Asian Journal of Research and Reports in Ophthalmology

An Overview of the Dosage, Side Effects, and Long-term Effects of Atropine Eye Drops in Management of Myopia Progression in Children

Hanan Ali Mohammad

Burjeel Hospital Llc, United Arab Emirates.

Nahla Adel Gamaleldin Sayed Shafie *

Mediclinic Hospitals - Baniyas Clinics, United Arab Emirates.

*Author to whom correspondence should be addressed.

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Abstract

Myopia, or nearsightedness, is a common refractive error affecting individuals worldwide, with its prevalence increasing significantly, particularly in children. Various strategies have been explored to manage myopia progression, among which atropine eye drops have gained attention for their potential efficacy. Atropine, a muscarinic antagonist, has been investigated for its ability to slow down myopia progression in children. However, concerns about dosage, side effects, and long-term effects remain significant considerations in utilizing atropine eye drops for myopia control in pediatric populations. The dosage of atropine eye drops in myopia control regimens varies across studies, with concentrations ranging from 0.01% to 0.5%. Lower concentrations, such as 0.01% and 0.02%, have been found effective in slowing myopia progression while minimizing adverse effects. Conversely, higher concentrations, such as 0.5%, may offer greater efficacy but are associated with an increased risk of adverse effects. Dosage frequency also varies, with daily administration being the most common regimen. However, individualized dosing strategies based on patient age, severity of myopia and response to treatment are crucial considerations for optimizing outcomes. Although atropine eye drops have shown promise in controlling myopia progression, they are associated with various ocular and systemic side effects. Common ocular side effects include photophobia, near-vision blur, and transient pupil dilation, which can affect visual acuity and quality of life. Systemic side effects, such as dry mouth, flushing, and tachycardia, may occur, particularly with higher concentrations of atropine. This literature review provides an overview of the utilization of atropine eye drops as a means to control myopia progression in children, focusing on dosage, side effects, and long-term effects. This review shall highlight the importance of individualized dosing regimens, vigilant monitoring of side effects, and longitudinal studies to optimize the use of atropine eye drops in managing myopia progression in children.

Keywords: Myopia, atropine eye drops, myopia progression, anti-muscarinic eye drops, visual acuity

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References

Subudhi P, Agarwal P. Myopia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Mar 4]. Available:http://www.ncbi.nlm.nih.gov/books/NBK580529/

Fredrick DR. Myopia. BMJ. 2002 May 18;324(7347):1195–9.

Tricard D, Marillet S, Ingrand P, Bullimore MA, Bourne RRA, Leveziel N. Progression of myopia in children and teenagers: A nationwide longitudinal study. Br J Ophthalmol. 2022 Aug 1;106(8):1104–9.

Recko M, Stahl ED. Childhood Myopia: Epidemiology, Risk factors, and prevention. Mo Med. 2015;112(2):116–21.

Theophanous C, Modjtahedi BS, Batech M, Marlin DS, Luong TQ, Fong DS. Myopia prevalence and risk factors in children. Clin Ophthalmol Auckl NZ. 2018 Aug 29;12: 1581–7.

Zhu M hong, Lin T nan, Lin J hua, Wen Q. Myopia among children and adolescents: An epidemiological study in Fuzhou City. Front Pediatr. 2023 Jun 13;11:1161329.

Larkin GL, Tahir A, Epley KD, Beauchamp CL, Tong JT, Clark RA. Atropine 0.01% eye drops for myopia control in American children: A multiethnic sample across three US sites. Ophthalmol Ther. 2019 Dec;8(4): 589–98.

Yu M, Jiang L, Chen M. Effect of atropine 0.01% on myopia control in children aged 6–13 years during the 2022 lockdown in Shanghai. Front Public Health. 2023 Jan 26;11:1074272.

Kumari S, Anand R, Tripathi S, Mishra RC, Jha SK. Efficacy of atropine for myopia control in children: A meta-analysis of randomized controlled trials. J Fam Med Prim Care. 2022 Nov;11(11):6668–77.

Galvis V, Tello A, Parra MM, Merayo-Lloves J, Larrea J, Julian Rodriguez C, et al. Topical atropine in the control of Myopia. Med Hypothesis Discov Innov Ophthalmol. 2016;5(3):78–88.

Simonaviciute D, Grzybowski A, Lanca C, Pang CP, Gelzinis A, Zemaitiene R. The effectiveness and tolerability of atropine eye drops for Myopia control in Non-Asian regions. J Clin Med. 2023 Mar 16;12(6):2314.

Chierigo A, Ferro Desideri L, Traverso CE, Vagge A. The role of atropine in preventing Myopia progression: An update. Pharmaceutics. 2022 Apr 20;14(5):900.

Polling JR, Tan E, Driessen S, Loudon SE, Wong HL, van der Schans A, et al. A 3-year follow-up study of atropine treatment for progressive myopia in Europeans. Eye Lond Engl. 2020 Nov;34(11):2020–8.

Simonaviciute D, Grzybowski A, Lanca C, Pang CP, Gelzinis A, Zemaitiene R. The effectiveness and tolerability of atropine eye drops for Myopia control in Non-Asian regions. J Clin Med. 2023 Jan;12(6):2314.

Lee SSY, Lingham G, Blaszkowska M, Sanfilippo PG, Koay A, Franchina M, et al. Low-concentration atropine eyedrops for myopia control in a multi-racial cohort of Australian children: A randomised clinical trial. Clin Experiment Ophthalmol. 2022 Dec;50(9):1001–12.

Yi S, Huang Y, Yu SZ, Chen XJ, Yi H, Zeng XL. Therapeutic effect of atropine 1% in children with low myopia. J Aapos off Publ Am Assoc Pediatr Ophthalmol Strabismus. 2015 Oct;19(5):426–9.

Wei S, Li SM, An W, Du J, Liang X, Sun Y, et al. Safety and efficacy of low-dose atropine eyedrops for the treatment of Myopia progression in Chinese children: A randomized clinical trial. JAMA Ophthalmol. 2020 Nov 1;138(11):1178–84.

Saxena R, Dhiman R, Gupta V, Kumar P, Matalia J, Roy L, et al. Atropine for the treatment of childhood Myopia in India: Multicentric randomized trial. Ophthalmology. 2021 Sep;128(9):1367–9.

Hieda O, Hiraoka T, Fujikado T, Ishiko S, Hasebe S, Torii H, et al. Efficacy and safety of 0.01% atropine for prevention of childhood myopia in a 2-year randomized placebo-controlled study. Jpn J Ophthalmol. 2021 May;65(3):315–25.

Sacchi M, Serafino M, Villani E, Tagliabue E, Luccarelli S, Bonsignore F, et al. Efficacy of atropine 0.01% for the treatment of childhood myopia in European patients. Acta Ophthalmol (Copenh). 2019 Dec;97(8):e1136–40.

Chia A, Chua WH, Cheung YB, Wong WL, Lingham A, Fong A, et al. Atropine for the treatment of childhood myopia: Safety and efficacy of 0.5%, 0.1%, and 0.01% doses (Atropine for the Treatment of Myopia 2). Ophthalmology. 2012 Feb;119(2):347–54.

Wu PC, Chuang MN, Choi J, Chen H, Wu G, Ohno-Matsui K, et al. Update in myopia and treatment strategy of atropine use in myopia control. Eye Lond Engl. 2019 Jan;33(1):3–13.

Yen MY, Liu JH, Kao SC, Shiao CH. Comparison of the effect of atropine and cyclopentolate on myopia. Ann Ophthalmol. 1989 May;21(5):180–2, 187.

Zhu Q, Tang Y, Guo L, Tighe S, Zhou Y, Zhang X, et al. Efficacy and safety of 1% atropine on retardation of moderate Myopia progression in chinese school children. Int J Med Sci. 2020 Jan 1;17(2): 176–81.

Chua WH, Balakrishnan V, Chan YH, Tong L, Ling Y, Quah BL, et al. Atropine for the treatment of childhood myopia. Ophthalmology. 2006 Dec;113(12):2285–91.

Kumari S, Anand R, Tripathi S, Mishra RC, Jha SK. Efficacy of atropine for myopia control in children: A meta-analysis of randomized controlled trials. Journal of Family Medicine and Primary Care. 2022 Nov 1;11(11):6668-77.

Bedrossian RH. The effect of atropine on myopia. Ophthalmology. 1979 May;86(5): 713–9.