Low-Dose Atropine Eye Drops No Better than Placebo for Myopia

Use of low-dose atropine eyedrops (concentration 0.01%) was no better than placebo at slowing myopia (nearsightedness) progression and elongation of the eye among children treated for two years, according to a randomized controlled trial conducted by the Pediatric Eye Disease Investigator Group. 

The NEI-funded trial aimed to identify an effective way to manage this leading and increasingly common cause of refractive error, which can cause serious uncorrectable vision loss later in life. Results from the trial were published in JAMA Ophthalmology.

Importantly, the findings contradict results from recent trials, primarily in East Asia, that showed a benefit from 0.01% atropine in slowing myopia.

“The overall mixed results on low-dose atropine show us we need more research,” said Dr. Michael Chiang, NEI director. “Would a different dose be more effective in a U.S. population? Would combining atropine with other strategies have a synergistic effect? Could we develop other approaches to treatment or prevention based on a better understanding of what causes myopia progression?”

Identifying an optimal approach for preventing high (advanced) myopia is urgently needed given the escalating prevalence of myopia overall and the risk of it progressing to high myopia. By 2030, it’s predicted that 39 million people in the U.S. will have myopia. By 2050, that number is expected to grow to 44 million in the U.S. and to 50% of the global population.  

Much stronger concentrations of atropine eyedrops (0.5-1.0%) have long been used by pediatric eye doctors to slow myopia progression. While effective, such doses cause light sensitivity and blurry near vision while on the nightly eyedrops. 

For the study, 187 children ages 5 to 12 years with low-to-moderate bilateral myopia were randomly assigned to use nightly atropine (0.01%) (125 children) or placebo (62 children) eyedrops for two years. After the treatment period, and 6 months after treatment stopped, there were no significant differences between the groups in degree of myopia compared with baseline. 

“Vision scientists may help us figure out what’s different about the myopic eye, even among different races and ethnicities, to help create new treatment strategies,” said study author Dr. Katherine Weise of the University of Alabama at Birmingham. “It will take a real convergence of eye research to solve the environmental, genetic and structural mystery of myopia.”