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  • Low-Dose Atropine for Myopia Control

    By Lynda Seminara
    Selected by Russell N. Van Gelder, MD, PhD
    Refractive Mgmt/Intervention
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    Journal Highlights

    Ophthalmology, July 2023

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    Bullimore and Brennan sought to predict the three-year efficacy of low-dose atropine by assessing results of the low-concentration atropine for myopia progression (LAMP) study and by reviewing a meta-analysis of 80 studies of axial length in untreated myopic children. They projected that three-year treatment with 0.05% atropine reduced axial length elongation (ALE) by 0.55 mm, which compares favorably with findings for higher atropine doses and other optical treatments for myopia.

    In year 1 of the LAMP study, participants (N = 438) were assigned randomly to receive 0.05%, 0.025%, or 0.01% atropine or placebo; treatment assignments were continued through year 2. In year 3, half of the treated chil­dren stayed on their dose of atropine, and treatment was discontinued for the other half. The main outcome measures were changes in axial length and my­opia progression. For this analysis, the authors focused on years 1 and 3.

    In year 1, ALE was slowed by 0.21, 0.12, and 0.05 mm with atropine 0.05%, 0.025%, and 0.01%, respectively, com­pared with placebo. Myopia progression was reduced by 0.54, 0.35, and 0.22 D, respectively. In the same period, the placebo group had ALE of 0.41 mm and myopia progression of –0.81 D. During year 3, there were no signifi­cant dose-related differences in myopia progression. The three-year cumulative absolute reductions in ALE were 0.55, 0.31, and 0.16 mm with atropine 0.05%, 0.025%, and 0.01%, respectively. In pairwise comparisons for year 3, ALE and myopia progression were signifi­cantly greater for children who received 0.05% atropine than for those given 0.01% atropine. Although this suggests a greater rebound effect with 0.05% atropine, the authors considered the difference to be nominal clinically. The meta-analysis demonstrated that low-dose atropine slowed ALE by an aver­age of 15%. As expected, the speed of myopia progression and ALE was faster after discontinuation of treatment.

    These findings suggest that the efficacy of low-concentration atropine beyond one year of treatment exceeds that of some optical therapies and pos­sibly even higher doses of atropine, said the authors. They concluded that an annual ALE slowing rate of 15% can be applied to predict three-year efficacy of low-dose atropine in the LAMP study.

    The original article can be found here.