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  • Review Article
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Low concentration atropine and myopia: a narrative review of the evidence for United Kingdom based practitioners

Eye volume 38, pages 434–441 (2024)Cite this article

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Abstract

The prevalence of myopia is increasing across the world. Controlling myopia progression would be beneficial to reduce adverse outcomes such as retinal detachment and myopic maculopathy which are associated with increased axial length. Pharmacological control of myopia progression with atropine has been investigated since the 19th century and the benefits of slowing myopia progression are considered against the side-effects of near blur and photophobia. More recently, randomised trials have focused on determining the optimum concentration of atropine leading to low-concentration atropine being used to manage myopia progression by practitioners across the world. Currently, in the United Kingdom, there is no licensed pharmacological intervention for myopia management. The aim of this review is to interpret the available data to inform clinical practice. We conducted a narrative review of the literature and identified peer-reviewed randomised controlled trials using the search terms ‘myopia’ and ‘atropine’, limited to the English language. We identified two key studies, which were the Atropine in the Treatment Of Myopia (ATOM) and Low-concentration Atropine for Myopia Progression (LAMP). Further studies were identified using the above search terms and the references from the identified literature. Atropine 0.01% has a modest effect on controlling axial length progression. Atropine 0.05% appears to be superior to atropine 0.01% in managing myopia progression. There is a dose-dependent rebound effect when treatment is stopped. Atropine is a well-tolerated, safe, and effective intervention. Treatment would be needed for several years and into adolescence, until axial length progression is stable.

摘要

近视患病率在全世界范围内不断上升。控制近视进展有利于减少视网膜脱离和近视性黄斑病变等与眼轴增加有关的不良后果。自19世纪以来, 专家一直在研究阿托品对近视进展的药理作用, 在考虑减缓近视进展益处的同时也考虑了其视近模糊和畏光的副作用。最近, 随机试验的重点是确定阿托品的最佳浓度, 因此低浓度阿托品被世界各地的研究者用来控制近视进展。目前在英国还没有获批治疗近视的药物。本综述的目的是通过现有数据指导临床实践。

我们对文献进行了回顾性分析, 使用检索词“近视”和“阿托品”确定了仅限于英语的同行评议的随机对照试验, 我们确定了两个关键研究, 即阿托品治疗近视(ATOM)和低浓度阿托品治疗近视进展(LAMP)两项研究。使用上述检索词和已确定文献中的参考文献确定了进一步的研究。

结果表明, 0.01% 阿托品对眼周进展的控制作用不大。0.05% 阿托品治疗近视进展的疗效优于0.01% 阿托品。当停止治疗时, 有剂量依赖性的反弹效应。阿托品是一种耐受性好、安全有效的干预措施。治疗需要持续数年, 直至青春期, 直到眼轴长度发育趋于稳定。

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Fig. 1: A summary of 8 studies utilising Atropine 0.01% demonstrating the one-year slowing of axial elongation (mm) and myopia progression (D).

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Authors and Affiliations

  1. Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, UK

    Imran Jawaid

  2. School of Biomedical Sciences, Ulster University, Northern Ireland, UK

    Kathryn Saunders

  3. Section of Academic Ophthalmology, School of Life Course Sciences, King’s College London, London, UK

    Christopher J. Hammond

  4. Moorfields Hospital, City Road, London, UK

    Annegret Dahlmann-Noor

  5. University of Houston, College of Optometry, Houston, TX, USA

    Mark A. Bullimore

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IJ was involved with study design, data analysis, initial draft, and review KS was involved with data analysis, initial draft and review MB was involved with data analysis, initial draft and review ADN and CJH were involved with review of the manuscript

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IJ is Co-PI for Ocumension. Advisory Board Santen and Altacor. Speaker fees for Novartis and Thea Pharmaceuticals. KS has received research funding from Nevakar, Vyluma and Hoya vision. AD-N is PI NEVAKAR CHAMP, CHAMP-UK, Ocumension and Myopia-X clinical trials, Advisory boards Santen Inc, SightGlass Vision, Novartis, Thea. ECP educational events and material Santen, CooperVision, Zeiss. Parent focus groups Novartis. Mark Bullimore is a consultant for Alcon Research, Bruno vision care, CooperVision, CorneaGen, EssilorLuxottica, Eyenovia, Genentech, Johnson & Johnson Vision, Lentechs, Novartis, Oculus, Paragon Vision Sciences, and Vyluma.

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Jawaid, I., Saunders, K., Hammond, C.J. et al. Low concentration atropine and myopia: a narrative review of the evidence for United Kingdom based practitioners. Eye 38, 434–441 (2024). https://doi.org/10.1038/s41433-023-02718-2

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