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  • Reduced Myopia Incidence and Progression Were Seen with Atropine 0.05% Eye Drops

    Pediatric Ophth/Strabismus

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    Review of: Effect of low-concentration atropine eyedrops vs placebo on myopia incidence in children: The LAMP2 randomized clinical trial

    Yam J, Zhang X, Zhang Y, et al. JAMA, June 2023

    A study conducted in Hong Kong found that treatment with atropine 0.05% eye drops led to lower 2-year rates of myopia incidence and myopic progression than either atropine 0.01% drops or placebo.

    Study Design

    This randomized, double-masked, placebo-controlled study assessed the efficacy of atropine 0.05% eye drops vs atropine 0.01% eye drops vs placebo for delaying the onset of myopia in non-myopic children. Four hundred seventy-four ethnically Chinese children aged 4–9 years with cycloplegic spherical equivalent (SE) refraction of +1.00 D to plano were enrolled. The 2-year incidence of myopia, the presence of fast myopic progression (defined as a myopic shift of at least 1.00 D), and mean myopic SE shift and axial length (AL) elongation were evaluated in all 3 groups.

    Outcomes

    The 2-year myopia incidence rates were 28.4%, 45.9%, and 53.0% in children treated with atropine 0.05%, atropine 0.01%, and placebo, respectively. In a similar vein, fast myopic progression was seen in 25.0% of the atropine 0.05% group, 45.1% of the atropine 0.01% group, and 53.9% of the placebo group. Greater decreases in mean myopic SE shift and AL elongation were seen with atropine 0.05% than with atropine 0.01% or placebo.

    Limitations

    One limitation of the study is that the findings may not have a similar effect in children with different myopic familial genetics and ethnic backgrounds. Older children (i.e., those in the early teenage years) were excluded; including that age group in future studies may help clinicians’ understanding of early vs late progression of myopia.

    Clinical Significance

    In summary, there was a significant treatment effect of atropine 0.05% compared with atropine 0.01% and placebo over a 2-year period in non-myopic ethnically Chinese children. These results represent a delay in myopia onset rather than a prevention of myopia. As clinicians, when we discuss the improved 2-year outcomes seen with atropine 0.05% with parents of children at risk for myopic SE progression and AL elongation, it is important to put these results into context regarding length of treatment, initial age at presentation, and the possibility of rebound effect.

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