Atropine Eye Drops for Myopia Control in Childhood—More Long-Term Data, Please

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

“…Almost half of the selected studies were conducted in East Asia, in predominately Chinese ethnic children [109,110,114,115,[118][119][120]. Four studies were conducted in Europe [107,111,112,116], two in India [113,117], one in Iran [108], one in the USA [121], and one in Australia [106]. Upon comparing these studies, it may be inferred that varying ethnic groups exhibit dosedependent differences in the pharmacokinetics and the effect of atropine.…”

“…Upon comparing these studies, it may be inferred that varying ethnic groups exhibit dosedependent differences in the pharmacokinetics and the effect of atropine. While reduced myopia progression was observable in several studies with low-dose atropine [108,110,112,113,115,[117][118][119], in two studies, one conducted in the USA and one in Ireland, 0.01% low dose atropine was not or only minimally effective [116,121] (Supplementary Table 3). Another possible explanation could be the differences in atropine eye drop composition, e.g., content of preservatives and pH, in the various studies as recently pointed out by Iribarren et al [122].…”

“…Another possible explanation could be the differences in atropine eye drop composition, e.g., content of preservatives and pH, in the various studies as recently pointed out by Iribarren et al [122]. It was noticed that studies conducted in Western Caucasian populations [107,116,121], showing low to no effect on myopia progression, used the same patented formulation with low pH and containing benzalkonium chloride, while previous studies in Asia had used compounded drops. Similarly, there are differences regarding safety and adverse events (AE).…”

“…Despite its extensive use in numerous clinical trials (Supplementary Table 3), no systemic adverse effects have been reported [19]. However, both the effect and safety of atropine remain controversial, which likely has led to differing opinions on its use [66,121,126]. In regions where atropine is relatively widely used to control myopia progression in children, studies are being conducted to investigate its use for preventing myopia onset in premyopic children and have shown positive results [109,120].…”

Is Recommending 0.01% Atropine for Myopia Control Clinically Meaningful?

“…If the effect size reported for 0.01% atropine in the CHAMP trial (0.24 D and −0.13 mm in 3 years) is considered clinically meaningful, this is at odds with the previous COMET conclusion that PALs with similar effect size (0.20 D and −0.11 mm in 3 years) are not clinically effective. Regardless, the lack of definite efficacy of 0.01% atropine in controlling eye elongation to any substantial degree, now reported in several trials including CHAMP, suggests that concentrations higher than 0.01% atropine or more effective optical interventions are warranted if the primary justification for myopia control is to reduce future risks of sight-threatening ocular pathologies.…”