Use of atropine for prevention of childhood myopia progression in clinical practice

Abstract

Introduction - The most effective strategy to reduce myopia-related complications is to prevent myopia progression during childhood. This review article examines the latest published evidence on the use of atropine in childhood myopia control and discusses practical aspects of in applying the findings to clinical practice. Future directions including possible forms of combination therapy are examined. Methods - A literature search with a focus on randomized controlled trials and meta-analyses on the subject was conducted. Observational studies with control groups were also reviewed to discuss issues regarding feasibility of using atropine for myopia control in clinical practice. Results - 5 randomized controlled trials and 2 meta-analyses were found. The studies all found beneficial effects of atropine in myopia control, as well as a clear but perhaps clinically insignificant dose-response relationship between atropine and myopia progression rates. Available evidence however is focused on predominantly Chinese populations and there is a current lack of guidance on timing of therapy initiation, duration of therapy and treatment cessation. For future directions, combining atropine with other forms of myopia control would be worth considering. Conclusions - Atropine is robust option for childhood myopia control. Further evidence including randomized controlled trials in different populations as well as the upcoming 5-year ATOM2 trial results will provide much needed answers for wider acceptance of its use.