Lower dose atropine may offer safer control of myopia progression

A lower dose of topical atropine controlled myopia progression in children with fewer side effects compared to higher dosage levels, according to a study.

“The lowest concentration of 0.01% atropine thus seems to retain efficacy and is a viable concentration for reducing myopia progression in children, while attaining a clinically significant improved safety profile in terms of accommodation, pupil size, and near visual acuity, and subsequently reduced adverse impact on visual function,” the study authors said.

Data were culled from the Atropine for the Treatment of Myopia 2 study (ATOM2). A previous study, ATOM1, showed that atropine 1% slowed myopic progression but caused visual side effects.

The double-masked, randomized clinical trial included 400 children aged 6 to 12 years with at least 2 D of myopia and astigmatism of –1.5 D or less. Patients were randomized to receive atropine dosages of 0.5% (161 patients), 0.1% (155 patients) or 0.01% (84 patients) once nightly in both eyes for 2 years.

Investigators assessed logMAR best corrected visual acuity, cycloplegic refraction, axial length, accommodation amplitude and pupil diameter at baseline, 2 weeks, and every 4 months for 2 years.

Study results at final follow-up showed that myopia progressed 0.49 D in the 0.01% group, 0.38 D in the 0.1% group and 0.3 D in the 0.5% group. Only the difference between the 0.01% and 0.5% groups was significant.

Myopia progressed by less than 0.5 D in 50% of the 0.01% group, 58% of the 0.1% group and 63% of the 0.5% group. Myopia increased by 1 D or more in 18% of all three groups.

Atropine 0.01% had a minimal effect on accommodation and no impact on visual acuity, the authors said.