Atropine effective for reducing myopic progression in children

This Ophthalmic Technology Assessment (OTA) by the Pediatric Ophthalmology/Strabismus Panel reviewed published literature regarding the efficacy of topical atropine for preventing myopic progression in children.

Study design

Literature searches conducted in December 2016 yielded 98 citations, 23 of which were reviewed in full text. Seventeen of these articles were chosen for inclusion and assigned a level of evidence rating by the panel methodologist.

Outcomes

All the level I evidence reviewed supports the use of atropine to prevent myopic progression, showing that patients who received the topical agent progressed less than untreated controls. Several reports with extended follow-up periods revealed that myopic rebound can occur after treatment is discontinued. However, this seems to be minimized by using lower doses (especially atropine 0.01%), which has the additional benefit of fewer side effects. Moreover, long-term progression remains slower in atropine-treated eyes than controls even after factoring in rebound myopia.

Limitations

The most robust and well-designed studies were carried out in Asian populations. Studies involving patients of other ethnic backgrounds failed to provide sufficient evidence of an effect of atropine on myopic progression. Therefore, generalizability of data to non-Asian populations remains a concern.

Clinical significance

Myopia is a very common cause of vision loss. Almost all studies reviewed in this OTA confirmed that atropine, regardless of the dose, is an effective method to curb myopic progression in children.