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.
Perspective
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Dashaini Retnasothie, OD, MS, FAAO
This review summarizes how 30 years of randomized controlled trials in Asia led to a shift from using high to low concentrations of atropine in slowing the progression of myopia. This work directs ODs to focus on low-dose atropine as we look to fine tune its use for myopia control across all ethnicities.
The LAMP study reviewed in this article reveals these key factors:
- comparing 0.05%, 0.025% and 0.01% atropine, 0.05% showed the best control effect on refractive error and axial length (the effect is concentration-dependent);
- atropine doses of 0.05%, 0.025% and 0.01% did not have significant effects on pupil size, accommodation, near and distance visual acuities;
- children using 0.05%, 0.025% and 0.01% atropine had similar vision and quality of life survey results vs. those using placebo eye drops; and
- some children did not respond to atropine.
For the clinician, these results suggest starting patients on 0.05% atropine, which is likely to be well-tolerated; however, 0.025% and 0.01% can be considered. The main shortcoming of this review is that it is written by individuals from the LAMP study, which may reveal potential bias. Also, all study populations were of Asian children, which narrows the applicability of the results.
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