Atropine for the Treatment of Childhood Myopia: Effect on Myopia Progression after Cessation of Atropine

• Published in: Ophthalmology (Rochester, Minn.) Vol. 116; no. 3; pp. 572 - 579
• Main Authors: Tong, Louis, Huang, Xiao Ling, Koh, Angeline L.T., Zhang, Xiaoe, Tan, Donald T.H., Chua, Wei-Han
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2009; Elsevier
• Subjects: Accommodation, Ocular - drug effects; Administration, Topical; Atropine - administration & dosage; Biological and medical sciences; Child; Disease Progression; Double-Blind Method; Female; Follow-Up Studies; Humans; Male; Medical sciences; Miscellaneous; Mydriatics - administration & dosage; Myopia - drug therapy; Myopia - physiopathology; Ophthalmic Solutions - administration & dosage; Ophthalmology; Vision disorders; Visual Acuity - drug effects; Withholding Treatment; Human; Prognosis; Vision disorder; Myopia; Anticholinergic agent; Eye disease; Cholinergic receptor; Treatment; Shutdown; Refractive error; Atropine; Evolution; Muscarinic receptor; Antagonist; Ophthalmology; Antidote; Child
• ISSN: 0161-6420; 1549-4713; 1549-4713
• DOI: 10.1016/j.ophtha.2008.10.020

The aim of this study was to assess the effect on myopia progression after cessation of topical atropine treatment. Parallel-group, placebo-controlled, randomized, double-masked study. Four hundred children aged 6 to 12 years with refractive error of spherical equivalent −1.00 to −6.00 diopters (D) and astigmatism of −1.50 D or less. No intervention was administered. Subjects were followed up for 12 months after stopping treatment, which consisted of either 1% atropine or vehicle eyedrops once nightly for 2 years. Only 1 eye of each subject was chosen through randomization for treatment. The main efficacy outcome measures were change in spherical equivalent refraction as measured by cycloplegic autorefraction and change in ocular axial length as measured by ultrasonography. After cessation of atropine drops, the mean progression in the atropine-treated group was −1.14±0.80 D over 1 year, whereas the progression in placebo-treated eyes was −0.38±0.39 D ( P<0.0001). However, after 3 years of participation in the trial (with 2 years on atropine treatment), eyes randomized to atropine have less severe myopia than other eyes. Spherical equivalent was −4.29±1.67 D in the atropine-treated eyes compared with −5.22±1.38 D in the placebo-treated eyes ( P<0.0001). Spherical equivalents in atropine-untreated and placebo-untreated eyes were −5.00±1.62 D and −5.28±1.43 D, respectively. Over the 3 years, the increase in axial length of the atropine-treated eyes was 0.29±0.37 mm compared with 0.52±0.45 mm in the placebo-treated eyes ( P<0.0001). After cessation of atropine, the amplitude of accommodation and near visual acuity returned to pretreatment levels. After stopping treatment, eyes treated with atropine demonstrated higher rates of myopia progression compared with eyes treated with placebo. However, the absolute myopia progression after 3 years was significantly lower in the atropine group compared with placebo. The author(s) have no proprietary or commercial interest in any materials discussed in this article.