May 1, 2025
By Mahmoud Haddara, BSc, OD
Photo Credit: Shutterstock
The use of topical low-dose atropine to slow progression in myopic children is well established, however initiating treatment in pre-myopes remains controversial and inconclusive. Researchers find delaying myopia onset attractive. They associate the onset age with high myopia risk and exponentially increasing pathological sequelae with dioptric power.
Ssu-Hsien Lee and colleagues performed a systematic review and meta-analysis aiming to evaluate the efficacy and safety profile of low-dose atropine in pre-myopic children. The researchers conducted four studies in Asian countries involving 644 children aged 7.13±1.60 years (mean ± standard deviation), who had pre-myopia (spherical equivalent refraction between ±1D) and received management with low-dose atropine (0.01% to 0.05%) over a period of 24 months.
Researchers found that children receiving low-dose atropine had a lower incidence of myopia and experienced a reduction in both the rate of rapid myopic progression (≥ 0.50DS/year) and axial elongation over 24 months. There were no major adverse events but a significant incidence of photophobia only in the first six to 12 months highlighting prolonged use may mitigate these effects.
This study supports the application of low-dose atropine in pre-myopic children to delay myopia onset and reduce progression. More studies with consistent atropine concentrations and standardized pre-myopia definitions will assist future research in confirming dose-dependent effects and long-term efficacy and safety.
Abstract
Efficacy and Safety of Low-Dose Atropine on Myopia Prevention in Premyopic Children: Systematic Review and Meta-Analysis
Ssu-Hsien Lee, Bor-Yuan Tseng, Jen-Hung Wang, Cheng-Jen Chiu
Background
Early-onset myopia increases the risk of irreversible high myopia.
Methods
This study systematically evaluated the efficacy and safety of low-dose atropine for myopia control in children with premyopia through meta-analysis using random-effects models. Effect sizes were calculated using risk ratios (RRs) with 95% confidence intervals (CIs). Comprehensive searches of PubMed, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov were conducted until 20 December 2023, without language restrictions.
Results
Four studies involving 644 children with premyopia aged 4-12 years were identified, with atropine concentrations ranging from 0.01% to 0.05%. The analysis focused on myopia incidence and atropine-related adverse events. Lower myopia incidence (RR, 0.62; 95% CI, 0.40-0.97 D/y; p = 0.03) and reduction in rapid myopia shift (≥0.5 D/1y) (RR, 0.50; 95% CI, 0.26-0.96 D/y; p < 0.01) were observed in the 12-24-month period. Spherical equivalent and axial length exhibited attenuated progression in the atropine group. No major adverse events were detected in either group, whereas the incidence of photophobia and allergic conjunctivitis did not vary in the 12-24-month period.
Conclusions
Our meta-analysis supports atropine’s efficacy and safety for delaying myopia incidence and controlling progression in children with premyopia. However, further investigation is warranted due to limited studies.
DOI: 10.3390/jcm13051506
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Mahmoud Haddara is a 2022 Doctor of Optometry graduate from the University of Melbourne. He started working at the Australian College of Optometry (ACO) in 2023 and began his PhD in visual neurovascular science at the Centre for Eye Research Australia (CERA) the same year. His research focuses on understanding the communication between neurons and blood vessels in animal models of glaucoma. |
