Skip to main content

  • Atropine 0.01% May Not Control Myopia in U.S. Children

    By Lynda Seminara
    Selected and reviewed by Neil M. Bressler, MD, and Deputy Editors
    Add to My Bookmarks

    Journal Highlights

    JAMA Ophthalmology, August 2023

    Download PDF

    It is plausible that genetic and environ­mental factors affect responses to myo­pia treatment. Most studies indicating that myopia can be slowed by low-dose atropine were conducted in East Asia, and the findings do not necessarily apply to other regions of the world. In a randomized placebo-controlled trial performed in the United States, Repka et al. explored the effectiveness of 0.01% atropine for myopia control in children. They found no significant differences in myopia progression or axial elon­gation between low-dose atropine and placebo.

    For this study, 5- to 12-year-old children with low to moderate my­opia in both eyes (range, −1.00 D to −6.00 D spherical equivalent refractive error [SER]) were recruited from a dozen ophthalmic practice centers in the United States. The children were assigned randomly (2:1) to receive one drop of 0.01% atropine or one drop of a placebo solution, each adminis­tered at night. This was continued for 24 months and was followed by six months of observation. Automated cycloplegic refraction, obtained by masked examiners, was conducted to evaluate the primary outcome of change in SER (mean value of both eyes) from baseline to month 24. A longitudinal discrete-time mixed model was applied, with adjustments for age, iris color (brown vs. other), race (East Asian vs. other), and baseline SER. Other outcomes were change in SER from baseline to 30 months and change in axial length from baseline to months 24 and 30.

    Altogether, there were 187 partici­pants (mean age, 10.1 years; range, 5.1-12.9 years); 125 received atropine and 62 received placebo. Follow-up through month 24 was completed by 95% of the active-treatment group and 94% of the placebo group. The respective rates of follow-up through month 30 were 94% and 92%. At 24 months, the adjusted mean change in SER from baseline was −0.82 D with atropine and −0.80 D with placebo (p = .83). At month 30 (i.e., six months without treatment), the SER changes from baseline were −0.94 D and −0.88 D, respectively. From baseline to month 24, mean axial length increased by 0.44 mm in the atropine group and by 0.45 mm in the placebo group.

    The authors concluded that these results do not support the use of 0.01% atropine for low or moderate myopia in the United States. They recommend studying stronger atropine concen­trations and researching optical and environmental strategies that may slow myopia progression. (Also see related commentary by Jeffrey J. Walline, OD, PhD, and David A. Berntsen, OD, PhD, in the same issue.)

    The original article can be found here.