Effectiveness Study of Atropine for Progressive Myopia in Europeans

JR Polling; RGW Kok; JWL Tideman; B Meskat; CCW Klaver


Eye. 2016;30(7):998-1004. 

In This Article

Abstract and Introduction


Purpose Randomized controlled trials have shown the efficacy of atropine for progressive myopia, and this treatment has become the preferred pattern for this condition in Taiwan. This study explores the effectiveness of atropine 0.5% treatment for progressive high myopia and adherence to therapy in a non-Asian country.

Methods An effectiveness study was performed in Rotterdam, the Netherlands. Overall 77 children (mean age 10.3 years±2.3), of European (n=53), Asian (n=18), and African (n=6) descent with progressive myopia were prescribed atropine 0.5% eye drops daily. Both parents and children filled in a questionnaire regarding adverse events and adherence to therapy. A standardized eye examination including cycloplegic refraction and axial length was performed at baseline and 1, 4, and 12 months after initiation of therapy.

Results Mean spherical equivalent at baseline was −6.6D (±3.3). The majority (60/77, 78%) of children adhered to atropine treatment for 12 months; 11 of the 17 children who discontinued therapy did so within 1 month after the start of therapy. The most prominent reported adverse events were photophobia (72%), followed by reading problems (38%), and headaches (22%). The progression rate of spherical equivalent before treatment (−1.0D/year±0.7) diminished substantially during treatment (−0.1D/year±0.7) compared to those who ceased therapy (−0.5D/year±0.6; P=0.03).

Conclusions Despite the relatively high occurrence of adverse events, our study shows that atropine can be an effective and sustainable treatment for progressive high myopia in Europeans.


Worldwide, the prevalence of myopia has been rising dramatically, and it is estimated that 2.5 billion people will be affected by myopia by 2020.[1] South-East Asia is now facing a myopia frequency up to 95.5% in young academics,[2,3] but a rising trend has also been observed in recent European studies.[4] The high rise also includes the prevalence of high myopia (<−6D; axial length ≥26 mm), which in particular is associated with severe complications, such as myopic macular degeneration, retinal detachment, and glaucoma.[2] The absolute risk of severe visual impairment is 30% in individuals with axial length of 26 mm, and increases up to 95% in those with an axial length of 30 mm or more.[5,6]

These dramatic figures create the need for effective counteractions. Current treatment options for progressive myopia can be categorized in conservative and pharmacological interventions.[7] The effects of the conservative regimens, except for the orthokeratology, are relatively small.[8] Pharmacological intervention has a much higher efficacy, in particular treatment with topically applied atropine eye drops.[9]

Atropine, a non-selective muscarinic receptor antagonist (M-antagonist), is the most studied pharmacological agent for the intervention of progressive myopia.[10] In animals, topical atropine showed an inhibitory effect on lens-induced and -deprived myopia.[11] In humans, the use of atropine to reduce myopic progression was published decades ago,[12] but it was not until the ATOM study performed their large randomized clinical trial in 400 children of Asian ethnicity that atropine was acknowledged as an effective treatment for myopia progression.[10] This 2-year study found 75% reduction of myopic progression with atropine 1%, and did not report serious side effects. A systematic Cochrane review on atropine studies reported that myopia progression can be reduced by 0.80–1.0D after a year of treatment of atropine 0.5 and 1%, respectively.[7]

Atropine is the preferred practice pattern for progressive myopia in Taiwan.[13] As early as the year 2000, the Ophthalmological Society of Taiwan advised to use atropine to slow down myopia progression.[13] This treatment is prescribed to nearly 50% of Taiwanese children with progressive myopia.[13] Although topical use of atropine is known to cause photophobia and accommodation lag, these adverse events do not appear to hamper its implementation in Taiwanese children. By contrast, the lighter iris color in Europeans is generally considered as a barrier for its use in the Western world.[14] Moreover, some studies have suggested that atropine is less effective in persons of non-Asian descent.[15]

The aim of this study was to investigate the effect of atropine for progressive myopia under 'real-world' conditions in a non-Asian country. We compared rates of myopia progression in consecutive children before and after therapy, assessed common complaints, evaluated reasons for discontinuation, and developed practice guidelines.