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To examine the published evidence on the effectiveness of topical atropine for the prevention childhood myopia progression and the myopic rebound occurring after cessation of atropine.
A meta analysis, with a focus on randomized controlled trials (RCTs), was conducted by using the following electronic databases: PubMed, EMBASE, and Cohrane Library.The search strategy were ‘myopia’ OR ‘refractive error’ OR ‘nearsighted’ AND ‘atropine’ OR ‘anti-muscarinic’ AND ‘child’ OR ‘children’ OR ‘kids’ OR ‘adolescent’. The last search was run on April 9, 2019 and Jadad scoring system was used to evaluate the quality of each RCT.
Eleven RCTs with 3 162 children aged 5-15 years and spherical equivalent ranging -0.50 to -6.75 D were included.Most of the studies found a beneficial effect in myopic control when treated with atropine compared with various control groups.The mean difference (MD) between the treatment and control groups in myopic progression were 0.95 D/year (95% confidence interval [CI]: 0.69-1.22), 0.93 D/year (95% CI: 0.50-1.36), 0.82 D/year (95% CI: 0.68-0.96), 0.46 D/year (95% CI: -0.02-0.94) for 1.0%, 0.5%, 0.1% and 0.01% topical atropine, respectively (P<0.001). After 12 months of atropine cessation, the analysis indicated that the MD between the different dosage of atropine, used during the treatment period, and the control group was -0.36 D/year (95% CI: -0.70—-0.02, P=0.04, I2: 98%).
Atropine is a potent option in myopic control.Even though, a myopic rebound was reported after treatment cessation, atropine-treated eyes have a slower myopia progression compare to controls.Low dosages of atropine (especially 0.01%) seem to have minimal rebound effect and few side effects.