetic retinopathy or experiencing rapid, substantial A1c reductions (as highlighted in trial contexts like SUSTAIN‑6)—while routine care suffices for others. Early detection of diabetic retinopathy and vision loss or decreased visual acuity can mitigate long-term damage. A recent analysis suggests these potential effects, advocating for proactive ophthalmologic surveillance following treatment initiation, as supported by a recent JAMA Ophthalmology analysis.

Key Takeaways:

• Both atropine and orthokeratology can be effective for myopia control, though results vary across studies; selection should be individualized.
• Low-dose atropine is generally well tolerated with mild, dose-dependent side effects; monitoring and tapering can help address rebound.
• GLP-1 receptor agonists have substantial systemic benefits; ocular risk signals are uncertain and warrant cautious interpretation.
• Enhanced monitoring is most appropriate for high-risk patients, while routine care is reasonable for others starting GLP-1 therapy.