EFFICACY OF ATROPINE SULPHATE EYE DROPS IN CONTROLLING MYOPIA PROGRESSION: A REVIEW
Abstract
Introduction: Myopia is major public health concern that has become increasingly common. Severe myopia has become one of the main causes of untreatable vision loss throughout the world, often due to its irreversible complications. Studies shows atropine can reduce myopia progression in children. Currently, there are no guidelines for the use of atropine specifically to control myopia progression. This study was made to review the efficacy of various atropine doses in controlling myopia progression.
Methods: Literature searching was conducted in four online databases (PubMed, EBSCOhost, ScienceDirect, and Scopus. Search terms included were “Atropine” and “Myopia”. Validity was assessed using assessment tool from Cochrane. Efficacy was evaluated using myopia progression in spherical equivalent per year and axial lengthening per year.
Results: Sixteen randomized controlled trial studies fulfilled our inclusion criteria and eligibility screening. Overall, atropine shows favorable results in spherical equivalent progression (D/year) compared to control, with SMD = -1.13, 95% CI (-0.58, -1.68). Less axial elongation (mm/year) was observed in atropine group, with SMD = -1.28, 95% CI (-0.18, -2.37). Atropine 0.01% concentration shows overall significantly better myopia progression and axial lengthening compared to control, with SMD = -0.76, 95% CI (-0.08, -1.44) and SMD = -0.63, 95% CI (-0.14, -1.12), respectively. Higher atropine doses showed larger effect sizes with higher occurrence of adverse effects.
Conclusion: Atropine eye drops in various doses shows overall effective myopia control in spherical equivalent and axial lengthening. Atropine 0.01% has significant myopia progression inhibition with less adverse effects than higher doses.
Full text article
References
World Health Organization. The Impact of Myopia and High Myopia: report of the joint World Health Organisation-Brian Holden Vision Institute Global Scientific Meeting on Myopia [Internet]. World Health Organization–Brien Holden Vision Institute. 2015. 1–40 p. Available from: https://www.who.int/blindness/causes/MyopiaReportforWeb.pdf
Morgan IG, French AN, Ashby RS, Guo X, Ding X, He M, et al. The epidemics of myopia: Aetiology and prevention. Prog Retin Eye Res [Internet]. 2018;62:134–49. Available from: https://doi.org/10.1016/j.preteyeres.2017.09.004
Loughman J, Flitcroft D. The acceptability and visual impact of 0.01% atropine in a Caucasian population. Br J Ophthalmol. 2016;100:1525–9.
Grzybowski A, Kanclerz P, Tsubota K, Lanca C, Saw SM. A review on the epidemiology of myopia in school children worldwide. BMC Ophthalmol. 2020;20:27.
Shih Y, Chen C, Chou A, Ho T. Effects of Different Concentrations of Atropine on Controlling Myopia in Myopic Children. J Ocul Pharmacol Ther. 1999;15:85–90.
Shih Y, Hsiao CK, Chen C, Chang C, Hung PT, Lin LL. An intervention trial on efficacy of atropine and multi-focal glasses in controlling myopic progression. Acta Ophthalmol Scand. 2001;233–6.
Chua W, Balakrishnan V, Chan Y, Tong L, Ling Y, Quah B, et al. Atropine for the Treatment of Childhood Myopia. Am Acad Ophthalmol. 2006;2285–91.
Yi S, Huang Y, Yu S-Z, Chen X-J, Yi H, Zeng X-L. Therapeutic effect of atropine 1% in children with low myopia. J AAPOS [Internet]. 2015;400014:1–5. Available from: http://dx.doi.org/10.1016/j.jaapos.2015.04.006
Wang Y, Bian H, Wang Q. Atropine 0.5% eyedrops for the treatment of children with low myopia. Medicine (Baltimore). 2017;27.
Yam JC, Edin F, Li FF, Zhang X, Tang SM, Yip BHK, et al. Two-Year Clinical Trial of the Low-Concentration Atropine for Myopia Progression (LAMP) Study Phase 2 Report. Am Acad Ophthalmol [Internet]. 2020;127:910–9. Available from: https://doi.org/10.1016/j.ophtha.2019.12.011
Zhu Q, Tang Y, Guo L, Tighe S, Zhou Y, Zhang X, et al. Efficacy and Safety of 1% Atropine on Retardation of Moderate Myopia Progression in Chinese School. Int J Med Sci. 2020;17:176–81.
Tan Q, Ng AL, Choy BN, Cheng GP, Woo VC, Cho P. One-year results of 0.01% atropine with orthokeratology (AOK) study: a randomised clinical trial. Ophthalmic Physiol Opt. 2020;40:557–66.
Wei S, Li S-M, An W, Du J, Liang X, Sun Y, et al. Safety and Efficacy of Low-Dose Atropine Eyedrops for the Treatment of Myopia Progression in Chinese Children A Randomized Clinical Trial. JAMA Ophthalmol. 2020;1–7.
Kinoshita N, Konno Y, Hamada N, Kanda Y. Efficacy of combined atropine solution for slowing axial elongation in children with myopia:a 2?year randomised trial. Nat Res [Internet]. 2020;1–11. Available from: https://doi.org/10.1038/s41598-020-69710-8
Zhao Q, Hao Q. Clinical efficacy of 0.01% atropine in retarding the progression of myopia in children. Int Ophthalmol [Internet]. 2020;0. Available from: https://doi.org/10.1007/s10792-020-01658-0
Saxena R, Dhiman R, Gupta V, Kumar P, Matalia J, Roy L, et al. Atropine for treatment of childhood myopia in India (I-ATOM): multicentric randomized trial. Ophthalmology [Internet]. 2021; Available from: https://doi.org/10.1016/j.ophtha.2021.01.026
Jethani J. Efficacy of low-concentration atropine (0.01%) eye drops for prevention of axial myopic progression in premyopes. Indian J Ophthalmol [Internet]. 2022;70:238. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28331284%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC5354527%5Cnhttp://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-11-49%5Cnhttp://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886
Chan HHL, Choi KY, Ng ALK, Choy BNK, Chan JCH, Chan SSH, et al. Efficacy of 0.01% atropine for myopia control in a randomized, placebo-controlled trial depends on baseline electroretinal response. Sci Rep [Internet]. 2022;12:1–10. Available from: https://doi.org/10.1038/s41598-022-15686-6
Cui C, Li X, Lyu Y, Wei L, Zhao B, Yu S, et al. Safety and efficacy of 0.02% and 0.01% atropine on controlling myopia progression: a 2-year clinical trial. Sci Rep [Internet]. 2021;11:1–8. Available from: https://doi.org/10.1038/s41598-021-01708-2
Sen S, Yadav H, Jain A, Verma S, Gupta P. Effect of atropine 0.01% on progression of myopia. Indian J Ophthalmol [Internet]. 2022;70:3373. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28331284%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC5354527%5Cnhttp://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-11-49%5Cnhttp://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886
Ang M, Wong TY. Updates on Myopia: Clinical Perspectives. 1st ed. Updates on Myopia. Singapore: Springer Open; 2020.
Carr BJ, Ph D, Stell WK, Ph D. Clinical aspects & health care burden Genes may play a role in development of myopia. Webvision. 2019;1–44.
Chiang STH, Phillips JR. Effect of Atropine Eye Drops on Choroidal Thinning Induced by Hyperopic Retinal Defocus. J Ophthalmol. 2018;2018.
Pugazhendhi S, Ambati B, Hunter AA. Pathogenesis and prevention of worsening axial elongation in pathological myopia. Clin Ophthalmol. 2020;14:853–73.
Vutipongsatorn K, Yokoi T, Ohno-Matsui K. Current and emerging pharmaceutical interventions for myopia. Vol. 103, British Journal of Ophthalmology. 2019. p. 1539–48.
Upadhyay A, Beuerman RW. Biological Mechanisms of Atropine Control of Myopia. Eye Contact Lens. 2020;46:129–35.
Chia A, Lu Q, Tan D. Five-Year Clinical Trial on Atropine for the Treatment of Myopia 2 Myopia Control with Atropine 0.01% Eyedrops. Am Acad Ophthalmol. 2015;1–9.
Chia A, Chua WH, Wen L, Fong A, Goon YY, Tan D. Atropine for the treatment of childhood myopia: Changes after stopping atropine 0.01%, 0.1% and 0.5%. Am J Ophthalmol [Internet]. 2014;157:451-457.e1. Available from: http://dx.doi.org/10.1016/j.ajo.2013.09.020
Tong L, Huang XL, Koh ALT, Zhang X, Tan DTH, Chua WH. Atropine for the Treatment of Childhood Myopia: Effect on Myopia Progression after Cessation of Atropine. Ophthalmology [Internet]. 2009;116:572–9. Available from: http://dx.doi.org/10.1016/j.ophtha.2008.10.020
Kothari M, Jain R, Khadse N, Rathod V, Mutha S. Allergic reactions to atropine eye drops for retardation of progressive myopia in children. Indian J Ophthalmol. 2018;66:1446–50.
Authors
Copyright (c) 2023 Arcci Pradessatama, Umar Mardianto
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.