Current and emerging pharmaceutical interventions for myopia
Current and emerging pharmaceutical interventions for myopia
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DOI：
10.1136/bjophthalmol-2018-313798
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发表时间：
2019-05
影响因子：
4.1
通讯作者：
K. Vutipongsatorn;Tae Yokoi;K. Ohno-Matsui
中科院分区：
文献类型：
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作者：
K. Vutipongsatorn;Tae Yokoi;K. Ohno-Matsui
近视是视力受损的一个主要原因。它的流行正在稳步增长，特别是在东亚。尽管近视带来了巨大的疾病和经济负担，但目前还没有食品和药物管理局批准的近视药物。该综述旨在总结近十年来临床和临床前阶段近视的药物干预，并讨论临床前近视药物进入临床试验所面临的挑战。在人类研究中，阿托品和口服7-甲基黄嘌呤被证明可以减少近视进展。前者已被广泛研究，可以说是最成功的药物。然而，它有副作用，低剂量阿托品的试验仍在进行中。其他正在进行临床试验的药物包括酮咯酸氨丁三醇、口服核黄素和BHVI2(一种实验药物)。由于近视的病理生理学尚未完全阐明，许多药物已经在临床前阶段进行了测试，并可根据已提出的近视机制进行大致分类，即抗肌钙蛋白、多巴胺能、抗炎等。然而，几种药物被注射到玻璃体内或结膜下，阻碍了它们进入人体试验。此外，由于阿托品是目前最成功的药物，未来的临床前干预应该与阿托品联合进行研究，以优化近视的治疗。
Myopia is a major cause of visual impairment. Its prevalence is growing steadily, especially in East Asia. Despite the immense disease and economic burden, there are currently no Food and Drug Administration-approved drugs for myopia. This review aims to summarise pharmaceutical interventions of myopia at clinical and preclinical stages in the last decade and discuss challenges for preclinical myopia drugs to progress to clinical trials. Atropine and oral 7-methylxanthine are shown to reduce myopia progression in human studies. The former has been extensively studied and is arguably the most successful medication. However, it has side effects and trials on low-dose atropine are ongoing. Other pharmaceutical agents being investigated at a clinical trial level include ketorolac tromethamine, oral riboflavin and BHVI2 (an experimental drug). Since the pathophysiology of myopia is not fully elucidated, numerous drugs have been tested at the preclinical stage and can be broadly categorised based on the proposed mechanisms of myopisation, namely antimuscarinic, dopaminergic, anti-inflammatory and more. However, several agents were injected intravitreally or subconjunctivally, hindering their progress to human trials. Furthermore, with atropine being the most successful medication available, future preclinical interventions should be studied in combination with atropine to optimise the treatment of myopia.