Efficacy of atropine eyedrops in reducing myopia progression and axial elongation in myopic children: a meta-analysis
Purpose: To determine the efficacy of various concentrations of atropine eyedrops on retarding myopia progression and axial elongation in Asian children.
Study design: Meta-analysis.
Methods: Randomized clinical trials and prospective interventional non-randomized studies which enrolled children aged 4 to 14 years old who received atropine treatment for myopia were included in the study. The Cochrane Collaboration 6 aspects of bias was used to assess the risk of bias for all included studies. Outcome measures were myopia progression and axial elongation. Meta-analysis was conducted using the random-effects model.
Results: Eight randomized clinical trials and two prospective interventional non-randomized studies which included a total of 1,229 Asian children were included in the analysis. The pooled mean difference between control and atropine for myopia progression was 0.77 diopters (D) per year [CI 0.64, 0.89]. Subgroup analysis by concentration showed a decreasing trend with decreasing concentration. The pooled mean difference of myopia progression for 1%, 0.5%, 0.25%, and 0.1–0.125% atropine was 0.97 D/year [CI 0.72, 1.21], 0.88 D/year [CI 0.74, 1.02], 0.79 D/year [CI 0.37, 1.21], and 0.80 D/year [CI 0.62, 0.97], respectively; whereas that for 0.01% atropine was 0.46 D/year [CI -0.02, 0.94] indicating that this intervention may or may not be favorable for slowing myopia progression. The pooled mean difference between control and atropine for axial elongation was -0.22 mm [CI -0.29, -0.14] favoring atropine. Subgroup analysis by concentration also showed decreasing trend with decreasing concentration. The pooled mean difference of axial elongation for 1%, 0.5%, 0.1%, 0.05%, and 0.025% atropine was -0.44 mm [CI -0.57, -0.32], -0.19 mm [CI -0.35, -0.04], -0.10 mm [CI -0.17, -0.03], -0.21 mm [CI -0.28, -0.14], and -0.12 mm [CI -0.16, -0.08], respectively; whereas that for 0.01% atropine was -0.01 mm [CI -0.09, 0.06] indicating that this intervention may or may not be favorable in reducing axial elongation.
Conclusion: This meta-analysis shows that the effects of atropine for both myopia progression and axial elongation are dose-dependent for the concentration 0.025% to 1%. Results for 0.01% atropine are still equivocal.
Gong Q, Janowski M, Luo M, Wei H, Chen B, Yang G, Liu L. Efficacy and Adverse Effects of Atropine in Childhood Myopia: A Meta-analysis. JAMA Ophthalmol. 2017;135(6):624-630. https://doi.org/10.1001/jamaophthalmol.2017.1091.
Pineles SL, Kraker RT, VanderVeen DK, et al. Atropine for the Prevention of Myopia Progression in Children. Ophthalmology. 2017;124(12):1857-1866. https://doi.org/10.1016/j.ophtha.2017.05.032. Epub 2017 Jun 29. PMID: 28669492.
Song YY, Wang H, Wang BS, Qi H, Rong ZX, Chen HZ. Atropine in Ameliorating the Progression of Myopia in Children with Mild to Moderate Myopia: A Meta-analysis of Controlled Clinical Trials. J Ocul Pharmacol Ther. 2011;27(4):361-8. https://doi.org/10.1089/jop.2011.0017. Epub 2011 Jun 7.
Yam JC, Jiang Y, Tang SM, et al. Low-Concentration Atropine for Myopia Progression (LAMP) Study: A Randomized, Double-Blinded, Placebo-Controlled Trial of 0.05%, 0.025%, and 0.01% Atropine Eye Drops in Myopia Control. Ophthalmology. 2019;126(1):113-124. https://doi.org/10.1016/j.ophtha.2018.05.029.
Li SM, Wu SS, Kang MT, et al. Atropine Slows Myopia Progression More in Asian than White Children by Meta-analysis. Optom Vis Sci. 2014;91(3):342-350. https://doi.org/10.1097/OPX.0000000000000178.
Walline JJ, Lindsley K, Vedula SS, Cotter SA, Mutti DO, Twelker JD. Interventions to slow progression of myopia in children. Cochrane Database Syst Rev. 2011;(12):CD004916. https://doi.org/10.1002/14651858.CD004916.pub3
Chia A, Chua WH, Cheung YB, 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(2):347-354. https://doi.org/10.1016/j.ophtha.2011.07.031. Epub 2011 Oct 2.
Shih YF, Chen CH, Chou AC, Ho TC, Lin LL, Hung PT. Effects of Different Concentrations of Atropine on Controlling Myopia in Myopic Children. J Ocul Pharmacol Ther. 1999;15(1):85-90.
Shih YF, Hsiao CK, Chen CJ, Chang CW, Hung PT, Lin LL. An Intervention Trial on Efficacy of Atropine and Multi-focal Glasses in Controlling Myopic Progression. Acta Ophthalmol. 2001;79(3):233-236.
Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928. https://doi.org/10.1136/bmj.d5928
Lee CY, Sun CC, Lin YF, Lin KK. Effects of topical atropine on intraocular pressure and myopia progression: a prospective comparative study. BMC Ophthalmol. 2016;16:114. https://doi.org/10.1186/s12886-016-0297-y
Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from: www.handbook.cochrane.org [accessed November 21, 2018].
Yen MY, Liu JH, Kao SC, Shiao CH. Comparison of the effect of atropine and cyclopentolate on myopia. Ann Ophthalmol. 1989;21(5):180-182, 187.
Chua WH, Balakrishnan V, Chan YH, et al. Atropine for the treatment of childhood myopia. Ophthalmology. 2006;113(12):2285-2291. Epub 2006 Sep 25. PMID: 16996612
Fan DS, Lam DS, Chan CK, Fan AH, Cheung EY, Rao SK. Topical atropine in retarding myopic progression and axial length growth in children with moderate to severe myopia: a pilot study. Jpn J Ophthalmol. 2007;51(1):27-33. Epub 2007 Feb 9.
Yi S, Huang Y, Yu SZ, Chen XJ, Yi H, Zeng XL. Therapeutic effect of atropine 1% in children with low myopia. J AAPOS. 2015;19(5):426-429. https://doi.org/10.1016/j.jaapos.2015.04.006. Epub 2015 Jul 27. PMID: 26228967
Wang YR, Bian HL, Wang Q. Atropine 0.5% eyedrops for the treatment of children with low myopia: A randomized controlled trial. Medicine (Baltimore). 2017 Jul;96(27):e7371. https://doi.org/10.1097/MD.0000000000007371.
Huang J, Wen D, Wang Q, et al. Efficacy Comparison of 16 Interventions for Myopia Control in Children: A Network Meta-analysis. Ophthalmology. 2016;123(4):697-708. https://doi.org/10.1016/j.ophtha.2015.11.010
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