Abstract
Several conflicting results regarding the efficacy of 0.01% atropine in slowing axial elongation remain in doubt. To solve this issue and evaluate the safety of 0.01% atropine, we conducted a systematic review and meta-analysis with the latest evidence. The review included a total of 1178 participants (myopic children). The efficacy outcomes were the mean annual progression in standardized equivalent refraction (SER) and axial length (AL). The safety outcomes included mean annual change in accommodative amplitude, photopic and mesopic pupil diameter. The results demonstrated that 0.01% atropine significantly retarded SER progression compared with the controls (weighted mean difference [WMD], 0.28 diopter (D) per year; 95% confidence interval (CI) = 0.17, 0.38; p < 0.01), and axial elongation (WMD, −0.06 mm; 95% CI = −0.09, −0.03; p < 0.01) during the 1-year period. Patients receiving 0.01% atropine showed no significant changes in accommodative amplitude (WMD, −0.45 D; 95% CI = −1.80, 0.90; p = 0.51) but showed dilated photopic pupil diameter (WMD, 0.35 mm; 95% CI = 0.02, 0.68; p = 0.04) and mesopic pupil diameter (WMD, 0.20 mm; 95% CI = 0.08, 0.32; p < 0.01). In the subgroup analysis of SER progression, myopic children with lower baseline refraction (>−3 D) and older age (>10-year-old) obtained better responses with 0.01% atropine treatment. Furthermore, the European and multi-ethnicity groups showed greater effect than the Asian groups. In conclusion, 0.01% atropine had favorable efficacy and adequate safety for childhood myopia over a 1-year period.
Highlights
Myopia is becoming a public health concern with a significant socioeconomic burden affecting 80% to 90% of young adults [1,2,3,4,5,6,7]
Chia et al [17] have evaluated the change in standardized equivalent refraction (SER) and axial length (AL) after stopping the administration of atropine in a 5-year study and concluded that cessation of 0.1% and 0.5% atropine resulted in a greater degree of myopic rebound, but 0.01% atropine appears to result in less myopic rebound, which led to a more sustained effect of myopia retardation
In the present meta-analysis, we evaluated the safety profiles of 0.01% atropine eye drops by quantifying the changes in accommodative amplitude, photopic, and mesopic pupil diameter
Summary
Myopia is becoming a public health concern with a significant socioeconomic burden affecting 80% to 90% of young adults [1,2,3,4,5,6,7]. Chia et al [17] have evaluated the change in standardized equivalent refraction (SER) and axial length (AL) after stopping the administration of atropine in a 5-year study and concluded that cessation of 0.1% and 0.5% atropine resulted in a greater degree of myopic rebound, but 0.01% atropine appears to result in less myopic rebound, which led to a more sustained effect of myopia retardation They proposed that a daily dose of atropine 0.01% is an effective first-line treatment in children aged 6 to 12 years with documented myopic progression of −0.5 D in the preceding year with few side effects
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