A STROBE-compliant case–control study

Abstract

Topical atropine has become a mainstream treatment of myopia throughout East and Southeast Asia, but it is uncertain whether long-term topical atropine therapy induces intraocular pressure (IOP) elevation and subsequent development of glaucoma. We then prospectively examined the effects of long-term atropine treatment on IOP. Our case series collected 186 myopic children who were younger than 16 years of age. Complete ocular examination data, IOP and refractive status measurements beginning in 2008 were collected for all participants. Participants were divided into two groups: 121 children who received atropine therapy at various concentrations were classified as the treated group, whereas 65 children who did not receive atropine therapy were classified as the untreated (reference) group. In the treated group, clinicians prescribed different concentrations of atropine eye drops according to their discretion with regard to the severity of myopia on each visit of the patient. We then calculated the cumulative dose of atropine therapy from 2008 to the patients’ last follow-up in 2009. Furthermore, the treated group was then further divided into low- and high-refractive-error groups of nearly equal size for further analysis. There were no significant differences for the baseline refractive errors and IOPs between the treated and untreated groups. Both the low- and high-cumulative atropine dosage subgroups showed significantly lower myopic progression than the untreated group, but there was no significant difference between the two subgroups in terms of different cumulative dosages. All groups, including the untreated group, showed an increase of mean IOP at the last follow-up, but both low- and high-cumulative atropine dosage subgroups experienced a smaller increase of IOP. The mean IOP of all atropine-treated groups showed no significant increase in either low- or high-refractive-error eyes. This study revealed that topical atropine eye drops do not induce ocular hypertension and are effective for slowing the progression of myopia. The treatment effects are not correlated with the cumulative atropine dosages.

Evaluating the Effect of Topical Atropine Use for Myopia Control on Intraocular Pressure by Using Machine Learning

“…The clinical discussion revealed the relevant factors such as age, dosage, use time, etc., and whether the changes of IOP will be caused by atropine before and after its use [ 29 ]. At present, other literature has discussed the clinical effects or side effects of different doses of atropine [ 37 , 54 ]. The new significance of this study of atropine in myopic children is the use of the clinical data, combined with four artificial intelligence methods, to find out the reliable predictive value and the important rank of factors which may be related to topical atropine use for myopia control on intraocular pressure.…”

Myopia Control: Are We Ready for an Evidence Based Approach?

“…However, this may have been caused by a rebound effect since most of the study participants discontinued atropine treatment abruptly without tapering. Other publications on long-term effects of atropine indicate that the use of topical atropine eye drops does not lead to ocular hypertension and observed treatment effects are not correlated with the total cumulative dosage of atropine administered [ 124 ]. The effect of atropine (0.05% and 0.1%) has shown to last up to 4.5 years, with smaller rebound in long-term use [ 48 , 125 ].…”

Corneal Penetration of Low-Dose Atropine Eye Drops

“…In a comparison of topical ocular drugs, atropine is generally considered to be well tolerated by the corneal epithelium: preparations of up to 1% were found to cause no epithelial damage [ 54 ]. A comparative analysis showed that there was no increase in eye pressure in the group of treated children [ 55 ]. BAC can exhibit toxic effects on the tear film and the corneal epithelium [ 56 , 57 ].…”