Nightly 0.05% atropine eyedrops may reduce incidence of myopia in children
Key takeaways:
- The 2-year incidence of myopia was 28.4% in the 0.05% atropine group compared with 45.9% and 53% in the 0.01% and placebo groups.
- Atropine drops were mostly well-tolerated, although photophobia was reported.
Using 0.05% atropine eyedrops every night for 2 years reduced the incidence of myopia in young children, although researchers acknowledge further study is needed.
“Among children aged 4 to 9 years without myopia, randomization to nightly use of 0.05% atropine eyedrops compared with placebo resulted in a significantly lower incidence of myopia and lower percentage of participants with fast myopic shift at 2 years,” Jason C. Yam, MPH, from the department of ophthalmology and visual sciences at The Chinese University of Hong Kong, and colleagues wrote in JAMA.
In a randomized, placebo-controlled trial of 474 nonmyopic children aged 4 to 9 years, researchers assigned participants to receive 0.05% atropine, 0.01% atropine or placebo eye drops nightly for 2 years.
According to results, the cumulative incidence of myopia over 2 years was 28.4% in the 0.05% atropine group, 45.9% in the 0.01% group and 53% in the placebo group.
Researchers also reported that the 0.05% atropine group had a significantly lower percentage of patients with fast myopic shift (25%) compared with the 0.01% atropine (45.1%) and placebo groups (53.9%).
While the differences in cumulative incidence of myopia and percentage of patients with fast myopic shift were significant between the 0.05% atropine group and others, there was no significant difference in these outcomes between the 0.01% atropine and placebo groups.
The most common adverse event was photophobia, which was reported in 12.9% of participants in the 0.05% atropine group, 18.9% in the 0.01% atropine group and 12.2% in the placebo group.
“Further research is needed to replicate the findings, to understand whether this represents a delay or prevention of myopia and to assess longer-term safety,” the authors wrote.
Perspective
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The LAMP2 randomized clinical trial takes the next significant step in myopia management: preventive care. To reduce the risk for myopia maculopathy and visual impairment, it is critical to make sure children finish high school no worse than –3 D. But what if we could do better?
By identifying young children aged 4 to 9 years with pre-myopia, dosing 0.05% or 0.01% atropine compared with placebo can delay the onset of myopia. And yet there remains a nonresponse rate — likely due to compliance and atropine penetration — where 25% still had a fast myopic shift, and 28.4% still developed myopia within 2 years under the highest concentration of 0.05%.
Doctors should not shy away from prescribing low-dose atropine in children at risk for myopia with this valid, generalizable evidence. This would be a significant cost savings for families by delaying the onset of myopia by even just 1 year. The sooner we start, the better the clinical outcomes.
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