Low-Concentration Atropine Eye Drops for Myopia Progression

Abstract

Purpose:Atropine eye drops is an emerging therapy for myopia control. This article reviews the recent clinical trials to provide a better understanding of the use of atropine eye drops on myopia progression.Methods:All randomized clinical trials of atropine eye drops for myopia progression in the literatures were reviewed.Results:Atropine eye drops 1% conferred the strongest efficacy on myopia control. However, its use was limited by the side effects of blurred near vision and photophobia. ATOM 2 study evaluated 0.5%, 0.1%, and 0.01% atropine on 400 myopic children, and suggested that 0.01% is the optimal concentration with good efficacy and minimal side effects. Since then, the use of atropine eye drops has been transitioned from high-concentration to low-concentration worldwide. Recent Low-concentration Atropine for Myopia Progression (LAMP) study evaluated 0.05%, 0.025%, 0.01% atropine eye drops and placebo group in 438 myopic children. The study firstly provided placebo-compared evidence of low-concentration atropine eye drops in myopia control. Furthermore, both efficacy and side effects followed a concentration-dependent response within 0.01% to 0.05% atropine. Among them, 0.05% atropine was the optimal concentration to achieve best efficacy and safety profile.Conclusions:Low concentration atropine is effective in myopia control. The widespread use of low-concentration atropine, especially in East Asia, may help prevent the myopia progression for the high-risk children. Further investigations on the rebound phenomenon following drops cessation, and longer-term individualized treatment approach should be warranted.

IMI Prevention of Myopia and Its Progression

“…In the first randomized, placebo-controlled trial of atropine for myopia control, Yen and colleagues 52 reported in 1989 that the progression of myopia was least marked in the group with application of 1% atropine eye drops for one year (myopia progression: −0.22 ± 0.54 diopters/y), followed by the group with application of 1% cyclopentolate eye drops (−0.58 ± 0.49 diopters/y), and a control group with application of placebo eye drops (−0.91 ± 0.58 diopters/y). 52 , 53 Because photophobia and near blur were severe side effects, the results of the study were not translated into clinical practice. Ten years later, Shih and associates 54 found in a randomized, controlled trial that the progression of myopia after two years was least pronounced in a study group with 0.5% atropine eye drops (−0.04 ± 0.63 diopters/y), followed by the atropine 0.25% group (−0.45 ± 0.55 diopters/y), and the atropine 0.1% eye drop group (−0.47 ± 0.91 diopters/y).…”

“… 56 In other randomized controlled trials, a concentration of atropine of 0.5% or 1% was associated with a relatively high antimyogenic effect (myopia control) and a relatively high rate of side effects, namely mydriasis and decrease in the amplitude of accommodation. 53 , 57 , 58 …”

COVID‐19, sweat, tears… and myopia?

“…2 Several authors classify myopia as an epidemic, 2 particularly in Asiatic populations in which the prevalence is around 80 per cent in the age group over 15 years. 3 In that respect, it seems to be clear that children and teenagers do not develop myopia without relevant environmental and cultural exposures.…”

Deduction of Novel Genes Potentially Involved in the Effects of Very Low Dose Atropine (0.003%) Treatment on Corneal Epithelial Cells Using Next-Generation Sequencing and Bioinformatics Approaches

“…Atropine at different concentrations have been widely used as topical eye drops in slowing the progression of myopia in children, particularly in the Asian area [1]. From the review and meta-analysis, the current lowest effective concentration of atropine in myopia control is reported to be 0.01%, controlling the axial growth with minimal side effects [16,17]. However, the studies focused on children with myopia, and the effective dose of atropine in myopia control as one of the treatment modalities.…”