The Preventive Role of Atropine Eye Drops on Myopia Progression: A Double‑Blind Randomized Clinical Trial

Abdolreza Medghalchi, Hasan Behboudi, Mitra Akbari, Reza Soltani Moghadam, Ehsan Kazemnejad, Salah Sabnan

Abstract


Background: In the present study, we investigated the effect of two doses of atropine eye drops versus placebo on myopia progression in children and adolescents. Methods: In this double‑blind, randomized clinical trial, 67 patients aged 6 to 18 years with myopia of ‑2 to ‑6 D were enrolled and randomized to receive a placebo eye drop, atropine 0.1%, or 0.01% ophthalmic solution (one drop per night for 6 months). All participants were followed‑up with for one year after the beginning of the study (at zero, one, three, six, and 12 months) and their spherical equivalent (SE), axial length (AL), anterior chamber depth (ACD), and far and near visual acuity (VA) and the eye drops side effects were recorded. A comparison among the groups was performed using SPSS software, version 24.0. Results: Spherical equivalent, AL, and ACD decreased and far VA improved in atropine groups to a greater extent than the placebo group (P < .05) at the 6‑month follow‑up. The most common side effects of atropine 0.1% eye drop included photophobia and decreased near VA. At the end of the study (six months after the cessation of atropine), a rebound effect was observed; this effect was especially severe in the 0.1% atropine group. Conclusions: Atropine eye drops are effective for slowing down and preventing myopia progression. However, without long‑term treatment, they will have a rebound effect. A lower dose (0.01%) is suggested for reducing the side effects and rebound effects.

Keywords


Atropine; eye drop; glass; myopia; visual acuity

Full Text:

PDF

References


Schiefer U, Kraus C, Baumbach P, Ungewiß J, Michels R.

Refractive errors: Epidemiology, effects and treatment options.

Dtsch Arztebl Int 2016;113:693‑702.

Pascolini D, Mariotti SP. Global estimates of visual impairment:

Br J Ophthalmol 2012;96:614‑8.

Holden BA, Wilson DA, Jong M, Sankaridurg P, Fricke TR, Smith III EL, et al. Myopia: A growing global problem with

sight‑threatening complications. Community Eye Health

;28:35.

Holden BA, Fricke TR, Wilson DA, Jong M, Naidoo KS,

Sankaridurg P, et al. Global prevalence of myopia and

high myopia and temporal trends from 2000 through 2050.

Ophthalmology 2016;123:1036‑42.

Pan C‑W, Dirani M, Cheng C‑Y, Wong T‑Y, Saw S‑M. The

age‑specific prevalence of myopia in Asia: A meta‑analysis.

Optom Vis Sci 2015;92:258‑66.

Williams K, Hammond C. High myopia and its risks. Community

Eye Health 2019;32:5‑6.

Cooper J, Schulman E, Jamal N. Current status on

the development and treatment of myopia. Optometry

;83:179‑99.

Cooper J, Tkatchenko AV. A review of current concepts of

the etiology and treatment of myopia. Eye Contact Lens

;44:231‑47.

Walline JJ, Lorenz KO, Nichols JJ. Long‑term contact lens wear

of children and teens. Eye Contact Lens 2013;39:283‑9.

Walline JJ, Lindsley KB, Vedula SS, Cotter SA, Mutti DO,

Ng SM, et al. Interventions to slow progression of myopia in

children. Cochrane Database Syst Rev 2020;1:CD004916. doi:

1002/14651858.CD004916.pub4.

Upadhyay A, Beuerman RW. Biological mechanisms of atropine

control of myopia. Eye Contact Lens 2020;46:129‑35.

Galvis V, Tello A, Rodriguez CJ, Rey JJ. Atropine dose to treat

myopia. Ophthalmology 2012;119:1718‑9.

Barathi VA, Chaurasia SS, Poidinger M, Koh SK, Tian D, Ho C,

et al. Involvement of GABA transporters in atropine‑treated

myopic retina as revealed by iTRAQ quantitative proteomics.

J Proteome Res 2014;13:4647‑58.

Luu CD, Lau AM, Koh AH, Tan D. Multifocal electroretinogram

in children on atropine treatment for myopia. Br J Ophthalmol

;89:151–3.

Zhu Q, Tang Y, Guo L, Tighe S, Zhou Y, Zhang X, et al.

Efficacy and safety of 1% atropine on retardation of moderate

myopia progression in chinese school children. Int J Med Sci

;17:176‑81.

Galvis V, Tello A, Parra MM, Merayo‑Lloves J, Larrea J,

Julian Rodriguez C, et al. Topical atropine in the control of

myopia. Med Hypothesis Discov Innov Ophthalmol 2016;5:78‑88.

Chia A, Chua WH, Cheung YB, Wong WL, Lingham A, Fong A,

et al. Atropine for the treatment of childhood myopia: Safety

and efficacy of 0.5%, 0.1%, and 0.01% doses (Atropine for the

Treatment of Myopia 2). Ophthalmology 2012;119:347‑54.

Yam JC, Li FF, Zhang X, Tang SM, Yip BHK, Kam KW,

et al. Two‑year clinical trial of the low‑concentration atropine

for myopia progression (LAMP) study: Phase 2 report.

Ophthalmology 2020;127:910‑9.

Chia A, Chua W‑H, Wen L, Fong A, Goon YY, Tan D.

Atropine for the treatment of childhood myopia: Changes after

stopping atropine 0.01%, 0.1% and 0.5%. Am J Ophthalmol

;157:451‑7.

Morgan IG, He M. An important step forward in myopia

prevention: Low‑dose atropine. Ophthalmology 2016;123:232‑3.

Wu P‑C, Chuang M‑N, Choi J, Chen H, Wu G, Ohno‑Matsui K,

et al. Update in myopia and treatment strategy of atropine use in

myopia control. Eye (Lond) 2019;33:3‑13.

Pineles SL, Kraker RT, VanderVeen DK, Hutchinson AK,

Galvin JA, Wilson LB, et al. Atropine for the prevention of

myopia progression in children: A report by the American

Academy of Ophthalmology. Ophthalmology 2017;124:1857‑66.

Pérez‑Flores I, Macías‑Murelaga B, Barrio‑Barrio J.

A multicenter Spanish study of atropine 0.01% in childhood

myopia progression. Sci Rep 2021;11:1‑9.

Wei S, Li S‑M, An W, Du J, Liang X, Sun Y, et al. Safety and

efficacy of low‑dose atropine eyedrops for the treatment of

myopia progression in Chinese children: A randomized clinical

trial. JAMA Ophthalmol 2020;138:1178‑84.

Clark TY, Clark RA. Atropine 0.01% eyedrops significantly

reduce the progression of childhood myopia. J Ocul Pharmacol

Ther 2015;31:541‑5.

Chia A, Lu Q‑S, Tan D. Five‑year clinical trial on atropine for

the treatment of myopia 2: Myopia control with atropine 0.01%

eyedrops. Ophthalmology 2016;123:391‑9.