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. 2024 Jun 18;17(6):1128-1137.
doi: 10.18240/ijo.2024.06.19. eCollection 2024.

The optimal atropine concentration for myopia control in Chinese children: a systematic review and network Meta-analysis

Xiao-Yan Wang  1 , Hong-Wei Deng  2 , Jian Yang  3 , Xue-Mei Zhu  3 , Feng-Ling Xiang  1 , Jing Tu  1 , Ming-Xue Huang  1 , Yun Wang  2 , Jin-Hua Gan  4 , Wei-Hua Yang  2
Affiliations

The optimal atropine concentration for myopia control in Chinese children: a systematic review and network Meta-analysis

Xiao-Yan Wang et al. Int J Ophthalmol. .

Abstract

Aim: To figure out whether various atropine dosages may slow the progression of myopia in Chinese kids and teenagers and to determine the optimal atropine concentration for effectively slowing the progression of myopia.

Methods: A systematic search was conducted across the Cochrane Library, PubMed, Web of Science, EMBASE, CNKI, CBM, VIP, and Wanfang database, encompassing literature on slowing progression of myopia with varying atropine concentrations from database inception to January 17, 2024. Data extraction and quality assessment were performed, and a network Meta-analysis was executed using Stata version 14.0 Software. Results were visually represented through graphs.

Results: Fourteen papers comprising 2475 cases were included; five different concentrations of atropine solution were used. The network Meta-analysis, along with the surface under the cumulative ranking curve (SUCRA), showed that 1% atropine (100%)>0.05% atropine (74.9%) >0.025% atropine (51.6%)>0.02% atropine (47.9%)>0.01% atropine (25.6%)>control in refraction change and 1% atropine (98.7%)>0.05% atropine (70.4%)>0.02% atropine (61.4%)>0.025% atropine (42%)>0.01% atropine (27.4%)>control in axial length (AL) change.

Conclusion: In Chinese children and teenagers, the five various concentrations of atropine can reduce the progression of myopia. Although the network Meta-analysis showed that 1% atropine is the best one for controlling refraction and AL change, there is a high incidence of adverse effects with the use of 1% atropine. Therefore, we suggest that 0.05% atropine is optimal for Chinese children to slow myopia progression.

Keywords: China; atropine; children and adolescents; myopia; network Meta-analysis.

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Conflict of interest statement

Conflicts of Interest: Wang XY, None; Deng HW, None; Yang J, None; Zhu XM, None; Xiang FL, None; Tu J, None; Huang MX, None; Wang Y, None; Gan JH, None; Yang WH, None.

Figures

Figure 1
Figure 1. A overview of the research selection process using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.
Figure 2
Figure 2. Overall risk of bias diagram.
Figure 3
Figure 3. Risk of bias diagram in each included studies.
Figure 4
Figure 4. Network plot about refraction change.
Figure 5
Figure 5. Network plot about axial length change.
Figure 6
Figure 6. The consistent model for refraction change
A: Control; B: Atropine 0.01%; C: Atropine 0.05%; D: Atropine 0.025%; E: Atropine 0.02%. CI: Confidence interval; IF: Inconsistency factor.
Figure 7
Figure 7. Consistent model for axis length change
A: Control; B: Atropine 0.01%; C: Atropine 0.05%; D: Atropine 0.025%; E: Atropine 0.02%. CI: Confidence interval; IF: Inconsistency factor.
Figure 8
Figure 8. Forest plots contrasting various atropine doses for myopia therapies (change in refraction)
CI: Confidence interval; Con: Control.
Figure 9
Figure 9. Forest plots contrasting various atropine doses for myopia therapies (change in AL)
CI: Confidence interval; Con: Control; AL: Axial length.
Figure 10
Figure 10. Cumulative probability ranking results for refraction change.
Figure 11
Figure 11. Cumulative probability ranking results for axial length change.
Figure 12
Figure 12. Inverted funnel plot of refraction change
A: Control; B: Atropine 0.01%; C: Atropine 0.05%; D: Atropine 0.025%; E: Atropine 0.02%; F: Atropine 1%.
Figure 13
Figure 13. Inverted funnel plot of AL
A: Control; B: Atropine 0.01%; C: Atropine 0.05%; D: Atropine 0.025%; E: Atropine 0.02%; F: Atropine 1%. AL: Axial length.
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