August 1, 2025
By Durgasri Jaisankar, PhD, Research Scientist at Brien Holden Vision Institute
Photo Credit: Dreamstime Photos
Low-dose atropine eye drops have demonstrated to be an effective pharmacological agent in controlling myopia. While high-concentration atropine (0.5%-1%) has shown strong efficacy, its associated side effects such as photophobia, blurred near vision and risk of rebound after cessation makes it less suitable for long-term use. In response, research and clinical interest have shifted towards low-dose atropine of various concentrations, aiming to identify the optimal balance between efficacy and minimal side effects.
A prospective, double-masked clinical trial was conducted at two centers in Vietnam. The study evaluated the effect of three different low-dose atropine drops on pupil diameter and amplitude of accommodation. A total of 57 children (114 eyes), aged between 6 to 12 years and myopia of -0.50D or worse, with less than 2.00D of astigmatism, were randomly selected to receive one of the three concentration of atropine eye drops. Twenty-one participants received 0.01%, 19 participants received 0.02% and 17 participants received 0.03% atropine. They were instructed to administer the low-dose atropine once a night in both eyes for two weeks.
At the two-week visit, a significant increase in pupil size and decrease in accommodative amplitude was noted for all three groups. The 0.01% group showed the least difference, and the 0.03% group showed the most difference for both parameters.
Abstract
Impact of Various Concentrations of Low-Dose Atropine on Pupillary Diameter and Accommodative Amplitude in Children with Myopia
Huy D M Tran, Thao T X Ha, Yen H Tran, Minas Coroneo, Tuan D Tran, Trang U Truong, Padmaja Sankaridurg
Purpose
To assess over 2 weeks, the effect of 3 different low concentrations of atropine on pupillary diameter and accommodative amplitude in children with myopia.
Methods
Fifty-eight children with myopia [spherical equivalent (SE) of -0.50 diopters (D) or worse, astigmatism of less than or equal to 2.00 D] were randomly allocated to 3 groups receiving 0.01%, 0.02%, or 0.03% atropine eye drops, once nightly for 2 weeks. The primary outcome was the change from baseline in pupillary diameter and accommodative amplitude with each of the concentrations.
Results
Fifty-seven participants (114 eyes), aged between 6 and 12 years, completed the 2-week trial (mean age 9.3 ± 1.7 years and mean SE -3.53 ± 1.79 D). After 2 weeks of use, all the 3 concentrations were found to have a statistically significant effect on both the pupillary diameter and accommodative amplitude. Accommodative amplitude reduced by an average of 5.23 D, 9.28 D, and 9.32 D, and photopic pupil size increased by an average of 0.95 ± 1.05 mm, 1.65 ± 0.93 mm, and 2.16 ± 0.88mm with 0.01%, 0.02%, and 0.03%, respectively. Of the eyes, a total of 5.3% and 5.9% of the eyes on 0.02% and 0.03% atropine had a mean residual accommodative amplitude of <5 D. The percentage of eyes having a pupillary dilation >3mm were 4.8%, 10.5%, and 23.5% for 0.01%, 0.02%, and 0.03% atropine, respectively.
Conclusions
Low-dose atropine had an effect on pupillary diameter and accommodative amplitude. With the highest concentration assessed, that is, 0.03% nearly 1 of 4 eyes had pupillary dilation of >3 mm.
Clinical Trial Registration number: NCT03699423
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Durgasri Jaisankar, PhD, is working as a postdoctoral researcher in lens design and development at the Brien Holden Vision Institute, Sydney. Her current area of research is spectacle and contact lens designs for myopia management and presbyopia. |
