Although several studies show the use of atropine can slow progressive myopia, the anticholinergic remains an off-label treatment for this condition that, for many, is difficult to come by and also challenging, when it comes to ensuring the correct formulation and patient safety. With this in mind, three optometrists who specialize in myopia control discuss where they get atropine for their patients:

• Nidhi Rana, O.D., who practices at Wills Eye Hospital, in Philadelphia, and in East Brunswick, N.J., says she provides her patients with a short list of vetted specialty pharmacies that direct mail to patients.
  “The pharmacies on that list are capable of compounding the needed formulation, don’t charge an exorbitant fee, or $100 and up, as insurance does not cover this treatment, and they make each concentration fresh,” she explains.

  

• Tom Aller, O.D., F.B.C.L.A., visiting scholar at the School of Optometry, University of California, Berkeley, and editor of Managemyopia.org , says he works with compounding pharmacies that formulate atropine in a sterile laminar flow cabinet to ensure sterility.
• Jeff Cooper, M.S., O.D., F.A.A.O., F.C.O.V.D., professor emeritus at SUNY College of Optometry, says he follows suit.

“We use compounding pharmacies that employ sterile techniques to make up the specific concentrations we prescribe, and we prefer preserved formulations for safety reasons,” he explains. “My advice to optometrists who want to offer atropine as a myopia control treatment is to find a compounding pharmacy that has stringent safety protocols, can ship direct to patients and offer these formulations at the lowest price.”

The future appears bright regarding atropine availability. The FDA recently accepted an investigational new drug application from Eyenovia to initiate a Phase 3 trial of the company’s MicroPine micro-therapeutic topical formulation of atropine, using the novel Optejet dispenser, to reduce the progression of myopia in children; Nevacar completed enrollment for its Phase 3 CHAMP (Childhood Atropine for Myopia Progression) study, evaluating the ability of its NVK-002 to slow the progression of myopia in children; and other clinical trials, bit.ly/2YTVCZJ , are in the works for the use of atropine on treating progressive myopia. OM