Atropine use may prevent myopic progression in children
The use of atropine appears to prevent myopic progression, as supported by level I evidence, according to a recent study. Additionally, myopic rebound has been reported after treatment discontinuation, but this is minimized by using low doses, particularly atropine 0.01%.
Researchers conducted literature searches in PubMed and the Cochrane Library databases to examine the efficacy of topical atropine for the prevention of myopic progression in children. A total of 98 citations were identified, of which 23 were reviewed in full text. Seventeen of these articles were then included in the assessment and subsequently assigned a level of evidence (I, II or III) rating by the panel methodologist.
Most studies reported less myopic progression in children administered with atropine vs controls. Eight of the level I and II studies that evaluated primarily myopic progression also reported less myopic progression with atropine (myopic progression ranging from 0.04 to 0.47 dioptres [D]/year) vs controls (0.38 to 1.19 D/year).
Studies evaluating myopic progression after treatment cessation reported a rebound effect. There were also some studies that assessed the optimal dosage of atropine for the prevention of myopic progression, rebound after discontinuation of treatment and minimization of side effects.
Atropine at lower dosages (0.5%, 0.1% and 0.01%) was slightly less effective during treatment periods of 1 to 2 years, but it was likely to result in less rebound myopic progression (mean myopic progression after treatment cessation, 0.28 vs 0.87 D/year for atropine 0.01% and 0.5%, respectively), fewer side effects and similar long-term results for myopic progression after the study period and rebound effect were considered.
“The most robust and well-designed studies were carried out in Asian populations,” researchers said. “Studies involving patients of other ethnic backgrounds failed to provide sufficient evidence of an effect of atropine on myopic progression.”