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  • Atropine for Myopia in Children: Dose Evaluation

    By Lynda Seminara
    Selected by Stephen D. McLeod, MD
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    Journal Highlights

    Ophthalmology, March 2022

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    Which dose of atropine is best for myo­pia control in children? Ha et al. looked at the effects of eight concentrations of topical atropine in a meta-analysis. They found that the probability for efficacy was not improved with higher doses of atropine—and that risk of adverse events increased in proportion to dos­age. The most effective concentration for myopia management was .05%.

    For their work, the authors searched for clinical studies of atropine-treated myopia in children; treatment must have lasted for at least one year. Concentrations were ranked by probability of being the best treatment. Main efficacy measures were mean annual changes in refraction (D/year) and axial length (mm/year). Other outcomes were safe­ty, best-corrected visual acuity (BCVA), and the proportion of eyes with myopia progression.

    Altogether, 30 pairwise comparisons met inclusion criteria, representing 3,272 participants (ages 4-18 years) and 16 randomized trials. Concentrations of atropine ranged from .01% to 1%. With respect to both main endpoints, the most beneficial concentrations were 1%, .5%, and .05%. Relative to controls, 1% atropine resulted in refraction of .81 D and axial length of –.35 mm. The respective values for .5% atropine were .70 and –.23, and those for .05% were .62 and –.25. As for reducing the overall risk of myopia pro­gression, .05% outperformed the others (relative risk, .39). Based on findings for pupil size and accommodation, adverse effects increased with higher doses of atropine, but this trend was not evident for distance BCVA. A determination could not be established for near BCVA.

    “The optimal atropine concentra­tion should be the one with the best balance between efficacy and safety,” the authors concluded. They acknowl­edged that most studies were in Asian populations, which limits generalizabil­ity of the findings. They recommend research in populations with greater variation of iris color, in addition to comparisons of the rebound effects of different atropine concentrations.

    The original article can be found here.