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. [Abstract copyright: © 2023. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.]
Bibliographical noteFunding Information:
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.
© 2023, The Author(s), under exclusive licence to The Royal College of Ophthalmologists.