Safety and efficacy of 0.02% and 0.01% atropine on controlling myopia progression: a 2-year clinical trial

Abstract

Four hundred myopic children randomly received atropine 0.02% (n = 138) or 0.01% (n = 142) in both eyes once-nightly or only wore single-vision spectacles (control group) (n = 120) for 2 years. Spherical equivalent refractive error (SER), axial length (AL), pupil diameter (PD), and amplitude of accommodation (AMP) were measured every 4 months. After 2 years, the SER changes were − 0.80 (0.52) D, − 0.93 (0.59) D and − 1.33 (0.72) D and the AL changes were 0.62 (0.29) mm, 0.72 (0.31) mm and 0.88 (0.35) mm in the 0.02% and 0.01% atropine groups and control group, respectively. There were significant differences between changes in SER and AL in the three groups (all P < 0.001). The changes in SER and AL in the 2nd year were similar to the changes in the 1st year in the three groups (all P > 0.05). From baseline to 2 years, the overall decrease in AMP and increase in PD were not significantly different in the two atropine groups, whereas the AMP and PD in the control group remained stable (all P > 0.05). 0.02% atropine had a better effect on myopia control than 0.01% atropine, and its effects on PD and AMP were similar to 0.01% atropine. 0.02% or 0.01% atropine controlled myopia progression and AL elongation synchronously and had similar effects on myopia control each year.

Combination of orthokeratology lens with 0.01% atropine in slowing axial elongation in children with myopia: a randomized double-blinded clinical trial

“…However, Yang reported that the AMP in the OK lens group increased as wearing time extended [ 34 ], the changing speed was faster after wearing the OK lens for 1 to 6 months, and then slowed down. Several studies, including our previous studies [ 5 – 7 , 15 ], have found that AMP is significantly reduced after using low-dose atropine. However, no significant changes were found in AMP in either the combination group or the OK lens alone group, which was consistent with the study by Tan et al [ 18 ].…”

“…0.01% atropine in the combination group significantly increased PD in children, which may facilitate the effect of OK lens to slow axial elongation through both pharmacological and optical mechanisms [ 16 , 18 ]. Studies from different countries have shown that moderate- and low-concentration atropine (e.g., 0.025%, 0.05%) may effectively and safely slow the progression of myopia in children [ 5 – 7 , 13 , 28 ]. It may have biochemical effects on the retina or sclera, which in turn affect remodeling of the sclera [ 29 ], or may increase collagen cross-linking with the sclera by increasing ultraviolet exposure (secondary to pupil dilation), thereby limiting scleral growth [ 30 ].…”

“…Increase in PD is one of the most important side effects of low-dose atropine eye drops [ 5 – 7 , 15 ]. Our study found that 0.01% atropine had a minimal impact on PD in the combination groups.…”

“…The increased severity of myopia significantly increases the risk of irreversible vision loss. Currently, orthokeratology (OK) and low-concentration atropine eye drops are commonly used to slow myopia progression [2][3][4][5][6][7]. OK lens could temporarily reduce myopia severity by reshaping the cornea, and OK control myopia progression most likely by increased peripheral myopic focus that reduces stimuli for axial elongation and subsequent development of myopia [8][9][10].…”

“…Atropine is a non-selective antagonist of muscarinic acetylcholine receptors that may mediate axial elongation by blocking of the muscarinic receptors in the retina and sclera [11,12]. Many studies have shown that some concentrations of low concentration atropine can effectively control the progression of myopia [5][6][7]13]. Conversely, it has been observed that the efficacy of the OK lens and low concentrations atropine was associated with many factors [14,15], and that OK lens and low concentration atropine failed to control myopia progression in a small number of children.…”