Efficacy and Safety of Atropine to Control Myopia Progression: A Systematic Review and Meta-analysis

Abstract

Background: The effect and safety of atropine on delaying the progression of myopia has been extensively studied, but its optimal effect dose is still unclear. Therefore, the purpose of this meta-analysis is to systematically evaluate the safety and effectiveness of atropine in controlling the progression of myopia, and to explore the relationship between the dose of atropine and the effect of controlling the progression of myopia. Methods: This work was done through the data search from PubMed, MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. The Cochrane Handbook was also used to evaluate the quality of these included studies. In addition, a meta-analysis was performed using Revman5.3 software. Results: A total of 10 randomized controlled trials (RCTs) were included. Myopia progression was mitigated greater in the atropine treatment group than the control group, with MD = -0.80, 95% CI (-0.94, -0.66) during the whole observation period. There was a statistical difference between 0.05%, 0.5%, and 1.0% atropine (P = 0.004). In addition, less axial elongation was showed, with MD = -0.26, 95% CI (-0.33, -0.18) during the whole observation period. Conclusion: The effect of atropine in controlling the progression of myopia was dose related. A 0.05% atropine was likely to be the optimal dose.

Efficacy and Safety of 8 Atropine Concentrations for Myopia Control in Children

“…Several previous studies have demonstrated associations of higher concentrations of atropine with more adverse effects such as photophobia and near-vision problems. 5,11 Our NMA showed similar results: the lower the atropine concentration was, the higher the ranking probabilities for safety profiles in pupil size and accommodation were. Although we were not able to obtain a reliable network for analysis of near BCVA, we can speculate that lower atropine concentration is correlated with lower possibility of decreased near BCVA, since accommodation and pupil size are components of near visual acuity.…”

“…Myopia also impacts children's overall quality of life, specifically in terms of academic performance, physical activity, social interaction, and future job choices. 5 Therefore, a treatment to effectively retard or even stop myopia progression in children is coveted by researchers, clinicians and medical practitioners.…”

“…Previous methodologies, such as limited comparisons and/or conventional metaanalysis using pairwise comparisons, were not able to demonstrate hierarchies among various J o u r n a l P r e -p r o o f Network Meta-Analysis: Atropine for Myopia Control atropine concentrations. 5,11 Direct and indirect comparison of different doses is essential in order to enable clinicians and parents to choose the safest and most effective treatment for myopia control. Network meta-analysis (NMA), an extension of traditional meta-analysis, provides an inclusive estimate of the efficacy or safety of multiple experimental trials not previously directly compared with adequate precision or at all.…”

“…Differences were discussed, and a third reviewer (JHJ) was contacted if consensus was not reached. Trial characteristics of interest included: (1) study ID (name of first author, year of publication), (2) country of study, (3) number of subjects, (4) race/ethnicity of study population, (5) ages and sexes of participants, (6) intervention and control, (7) length of follow-up, (8) baseline and annual mean change in refraction, (9) baseline and annual mean change in axial length (AXL), (10) proportion of eyes showing overall/rapid myopic progression, and (11) adverse outcomes (i.e., photopic/mesopic pupil diameters, change in accommodation amplitude, and distance/near best-corrected visual acuity [BCVA]). For studies reporting more than 2 atropine concentrations that could be independently subjected to the present NMA, data were extracted from all of the atropinetreated arms.…”

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

“…However, previous systematic review and meta-analysis have identified the efficacy and safety of atropine with ambiguous findings [20][21][22][23]. It was shown that the optimal dose of atropine may be 0.5% and 1% by Song et al [21] and equally beneficial by Gong et al [20], 0.01% by Zhao et al [22], and 0.05% by Zhao et al [23], but lacking consensus on atropine dose. As new clinical trials continually emerge, it is essential to conduct a meta-analysis to identify the optimal dose of atropine.…”