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Original Investigation
October 1, 2020

Safety and Efficacy of Low-Dose Atropine Eyedrops for the Treatment of Myopia Progression in Chinese Children: A Randomized Clinical Trial

Author Affiliations
  • 1Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
  • 2Peking Union Medical College, Beijing, China
JAMA Ophthalmol. 2020;138(11):1178-1184. doi:10.1001/jamaophthalmol.2020.3820
Key Points

Question  Do atropine, 0.01%, eyedrops slow the myopia progression and axial elongation when compared with a placebo group in Chinese children?

Findings  In this randomized clinical trial, atropine, 0.01%, eyedrops reduced myopia progression and axial elongation compared with placebo treatment after 1 year.

Meaning  While the clinical relevance of the results cannot be determined from this trial, these results support the potential that atropine, 0.01%, eyedrops can slow myopia progression in Chinese children and warrant future studies to determine longer-term results and potential effects on slowing sight-threatening pathologic changes later in life.

Abstract

Importance  Because studies have suggested that atropine might slow the progression of myopia in children, randomized clinical trials are warranted to understand this potential causal relationship.

Objective  To evaluate the efficacy and safety of atropine, 0.01%, eyedrops on slowing myopia progression and axial elongation in Chinese children.

Design, Setting, and Participants  This was a randomized, placebo-controlled, double-masked study. A total of 220 children aged 6 to 12 years with myopia of −1.00 D to −6.00 D in both eyes were enrolled between April 2018 and July 2018 at Beijing Tongren Hospital, Beijing, China. Cycloplegic refraction and axial length were measured at baseline, 6 months, and 12 months. Adverse events were also recorded.

Interventions  Patients were randomly assigned in a 1:1 ratio to atropine, 0.01%, or placebo groups to be administered once nightly to both eyes for 1 year.

Main Outcomes and Measures  Mean changes and percentage differences in myopia progression and axial elongation between atropine, 0.01%, or placebo groups.

Results  Of 220 participants, 103 were girls (46.8%), and the mean (SD) age was 9.64 (1.68) years. The mean (SD) baseline refractive error and axial length were –2.58 (1.39) D and 24.59 (0.87) mm. Follow-up at 1 year included 76 children (69%) and 83 children (75%) allocated into the atropine, 0.01%, and placebo groups, respectively, when mean myopia progression was −0.49 (0.42) D and −0.76 (0.50) D in the atropine, 0.01%, and placebo groups (mean difference, 0.26 D; 95% CI, 0.12-0.41 D; P < .001), with a relative reduction of 34.2% in myopia progression. The mean (SD) axial elongation in the atropine, 0.01%, group was 0.32 (0.19) mm compared with 0.41 (0.19) mm in the placebo group (mean difference, 0.09 mm; 95% CI, 0.03-0.15 mm; P = .004), with relative reduction of 22.0% in axial elongation. Fifty-one percent and 13.2% of children progressed by at least 0.50 D and 1.00 D in the atropine, 0.01%, group, compared with 69.9% and 34.9% in the placebo group. No serious adverse events related to atropine were reported.

Conclusions and Relevance  While the clinical relevance of the results cannot be determined from this trial, these 1-year results, limited by approximately 70% follow-up, suggest that atropine, 0.01%, eyedrops can slow myopia progression and axial elongation in children and warrant future studies to determine longer-term results and potential effects on slowing sight-threatening pathologic changes later in life.

Trial Registration  http://www.chictr.org.cn Identifier: ChiCTR-IOR-17013898

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