Use of low-dose atropine eyedrops (concentration 0.01%) was no better than placebo at slowing myopia progression among children treated for two years, according to a new study.
The randomised, controlled trial, published in JAMA Ophthalmology,1 aimed to identify an effective way to manage myopia, which can cause serious uncorrectable vision loss later in life.
Importantly, the findings contradict results from recent trials, primarily in East Asia, which showed a benefit from 0.01% atropine in slowing myopia.
Dr Michael Chiang, Director of the National Eye Institute (NEI) in the United States, said the “overall mixed results on low-dose atropine show us we need more research”.
“Would a different dose be more effective… Would combining atropine with other strategies have a synergistic effect? Could we develop other approaches to treatment or prevention based on a better understanding of what causes myopia progression?” Dr Chiang asked.
The NEI, which funded the study, said identifying an optimal approach for preventing high (advanced) myopia is urgently needed given the escalating prevalence of myopia.
Importantly, the findings contradict results from recent trials, primarily in East Asia, which showed a benefit from 0.01% atropine in slowing myopia.
Reflection of Racial Differences
Much stronger concentrations of atropine eyedrops (0.5-1.0%) have long been used by eye care professionals to slow myopia progression. While effective, such doses cause light sensitivity and blurry near vision while on the nightly eyedrops. Thus, there is interest in clinical studies assessing lower concentrations that have been shown to have fewer side effects.
“The absence of a treatment benefit in our US-based study, compared with East Asian studies, may reflect racial differences in atropine response,” the study’s lead co-author Professor Michael X. Repka said.
Professor Repka, from John Hopkins University, said the study enrolled fewer Asian children, whose myopia progresses more quickly, and included Black children, whose myopia progresses less quickly compared with other races.
For the masked study, 187 children ages five to 12 years with low-to-moderate bilateral myopia were randomly assigned to use nightly atropine (0.01%) (125 children) or placebo (62 children) eyedrops for two years.
After the treatment period, and six months after treatment stopped, there were no significant differences between the groups in terms of changes in degree of myopia compared with baseline. Nor were there significant differences in axial length within the two groups when compared with baseline measurements.
Reference
- Repka, M.X., Weise, K.K., Chandler, D.L., et al., on behalf of the Pediatric Eye Disease Investigator Group, Randomized trial of low-dose atropine eyedrops for myopia control, JAMA Ophthalmol. Published online 13 July 2023. doi:10.1001/jamaophthalmol.2023.2855.
