Efficacy and safety of atropine in myopic children: A meta-analysis of randomized controlled trials

Abstract

To evaluate the safety and efficacy of atropine for childhood myopia and further explore the optimal concentration of atropine, so as to provide more reference for clinical application. PubMed, Embase, Cochrane Library and ClinicalTrials.gov were comprehensively searched for randomized controlled trials (RCTs) up to October 14, 2021. The efficacy outcomes were progression of spherical equivalent (SE) and axial length (AL). The safety outcomes included accommodation amplitude, pupil size and adverse effects. The meta-analysis was performed using Review Manager 5.3. Eighteen RCTs involving 3002 eyes were included. The results showed that at 6-36months of treatment, atropine was effective in slowing the progression of myopia in children. At 12months, the WMD of SE and AL of low-dose atropine was 0.25diopters (D) and 0.1millimeter (mm), moderate-dose atropine was 0.44D and 0.16mm, high-dose atropine was 1.21D and 0.82mm, respectively, compared with the control group. Similarly, at 24months, low-dose atropine was 0.22D and 0.14mm, moderate-dose atropine was 0.60D, high-dose atropine was 0.66D and 0.24mm, respectively. Interestingly, we also found that there was no significant difference in the effects of low-dose atropine on accommodation amplitude and photopic pupil size compared with the control group, and the rate of photophobia, allergy, blurred vision and other side effects was similar between the low-dose atropine group and the control group. In addition, atropine appears to be more effective in myopic children in China than in other countries. Atropine in various concentrations can effectively slow myopia progression in children, and its effect is dose-dependent, while low-dose atropine (0.01% atropine) appears to be safer.