Efficacy and Safety of Low-Dose Atropine on Myopia Prevention in Premyopic Children: Systematic Review and Meta-Analysis

Abstract

Background: Early-onset myopia increases the risk of irreversible high myopia. Methods: This study systematically evaluated the efficacy and safety of low-dose atropine for myopia control in children with premyopia through meta-analysis using random-effects models. Effect sizes were calculated using risk ratios (RRs) with 95% confidence intervals (CIs). Comprehensive searches of PubMed, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov were conducted until 20 December 2023, without language restrictions. Results: Four studies involving 644 children with premyopia aged 4–12 years were identified, with atropine concentrations ranging from 0.01% to 0.05%. The analysis focused on myopia incidence and atropine-related adverse events. Lower myopia incidence (RR, 0.62; 95% CI, 0.40–0.97 D/y; p = 0.03) and reduction in rapid myopia shift (≥0.5 D/1y) (RR, 0.50; 95% CI, 0.26–0.96 D/y; p < 0.01) were observed in the 12–24-month period. Spherical equivalent and axial length exhibited attenuated progression in the atropine group. No major adverse events were detected in either group, whereas the incidence of photophobia and allergic conjunctivitis did not vary in the 12–24-month period. Conclusions: Our meta-analysis supports atropine’s efficacy and safety for delaying myopia incidence and controlling progression in children with premyopia. However, further investigation is warranted due to limited studies.

Efficacy and Safety of 0.03% Atropine Eye Drops in Controlling Myopia Progression: A One-Year Prospective Clinical Study

“…Various approaches have been explored to slow down myopia progression, including spectacle lenses, dual-focus lenses, orthokeratology contact lenses, repeated low-level red-light therapy and atropine eye drops [ 4 , 5 , 6 ]. Among the strategies available for managing myopia progression, atropine eye drops are widely regarded as one of the most effective interventions, with numerous studies demonstrating their ability to effectively and safely manage myopia progression in children, both those with premyopia and those already myopic [ 7 , 8 , 9 , 10 , 11 ]. However, it is important to note that the efficacy of atropine is concentration-dependent, with higher concentrations associated with increased risk of adverse events and rebound effects [ 11 , 12 , 13 ].…”