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  • Atropine 0.01% Eye Drops Did Not Slow Myopia Progression Among Children in the US

    Pediatric Ophth/Strabismus

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    Review of: Low-dose 0.01% atropine eye drops vs placebo for myopia control: A randomized clinical trial

    Repka M, Weise K, Chandler D, et al. JAMA Ophthalmology, August 2023

    Some concentrations of low-dose atropine have been shown to modestly decrease myopia progression with children with low or moderate myopia, but most of these studies were conducted in East Asia. The current study looked at the effects of atropine 0.01% eye drops in a US-based pediatric population.

    Study Design

    This was a randomized, double-masked, placebo-controlled clinical trial conducted from 2018 to 2022 in 187 children aged 5–12 years (mean age 10.1 years) with refraction of −1.00 D to −6.00 D. Children received either 1 eye drop of atropine 0.01% or placebo once nightly for 24 months; there was an additional observation period of 6 months. The primary outcome was mean change in cycloplegic spherical equivalent (SE), and the secondary outcome was mean change in axial length (AL) elongation.

    Outcomes

    After 24 months, mean changes in SE vs baseline were nearly identical for the atropine and placebo groups (−0.82 D vs −0.80 D, respectively). Changes in AL elongation from baseline to 24 months were also nearly identical: 0.44 mm for those given atropine 0.01% and 0.45 mm for those given placebo.

    Limitations

    Limitations included the fact that in both groups, eye drop use was self-reported. In addition, the treatment phase of this study was completed during the COVID-19 pandemic-related shutdowns. There were some virtual visits without refractions completed at 6, 12, and 18 months; however, 95% of the study participants did complete the in-office primary outcome visits.

    Clinical Significance

    Clinicians who treat children with low-to-moderate myopia may want to consider administering a higher concentration of dilute atropine. The authors recommend that future studies of pharmacologic intervention for children with myopia compare different concentrations of low-concentration atropine and also assess the use of atropine in combination with other treatment modalities, rather than as monotherapy.

    Financial Disclosures: Dr. Jennifer Galvin discloses no financial relationships.