Strategy of Suppressing Myopia Progression in Children With Atropine: A Systematic Review

Introduction: The prevalence of myopia in children has been a global issue in recent decades. Atropine is becoming more popular in suppressing myopia progression. Still, there is no clear guidance regarding the timing of commencement and cessation, as well as the duration of treatment. Objectives: To assess the timing and regimen of atropine therapy in myopia progression, response towards therapy, and rebound phenomenon. Method: A comprehensive literature search (Cochrane®, Pubmed®, and ProQuest®) was performed using relevant search terms. Inclusion criteria included randomized controlled trials and cohorts of myopic children undergoing atropine therapy. Conference abstracts, case reports, and duplicate publications were excluded. The primary outcome is identifying the optimal treatment regimen. The secondary outcome is the evaluation of the rebound effect. Results: Some studies revealed that atropine can be administered once myopia progression is diagnosed, as early as 4 years old. Yet younger age would apt to rebound. The administration suggestion is the 2-year period with 6 monthly follow-ups, with increasing concentration if myopia continues to progress. Tapering off recommendations differs by population. Higher concentrations were prone to rebound, hence lower concentrations (0.01%) maintain better clinical efficacy with minimal side effects. However, another study revealed that a higher myopia baseline requires a slightly higher dose (0.05%) for its axial elongation suppression, with tolerable pupil size and accommodation. Although atropine showed more progression after cessation compared to placebo (-1.14±0.80D vs. -0.38±0.39D), absolute progression significantly lowered after 3 years (-4.29±1.67D vs. -5.22±1.38D). Conclusion: Atropine is widely used and appears to be effective in controlling myopia in children with appropriate doses and proper duration of treatment to minimize rebound.