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Review
. 2024 Mar 5;13(5):1506.
doi: 10.3390/jcm13051506.

Efficacy and Safety of Low-Dose Atropine on Myopia Prevention in Premyopic Children: Systematic Review and Meta-Analysis

Ssu-Hsien Lee  1 , Bor-Yuan Tseng  1 , Jen-Hung Wang  2 , Cheng-Jen Chiu  3   4
Affiliations
Review

Efficacy and Safety of Low-Dose Atropine on Myopia Prevention in Premyopic Children: Systematic Review and Meta-Analysis

Ssu-Hsien Lee et al. J Clin Med. .

Abstract

Background: Early-onset myopia increases the risk of irreversible high myopia. Methods: This study systematically evaluated the efficacy and safety of low-dose atropine for myopia control in children with premyopia through meta-analysis using random-effects models. Effect sizes were calculated using risk ratios (RRs) with 95% confidence intervals (CIs). Comprehensive searches of PubMed, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov were conducted until 20 December 2023, without language restrictions. Results: Four studies involving 644 children with premyopia aged 4-12 years were identified, with atropine concentrations ranging from 0.01% to 0.05%. The analysis focused on myopia incidence and atropine-related adverse events. Lower myopia incidence (RR, 0.62; 95% CI, 0.40-0.97 D/y; p = 0.03) and reduction in rapid myopia shift (≥0.5 D/1y) (RR, 0.50; 95% CI, 0.26-0.96 D/y; p < 0.01) were observed in the 12-24-month period. Spherical equivalent and axial length exhibited attenuated progression in the atropine group. No major adverse events were detected in either group, whereas the incidence of photophobia and allergic conjunctivitis did not vary in the 12-24-month period. Conclusions: Our meta-analysis supports atropine's efficacy and safety for delaying myopia incidence and controlling progression in children with premyopia. However, further investigation is warranted due to limited studies.

Keywords: atropine; efficacy; meta-analysis; myopia; myopia control; premyopia; safety; systematic review.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flow chart.
Figure 2
Figure 2
Forest plot of the risk ratio of myopia incidence between the atropine and placebo groups.
Figure 3
Figure 3
Forest plot of the risk ratio of fast myopia shift between the atropine and placebo groups.
Figure 4
Figure 4
Forest plot of the mean difference in spherical equivalent between the atropine and placebo groups.
Figure 5
Figure 5
Forest plot of the mean difference in axial length between the atropine and placebo groups.
Figure 6
Figure 6
Forest plot of the risk ratio of photophobia incidence between the atropine and placebo groups.
Figure 7
Figure 7
Forest plot of the risk ratio of allergic conjunctivitis incidence between the atropine and placebo groups.
Figure 8
Figure 8
Forest plot of the mean difference in accommodation amplitude incidence between the atropine and placebo groups.
Figure 9
Figure 9
Forest plot of the mean difference in pupil size incidence between the atropine and placebo groups.
See this image and copyright information in PMC

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