Efficacy and Adverse Effects of Atropine for Myopia Control in Children: A Meta-Analysis of Randomised Controlled Trials

Abstract

Objectives. To explore the rebound effects and safety of atropine on accommodation amplitude in slowing myopia progression. Methods. We conducted a meta-analysis to testify proper dosage of atropine in children with myopia. We searched in PubMed, EMBASE, Ovid, and the Cochrane Library up to March 30, 2021. We selected randomised controlled trials (RCTs) that evaluated the efficacy of atropine for controlling myopia progression in children. We performed the inverse variance random-effects model to pool the data using mean difference (MD) for continuous variables. Statistical heterogeneity was assessed using the I2 test. Additionally, we conducted subgroup analyses and sensitivity analyses. Results. Seventeen RCTs involving 2955 participants were included. Myopia progression was significantly less in the atropine group than that of the control group, with MD = 0.38 D per year (95% confidence interval, 0.20 to 0.56). Less axial elongation was shown with MD = −0.19 mm per year (95% CI, −0.25 to −0.12). There was a statistically difference among various doses ( p = 0.00001 ). In addition, 1.0% atropine showed the rebound effect with MD = −0.54 D per year (95% CI, −0.81 to −0.26) and was more effective in the latter six months than in the former one. Less accommodation amplitude was shown in 0.01% atropine. Conclusion. The efficacy of atropine is dose dependent, and 0.01% atropine may be the optimal dose in slowing myopia progression in children with no accommodation dysfunction. A rebound effect is more prominent in high-dose atropine in the former cessation after discontinuation.

Effectiveness of myopia control interventions: A systematic review of 12 randomized control trials published between 2019 and 2021

“…Several treatment options for myopia control have emerged in recent years. A few meta-analyses on myopia treatment efficacy were published in 2022 (5)(6)(7). Those publications have analyzed the efficacy of individual therapies on myopia control, such as atropine (7), multifocal lens (8) or atropine and orthokeratology (9).…”

“…A few meta-analyses on myopia treatment efficacy were published in 2022 (5)(6)(7). Those publications have analyzed the efficacy of individual therapies on myopia control, such as atropine (7), multifocal lens (8) or atropine and orthokeratology (9). However, those studies did not compare the overall treatment effects.…”

Synergistic effects of defocus-incorporated multiple segments and atropine in slowing the progression of myopia

“…ATP, a nonselective antimuscarinic agent, is the only pharmaceutical agent that has been broadly adopted for myopia control for decades. The efficacy of ATP 22 and several adverse effects, such as the rebound effect 22 , pupillary diameter, and accommodative amplitude, are dose-dependent 23 . Thus, low-concentration ATP may be a safe dose for slowing myopia progression in children with the least side effect.…”

Empfehlungen bei progredienter Myopie im Kindes- und Jugendalter. Stellungnahme von DOG, BVA und der Bielschowsky Gesellschaft für Schielforschung und Neuroophthalmologie

“…Das Studiendesign und die Erfassung möglicher Nebenwirkungen sind zu heterogen, um eine abschließende Beurteilung der Dosierung in dem Bereich von 0,01–0,05 % mit dem besten Verhältnis von Wirkung und Nebenwirkungen zu erlauben [ 40 ]. Die bisherigen Metaanalysen können als Beleg für die Sicherheit herangezogen werden, ohne die Verträglichkeit im Einzelfall zu garantieren [ 41 ]. Eine aktuelle Recherche in ClinicalTrials.gov mit den Suchstichworten „Atropine AND Myopia“ erbrachte insgesamt 26 Studien, von denen sich 10 mit kurzfristigen Nebenwirkungen und Änderungen der Aderhautdicke befassten.…”