March 11, 2020
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Low-concentration atropine drops safe, effective in myopia control

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Data from a literature review showed that low-concentration atropine was effective in myopia control and may help prevent myopia progression in high-risk children.

“Atropine is the most effective medication that has been demonstrated to be consistently effective in slowing myopia progression,” Fen Li, MD, and Jason C. Yam, FCOphthHK, FRCSEd, from the department of ophthalmology and visual sciences at The Chinese University of Hong Kong, wrote.

While an early study showed that atropine 1% was most effective compared with cyclopentolate 1% or placebo (Yen et al.), photophobia was a common side effect. A later study (Shih et al.) demonstrated similar efficacy at 0.01%, 0.25% and 0.5% compared with placebo, and only 22% of children in the 0.5% group reported photophobia within 3 months of treatment.

Following this outcome, researchers in the ATOM2 study of 2012 (Chia et al.) evaluated myopia progression in 400 children who received 0.5%, 0.1% or 0.01% of atropine. Overall myopia progression during 3 years of treatment was slowest in the 0.01% group, with fewer side effects compared with higher concentrations.

The Low-Concentration Atropine for Myopia Progression (LAMP) study (Yam et al.) included 438 children with myopia of at least –1.0 D. Li, Yam and colleagues randomly assigned patients to receive atropine 0.05%, 0.025%, 0.01% or placebo eye drops daily.

In contrast to ATOM2, 0.05% was the most effective for controlling myopia progression and axial elongation during 1 year of treatment. All three low concentrations were well-tolerated.

“Current randomized controlled trials confirm the efficacy of low-concentration atropine compared with placebo, and 0.05% provides the best efficacy and safety in controlling myopia progression and axial length elongation,” Li and Yam wrote in their review.

However, they highlighted important questions that remain unanswered, including the optimal concentration of atropine drops for longer treatment periods and the efficacy from one year to the next. – by Talitha Bennett

References:

Chia A, et al. Ophthalmology. 2012;doi:10.1016/j.ophtha.2011.07.031.

Shih YF, et al. J Ocul Pharmacol Ther. 1999;doi:10.1089/jop.1999.15.85.

Yam JC, et al. Ophthalmology. 2019;doi:10.1016/j.ophtha.2018.05.029.

Yen MY, et al. Ann Ophthalmol. 1989;21:180–182,187.

Disclosures: The authors report no relevant financial disclosures.