Nightly use of 0.05% atropine treatment may lower incidences of myopia and fast myopic shift, according to a study published in the Journal of the American Medical Association. While the report suggests that this preventative treatment may delay myopia onset, the short study duration does not allow researchers to determine whether it delays or prevents myopia among pediatric patients.
Investigators included 474 children with emmetropia or hyperopia (spherical equivalent [SE], 0.00 to +1.00 diopters [D]) in a randomized, placebo-controlled, double-masked trial and randomly assigned participants to 0.05% atropine treatment (n=160; 50% boys; mean age, 6.86 years), 0.01% atropine (n=159; 49% boys; mean age, 6.88 years), or placebo (n=155; 50% boys; mean age, 6.75 years). Participants underwent comprehensive examination, near point of accommodation assessment, cycloplegic autorefraction, and pupil size and axial length measurements at baseline and during 2-week, and 4-, 8-, 12-, 16-, 20-, and 24-month follow-up visits. Primary outcome measures were cumulative myopia incidence (SE≤-0.50 D) and the percentage of participants with fast myopia progression (1.00 D or more over 2 years). Secondary outcomes were SE and axial length changes.
The cohort receiving 0.05% atropine treatment experienced the lowest myopia incidence (28.4%) during the 2-year study duration compared with the groups treated with 0.01% atropine (45.9%) or placebo (53.0%). Results were similar for fast myopia shifts, with 25.0% of the 0.05% atropine group, 45.1% of the 0.01% atropine group, and 53.9% of the control group experiencing fast progression. Statistical significance was achieved when comparing individuals treated with 0.05% atropine with control group participants for cumulative myopia incidence (mean difference, 24.6%; 95% CI, 12.0%-36.4%; P <.001) and fast myopic shift (mean difference, 28.9%; 95% CI, 16.5%-40.5%; P <.001). However, no significant difference was noted in the 2-year cumulative myopia incidence or percentage of patients with fast myopic shift between the 0.01% atropine and placebo groups.
This atropine treatment resulted in less axial growth (0.48 mm) compared with 0.01% atropine (0.63 mm) or placebo (0.70 mm; P <.001 for both) at the study conclusion. SE was also significantly lower among the 0.05% atropine group (-0.46 D) compared with the 0.01% atropine (-0.84 D) and control groups (-1.01 D; P <.001 for both).
“This study provides evidence for atropine as an additional strategy for delaying myopia onset beyond increasing time spent outdoors,” according to researchers. “Although increasing outdoor time offers an effective approach for general populations of children, the addition of low-concentration atropine could be considered for children at high risk of developing myopia.”
Study limitations include a short study duration, single center design, high loss to follow-up, and ethnic homogeneity, which may limit the globalization of these findings.
Yam JC, Zhang XJ, Zhang Y, et al. Effect of low-concentration atropine eyedrops vs placebo on myopia incidence in children: the LAMP2 randomized clinical trial. JAMA. 2023;329(6):472-481. doi:10.1001/jama.2022.24162