Atropine was first introduced as a means of myopia control in the 1920s although large scale research studies are much more recent. It was believed that the eye-drops works by paralysing the accommodation of the eye, but more recent evidence suggest that myopia progression is slowed down via the effect of the anti-muscarinic biochemical on the sclera or retina.
A series of double-masked clinical trials has investigated atropine eye-drops in various concentrations for myopia control in Singaporean children. This is entitled “Atropine in the Treatment of Myopia (ATOM)” and results were published internationally on Ophthalmology in 2006 (ATOM1) and 2012 (ATOM2).
Results from ATOM1 showed that the instillation of atropine 1% eye-drop slowed down the progression of myopia by 77% compared to its placebo. However, atropine eye-drop users suffered from a significant rebound effect upon treatment cessation: Myopia progressed thereafter at a much higher rate, although the treated eyes were still considerably less myopic than the control group (average -4.29D vs. -5.22D) after three years.
Results from ATOM2 demonstrated the dose-response relationship of myopia control and its corresponding side-effects when atropine eye-drops are used in different levels of concentration.
Treatment Myopia Progression (Over 2 years)
1.0% Atropine -0.29D
0.5% Atropine -0.30D
0.1% Atropine -0.38D
0.01% Atropine -0.49D
Measures of visual function, such as accommodative amplitudes, visual acuities and pupil sizes, were considerably less affected in lower concentration. During the study, 70% of children on atropine 0.5% had requested for spectacles with a reading prescription in comparison to only 61% who were on atropine 0.1%. Only 6% of children on atropine 0.01% opted to do so.
Atropine eye-drops are widely used in Singapore in myopia control in children.
However, it is important to note that there is still no direct evidence showing that 0.01% atropine would slow down eye elongation in myopia. In fact, this topic is extensively discussed recently in the link below:
“Despite evidence that 0.01% atropine does not slow eye elongation, it is being rapidly adopted in clinical practice and widely used – which is both unfortunate and concerning. The efficacy of 0.05% atropine appears to be equivalent to that of orthokeratology lens wear.”