Atropine eye drops may lower incidence of myopia in kids

Nightly use of 0.05% atropine eye drops among children appears to lead to a significantly lower incidence of near-sightedness, as shown in the results of the LAMP2 study from Hong Kong.

In a cohort of children aged 4–9 years, the 2-year cumulative incidence of myopia was 28.4 percent with 0.05% atropine, 45.9 percent with 0.01% atropine, and 53.0 percent with placebo. The corresponding proportion of children with fast myopic shift at 2 years were 25.0 percent, 45.1 percent, and 53.9 percent. [JAMA 2023;329:472-481]

Treatment with the 0.05% atropine eye drops was associated with a significantly lower 2-year cumulative myopia incidence and proportion of children with fast myopic shift as compared with placebo (difference, 24.6 percent and 28.9 percent, respectively) and 0.01% atropine (difference, 17.5 percent and 20.1 percent, respectively).

Notably, both outcomes with 0.01% atropine did not achieve a statistically significant difference relative to those with placebo. This suggests that the 0.01% concentration of atropine might not have sufficient potency to induce treatment effects, according to the investigators.

“Such results were consistent with the LAMP1 study, which reported no effect of 0.01% atropine on ocular axial elongation,” they added. [Ophthalmology 2019;126:113-124; Ophthalmology 2020;127:910-919; Ophthalmology 2022;129:308-321; Ophthalmology 2016;123:391-399]

In terms of safety, photophobia was the most common adverse event, occurring in 12.9 percent of children in the 0.05% atropine arm, 18.9 percent in the 0.01% atropine arm, and 12.2 percent in the placebo arm at year 2.

LAMP2 included 474 children (mean age 6.8 years, 50 percent girls), among whom 353 (74.5 percent) completed the trial. These children had cycloplegic spherical equivalent between +1.00 D to 0.00 D and astigmatism less than −1.00 D.

Of the children, 160 were in the 0.05% atropine arm, 159 were in the 0.01% atropine arm, and 155 were in the placebo arm. Treatment was applied once every night for over 2 years.

“Low-concentration atropine is one of the few interventions that can be initiated in high-risk children … to delay the potential onset of myopia,” the investigators said. [J Ocul Pharmacol Ther 2010;26:341-345] 

However, they acknowledged that the beneficial effect of 0.05% atropine on myopia incidence seen in LAMP2 could not be interpreted as a means of prevention or decreasing the future risk of myopia. This was because the study duration was only 2 years, and the data were suggestive of a delay in myopia onset and progression rather than prevention.

Then again, despite the presence of several limitations, LAMP2 “provides evidence for atropine as an additional strategy for delaying myopia onset beyond increasing time spent outdoors. Although increasing outdoor time offers an effective approach for general populations of children, the addition of low-concentration atropine could be considered for children at high risk of developing myopia,” the investigators pointed out.

More studies are needed to validate the findings, assess the drug’s longer-term safety, and to shed light on whether the treatment effect represents a delay or prevention of myopia, they said.