Efficacy and Safety of 8 Atropine Concentrations for Myopia Control in Children

Ha, Ahnul; Kim, Seong Joon; Shim, Sung Ryul; Kim, Young Kook; Jung, Jae Ho

doi:10.1016/j.ophtha.2021.10.016

Cited by 78 publications

(109 citation statements)

References 58 publications

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“…Moreover, different doses of atropine had a significantly lower OR in children with rapid myopia progression (OR = 0.16, 95% CI = 0.11–0.23, eFigure 4A in the Supplementary Material ) and a significantly higher OR in children with slow myopia progression (OR = 5.88, 95% CI = 3.86–8.95, eFigure 4B in the Supplementary Material ), which was consistent with Ha et al ( 18 ) and our previous meta-analysis published in 2014 ( 15 ).…”

Section: Discussionsupporting

confidence: 90%

“…Previously, few data were available for the quantitative assessment of adverse effects of topical atropine, except the meta-analysis conducted by Gong et al ( 13 ) and Ha et al ( 18 ), which showed that a higher dose of atropine led to an increasing number of adverse effects. Our results also demonstrated that the side effects of atropine, such as photophobia was dose-dependent.…”

Section: Discussionmentioning

confidence: 99%

“…A previous meta-analysis by Song et al ( 55 ), Li et al ( 15 ) and Gong et al ( 13 ) included only 6, 11, and 19 studies, respectively. Recently, a network meta-analysis conducted by Ha et al built up hierarchies of atropine treatment in terms of efficacy and safety among the 8 concentrations ( 18 ). But the analysis included only 16 RCTs, without comparing the treatment difference during the first year and second year.…”

Section: Discussionmentioning

confidence: 99%

“…There have been several meta-analyses investigating various doses of atropine treatment in myopia control. A previous metaanalysis by Song et (18). But the analysis included only 16 RCTs, without comparing the treatment difference during the first year and second year.…”

Section: Discussionmentioning

confidence: 99%

“…However, there are still some uncertainties and controversies. Some studies reported that the efficacy of atropine was dose-related ( 17 ), whereas others found that efficacy of atropine was dose-independent within the range of 0.01–1% ( 13 , 18 ). Most RCTs and cohort studies reported a first-year protective effect on myopia, whereas the Atropine for the Treatment of Myopia 2 (ATOM 2) study showed a better effect of 0.01% atropine treatment in the second year than in the first year, and it is recommended that the initial treatment of 0.01% atropine should last at least 2 years ( 19 ).…”

Section: Introductionmentioning

confidence: 99%

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Varying Dose of Atropine in Slowing Myopia Progression in Children Over Different Follow-Up Periods by Meta-Analysis

Gan

et al. 2022

Front. Med.

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Purpose: To evaluate the efficacy and safety of atropine for slowing myopia progression and to investigate whether the treatment effect remains constant with continuing treatment.Method: Studies were retrieved from MEDLINE, EMBASE, and the Cochrane Library from their inception to May 2021, and the language was limited to English. Randomized controlled trials (RCTs) and cohort studies involving atropine in at least one intervention and placebo/non-atropine treatment in another as the control were included and subgroup analysis based on low dose (0.01%), moderate dose (0.01%–<0.5%), and high dose (0.5–1.0%) were conducted. The Cochrane Collaboration and Newcastle-Ottawa Scale were used to evaluate the quality of RCTs and cohort studies, respectively.Results: Twelve RCTs and fifteen cohort studies involving 5,069 children aged 5 to 15 years were included. The weighted mean differences in myopia progression between the atropine and control groups were 0.73 diopters (D), 0.67 D, and 0.35 D per year for high-dose, moderate-dose, and low-dose atropine, respectively (χ2 = 13.76; P = 0.001, I2 = 85.5%). After removing studies that provided extreme findings, atropine demonstrated a significant dose-dependent effect on both refractive change and axial elongation, with higher dosages of atropine resulting in less myopia progression (r = 0.85; P = 0.004) and less axial elongation (r = −0.94; P = 0.005). Low-dose atropine showed less myopia progression (−0.23 D; P = 0.005) and less axial elongation (0.09 mm, P < 0.001) in the second year than in the first year, whereas in high-dose atropine more axial elongation (−0.15 mm, P = 0.003) was observed. The higher dose of atropine was associated with a higher incidence of adverse effects, such as photophobia with an odds ratio (OR) of 163.57, compared with an OR of 6.04 for low-dose atropine and 8.63 for moderate-dose atropine (P = 0.03).Conclusion: Both the efficacy and adverse effects of atropine are dose-dependent in slowing myopia progression in children. The efficacy of high-dose atropine was reduced after the first year of treatment, whereas low-dose atropine had better efficacy in a longer follow-up period.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Varying Dose of Atropine in Slowing Myopia Progression in Children Over Different Follow-Up Periods by Meta-Analysis

Gan

et al. 2022

Front. Med.

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Effect of Low-Concentration Atropine Eyedrops vs Placebo on Myopia Incidence in Children

Yam

Zhang

et al. 2023

JAMA

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ImportanceEarly onset of myopia is associated with high myopia later in life, and myopia is irreversible once developed.ObjectiveTo evaluate the efficacy of low-concentration atropine eyedrops at 0.05% and 0.01% concentration for delaying the onset of myopia.Design, Setting, and ParticipantsThis randomized, placebo-controlled, double-masked trial conducted at the Chinese University of Hong Kong Eye Centre enrolled 474 nonmyopic children aged 4 through 9 years with cycloplegic spherical equivalent between +1.00 D to 0.00 D and astigmatism less than −1.00 D. The first recruited participant started treatment on July 11, 2017, and the last participant was enrolled on June 4, 2020; the date of the final follow-up session was June 4, 2022.InterventionsParticipants were assigned at random to the 0.05% atropine (n = 160), 0.01% atropine (n = 159), and placebo (n = 155) groups and had eyedrops applied once nightly in both eyes over 2 years.Main Outcomes and MeasuresThe primary outcomes were the 2-year cumulative incidence rate of myopia (cycloplegic spherical equivalent of at least −0.50 D in either eye) and the percentage of participants with fast myopic shift (spherical equivalent myopic shift of at least 1.00 D).ResultsOf the 474 randomized patients (mean age, 6.8 years; 50% female), 353 (74.5%) completed the trial. The 2-year cumulative incidence of myopia in the 0.05% atropine, 0.01% atropine, and placebo groups were 28.4% (33/116), 45.9% (56/122), and 53.0% (61/115), respectively, and the percentages of participants with fast myopic shift at 2 years were 25.0%, 45.1%, and 53.9%. Compared with the placebo group, the 0.05% atropine group had significantly lower 2-year cumulative myopia incidence (difference, 24.6% [95% CI, 12.0%-36.4%]) and percentage of patients with fast myopic shift (difference, 28.9% [95% CI, 16.5%-40.5%]). Compared with the 0.01% atropine group, the 0.05% atropine group had significantly lower 2-year cumulative myopia incidence (difference, 17.5% [95% CI, 5.2%-29.2%]) and percentage of patients with fast myopic shift (difference, 20.1% [95% CI, 8.0%-31.6%]). The 0.01% atropine and placebo groups were not significantly different in 2-year cumulative myopia incidence or percentage of patients with fast myopic shift. Photophobia was the most common adverse event and was reported by 12.9% of participants in the 0.05% atropine group, 18.9% in the 0.01% atropine group, and 12.2% in the placebo group in the second year.Conclusions and RelevanceAmong children aged 4 to 9 years without myopia, nightly use of 0.05% atropine eyedrops compared with placebo resulted in a significantly lower incidence of myopia and lower percentage of participants with fast myopic shift at 2 years. There was no significant difference between 0.01% atropine and placebo. Further research is needed to replicate the findings, to understand whether this represents a delay or prevention of myopia, and to assess longer-term safety.Trial RegistrationChinese Clinical Trial Registry: ChiCTR-IPR-15006883

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Topical Atropine for Childhood Myopia Control

Li,

Yip,

Ning

et al. 2024

JAMA Ophthalmol

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ImportanceClinical trial results of topical atropine eye drops for childhood myopia control have shown inconsistent outcomes across short-term studies, with little long-term safety or other outcomes reported.ObjectiveTo report the long-term safety and outcomes of topical atropine for childhood myopia control.Design, Setting, and ParticipantsThis prospective, double-masked observational study of the Atropine for the Treatment of Myopia (ATOM) 1 and ATOM2 randomized clinical trials took place at 2 single centers and included adults reviewed in 2021 through 2022 from the ATOM1 study (atropine 1% vs placebo; 1999 through 2003) and the ATOM2 study (atropine 0.01% vs 0.1% vs 0.5%; 2006 through 2012).Main Outcome MeasuresChange in cycloplegic spherical equivalent (SE) with axial length (AL); incidence of ocular complications.ResultsAmong the original 400 participants in each original cohort, the study team evaluated 71 of 400 ATOM1 adult participants (17.8% of original cohort; study age, mean [SD] 30.5 [1.2] years; 40.6% female) and 158 of 400 ATOM2 adult participants (39.5% of original cohort; study age, mean [SD], 24.5 [1.5] years; 42.9% female) whose baseline characteristics (SE and AL) were representative of the original cohort. In this study, evaluating ATOM1 participants, the mean (SD) SE and AL were −5.20 (2.46) diopters (D), 25.87 (1.23) mm and –6.00 (1.63) D, 25.90 (1.21) mm in the 1% atropine-treated and placebo groups, respectively (difference of SE, 0.80 D; 95% CI, −0.25 to 1.85 D; P = .13; difference of AL, −0.03 mm; 95% CI, −0.65 to 0.58 mm; P = .92). In ATOM2 participants, the mean (SD) SE and AL was −6.40 (2.21) D; 26.25 (1.34) mm; −6.81 (1.92) D, 26.28 (0.99) mm; and −7.19 (2.87) D, 26.31 (1.31) mm in the 0.01%, 0.1%, and 0.5% atropine groups, respectively. There was no difference in the 20-year incidence of cataract/lens opacities, myopic macular degeneration, or parapapillary atrophy (β/γ zone) comparing the 1% atropine-treated group vs the placebo group.Conclusions and RelevanceAmong approximately one-quarter of the original participants, use of short-term topical atropine eye drops ranging from 0.01% to 1.0% for a duration of 2 to 4 years during childhood was not associated with differences in final refractive errors 10 to 20 years after treatment. There was no increased incidence of treatment or myopia-related ocular complications in the 1% atropine-treated group vs the placebo group. These findings may affect the design of future clinical trials, as further studies are required to investigate the duration and concentration of atropine for childhood myopia control.

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Efficacy and Safety of 8 Atropine Concentrations for Myopia Control in Children

Cited by 78 publications

References 58 publications

Varying Dose of Atropine in Slowing Myopia Progression in Children Over Different Follow-Up Periods by Meta-Analysis

Varying Dose of Atropine in Slowing Myopia Progression in Children Over Different Follow-Up Periods by Meta-Analysis

Effect of Low-Concentration Atropine Eyedrops vs Placebo on Myopia Incidence in Children

Topical Atropine for Childhood Myopia Control

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