Varying Dose of Atropine in Slowing Myopia Progression in Children Over Different Follow-Up Periods by Meta-Analysis

Gan, Jiahe; Li, Shiming; Wu, Shanshan; Cao, Kai; Ma, Dandan; He, Xi; Zeng, Hua; Kang, Meng-Tian; Wei, Shifei; Bai, Weiling; Wang, Ke

doi:10.3389/fmed.2021.756398

Cited by 13 publications

(16 citation statements)

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“…In our case, we found that atropine 0.01% had similar effect during the first and second year of treatment in terms of mean SE progression (− 0.42 ± 0.41 D and − 0.45 ± 0.39 D, respectively). However, these results differ from the results of the ATOM 2 (phase 2) and LAMP 2 Asian studies that found better efficacy with atropine 0.01% during the second year 12 , 35 , 36 . While some studies have found a decrease in treatment efficacy 37 , 38 , other have also found similar efficacy over the 2-years of treatment 21 , 33 .…”

Section: Discussioncontrasting

confidence: 99%

Age-related results over 2 years of the multicenter Spanish study of atropine 0.01% in childhood myopia progression

Pérez-Flores,

Macías-Murelaga,

Flores

et al. 2023

Sci Rep

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To evaluate the age-related efficacy and safety of atropine 0.01% eye drops over 2 years for myopia control in a multicentric pediatric Spanish cohort. A non-controlled, interventional, prospective multicenter study was conducted as an extension of the Spanish Group of Atropine Treatment for Myopia Control Study (GTAM 1). Children aged 6–14 years with myopia from − 2.00 to − 6.00 D, astigmatism < 1.50 D and documented annual myopic progression of at least − 0.50 D under cycloplegic examination were recruited. From the original cohort of 105 participants, 92 children who had been receiving atropine 0.01% eye drops once nightly in each eye for 1 year continued their participation in this extended study (GTAM 2). All the patients underwent a standardized quarterly follow-up protocol, which included measurements of best-corrected visual acuity (BCVA), cycloplegic autorefraction, axial length (AL), anterior chamber depth (ACD), and pupil diameter. The study sample was divided into three age groups: 6–8, 9–11, and 12–14 years old. The mean change in cycloplegic spherical equivalent (SE) and axial length (AL) during the 24 months of follow-up was analyzed. Correlations between SE and AL, as well as the distribution of annual progression, were evaluated. Adverse effects were recorded using a specific questionnaire. Finally, 81 children completed the follow-up and were included in the analysis. Over the 2-year period, the mean changes in SE and AL were − 0.88 ± 0.60 D and 0.49 ± 0.25 mm, respectively. Additionally, 51 patients (63%) experienced SE annual progression lower than − 0.50 D. The correlation between the progression of SE and AL during the total period of treatment was mild (r = − 0.36; p < 0.001). There were no differences between the first and the second year of treatment in the progression of SE (− 0.42 ± 0.41 D versus − 0.45 ± 0.39 D; p = 0.69) or AL (0.25 ± 0.16 mm versus 0.23 ± 0.14 mm; p = 0.43). Older patients (12–14 years old) showed less AL progression than younger children (6–8 years old): 0.36 ± 0.18 mm versus 0.59 ± 0.30 mm; p = 0.01. Adverse effects were mild, infrequent, and decreased over time. On average, the myopia progression in control groups from other published biannual studies exceeded that observed in our study. Over 2 years, atropine 0.01% demonstrated a safe treatment for controlling myopia progression in a multicentric cohort of Spanish children. The effect remained stable during this period. Older patients exhibited a more favorable response in terms of AL enlargement. However, further studies are needed to investigate the age-related effect of low-dose atropine in the Caucasian population.

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Section: Discussioncontrasting

confidence: 99%

Age-related results over 2 years of the multicenter Spanish study of atropine 0.01% in childhood myopia progression

Pérez-Flores,

Macías-Murelaga,

Flores

et al. 2023

Sci Rep

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“…In this meta-analysis, we combined the results from 27 RCTs and 17 cohort studies, and confirmed that there was significantly less myopia progression (WMD = 0.45 D/year; high dose: 0.73 D/year; moderate dose: 0.65 D/year, low dose: 0.35 D/year) and slower axial elongation (WMD = −0.15 mm/year; high dose: −0.26 mm/year; moderate dose: −0.37 mm/year, low dose: −0.11 mm/year) in the atropine group than in the control group. These results are similar to two previously published meta-analyses ( Gong et al, 2017 ; Gan et al, 2021 ). Moreover, we observed linear and nonlinear dose−response correlations, suggesting that as the concentration increases, the ESs of atropine on retarding refraction and axial length progression increases.…”

Section: Discussionsupporting

confidence: 93%

“…Secondary outcomes included risk of rapid (>1.0 D/year)/slow (<0.5 D/year) myopia progression ( Gan et al, 2021 ; Ha et al, 2022 ), progression in different treatment duration (D/year, mm/year), rebound effect (D/year, mm/year), progression in 3 years (D, mm), accommodation change (D), photopic pupil diameter change (mm), best-corrected visual acuity change (BCVA, logMAR/year), astigmatism change (D/year), anterior chamber depth change (ACD, mm/year), corneal curvature change (D/year), intraocular pressure change (IOP, mmHg/year), lens thickness change (LT, mm/year) and incidence of photophobia, blurred near vision and allergic reactions. Among them, the first four outcomes evaluated the efficacy of atropine, and the other secondary outcomes evaluated the safety of atropine.…”

Section: Methodsmentioning

confidence: 99%

“…On the other hand, how to balance the increasing myopia control effect with higher doses against side effects is still an important issue. Although the previous meta-analyses have focused on the changes in accommodation and pupil diameter ( Chen and Yao, 2021 ; Gan et al, 2021 ; Tran et al, 2021 ; Ha et al, 2022 ), which are two important parameters that affect the compliance with atropine use, they had not combined the clinically tolerable accommodation and pupil diameter changes to select the optimal dose of atropine for myopia control.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the efficacy and safety of different doses of atropine for myopic control in children: a meta-analysis

Hou,

Wu,

Nie

et al. 2023

Front. Pharmacol.

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Purpose: To comprehensively reassess the efficacy and safety of different concentrations of atropine for retarding myopia progression and seek the most appropriate therapeutic concentration for clinical practice.Methods: We searched PubMed, Cochrane Library, Embase, Chinese Science and Technology Periodicals (VIP) and China National Knowledege Infrastructure (CNKI) from their inception to 23 March 2023, to obtain eligible randomized controlled trials (RCTs) and cohort studies that had atropine in at least one treatment arm and placebo/no intervention in another arm. We evaluated the risk of bias of the RCTs according to the recommendations of the Cochrane Collaboration for RCTs and quality of cohort studies by the Newcastle‒Ottawa Scale. Weighted mean difference (WMD), 95% confidence interval were calculated for meta-analysis. All data analyses were performed using Review Manager 5.3, STATA 12.0 and SPSS 26.0 software.Results: A total of 44 studies were included in the meta-analysis. Weighted mean difference (WMD) were 0.73 diopters (D), 0.65 D, 0.35 D per year in refraction progression (χ2 = 14.63, I2 = 86.3%; p < 0.001) and −0.26 mm, −0.37 mm, −0.11 mm per year in axial length progression (χ2 = 5.80, I2 = 65.5%; p = 0.06) for high (0.5%–1%), moderate (0.1%–0.25%), and low (0.005%–0.05%) dose atropine groups, respectively. Logarithmic dose‒response correlations were found between atropine and their effect on change of refraction, axial length, accommodation and photopic pupil diameter. Through these curves, we found that atropine with concentrations ≤0.05% atropine resulted in a residual value of accommodation of more than 5 D and an increase in pupil diameter no more than 3 mm. Higher doses of atropine resulted in a higher incidence of adverse effects, of which the incidence of photophobia was dose-dependent (r = 0.477, p = 0.029).Conclusion: Both the efficacy and risk of adverse events for atropine treatment of myopia were mostly dose dependent. Comprehensively considered the myopia control effect and safety of each dose, 0.05% may be the best concentration of atropine to control myopia progression at present, at which myopia is better controlled and the side effects are tolerable.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/#recordDetails, CRD42022377705.

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“…We started with 0.02, 0.03, and 0.05% atropine in low-risk, moderate-risk, and high-risk groups, respectively. It is known that atropine has a significant dose-dependent effect on refractive change, axial elongation, and adverse effects (15). We choose 0.02% atropine as a starting dose instead of 0.01% in low-risk group based upon below reasons: (1) 0.02% atropine had a better effect on myopia progression than 0.01% atropine, but 0.02% and 0.01% atropine showed similar effects on pupil diameter and accommodative amplitude (16).…”

Section: Discussionmentioning

confidence: 99%

Classification-Based Approaches to Myopia Control in a Taiwanese Cohort

et al. 2022

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PurposeMyopia is a disorder of growing prevalence in school-aged children worldwide, especially in Asia. Although low-dose atropine is recognized as an effective treatment to slow myopia progression, different studies have reported varying efficacies of treatment, and the optimal concentration of low-dose atropine remains an open question.MethodsA two-stage approach was conducted in this study. First, an observational study was conducted to plot the axial length growth curve for Taiwanese children. Second, an interventional 2-year study was performed in which different concentrations of low-dose atropine were applied based upon the risk-level status from the first stage.ResultsA total of 4,091 subjects, consisting of 2,105 boys (51.5%) and 1,986 girls (48.5%), were enrolled in the first stage to plot the axial growth curve for Taiwanese children aged between 3 and 16 years. The percentage of children with myopia increased from 2.3% in 4-year-olds to 88.0% in 16-year-olds. At the second stage, a total of 886 subjects [307 (34.65%) at low risk, 358 (40.41%) at moderate risk and 221 (24.94%) at high risk] were enrolled to receive low-dose atropine based upon the risk level (0.02, 0.03, and 0.05%, respectively). With this approach, the mean annual myopia progression was −0.33, −0.57, and −0.82 D in the low-risk, moderate-risk and high-risk groups, respectively. Applying annual myopic progression < -1.0 D as a criterion for responder, the responder rates were 95.77, 83.52, and 70.59% in the low-risk, moderate-risk, and high-risk groups, respectively.ConclusionsWe proposed a classification-based approach involving different concentrations of low-dose atropine based upon an individual's risk-level status. With this approach, myopic progression can be effectively controlled in patients without exposure to atropine side effects due to exposure to a higher dose than actually needed.

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Varying Dose of Atropine in Slowing Myopia Progression in Children Over Different Follow-Up Periods by Meta-Analysis

Cited by 13 publications

References 59 publications

Age-related results over 2 years of the multicenter Spanish study of atropine 0.01% in childhood myopia progression

Age-related results over 2 years of the multicenter Spanish study of atropine 0.01% in childhood myopia progression

Comparison of the efficacy and safety of different doses of atropine for myopic control in children: a meta-analysis

Classification-Based Approaches to Myopia Control in a Taiwanese Cohort

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