Low-Dose Atropine Does Not Affect Binocular Vision, Accommodation

Low-dose atropine treatment does not significantly affect accommodation, binocular vision, or visual acuity.

Low-dose atropine does not affect accommodation, binocular vision, or visual acuity, but concentrations of 0.03% and 0.05% can temporarily increase pupil size, according to a study published in Optometry and Vision Science

Investigators included 46 children with myopia (mean age, 10.73 years; 28 girls) in the double-masked study and randomly assigned them to treatment with placebo (n=10) or low-dose atropine consisting of 0.01% (n=13), 0.03% (n=11), or 0.05% (n=12) concentrations. The research team evaluated visual acuity at distance and near, pupil size, dissociated phoria at distance and near, negative and positive fusional vergence, near point convergence, near point convergence stamina and fragility, accommodative lag, and amplitude of accommodation in photopic and scotopic conditions at 30 and 60 minutes, and 24 hours following drop instillation.

Although both 0.03% and 0.05% atropine drops increased pupil size in photopic and scotopic conditions, visual acuity, accommodation, and binocular vision function remained unaffected.

Pupil diameter was significantly larger among individuals undergoing low-dose atropine concentrations of 0.03% and 0.05% in both photopic and scotopic conditions compared with control group participants at all time points, the report shows. Participants treated with 0.01% atropine experienced statistically significant pupil enlargement only at 60 minutes in scotopic conditions.

Aside from pupillary enlargement, treatment with the low-dose atropine did not significantly affect accommodation, binocular vision, or visual acuity compared with placebo treatment.

“Although both 0.03% and 0.05% atropine drops increased pupil size in photopic and scotopic conditions, visual acuity, accommodation, and binocular vision function remained unaffected,” the researchers explain. “Thus, we conclude that it is safe to utilize 0.01%, 0.03%, and 0.05% atropine in children ages 6 to 17 years.”  

Study limitations include small sample size, a short study duration, failure to verify low-dose atropine concentration following reception from the compounding pharmacy, and failure to consider participants’ ethnicity or iris color.

References:

Breliant R, Pang Y, Bandstra A, Kattouf V. Effect of low-dose atropine on binocular vision and accommodation in children ages 6 to 17 Years. Optom Vis Sci. Published online June 6, 2023. doi:10.1097/OPX.0000000000002031.