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Use of Atropine for Prevention of Childhood Myopia Progression in Clinical Practice

Shih, Kendrick Co M.R.C.S.Ed.; Chan, Tommy Chung-Yan F.R.C.S.Ed.; Ng, Alex Lap-Ki M.R.C.S.Ed.; Lai, Jimmy Shiu-Ming F.R.C.Ophth.; Li, Walton Wai-Tat M.D.; Cheng, Arthur Chak-Kwan F.R.C.S.Ed.; Fan, Dorothy Shu-Ping F.R.C.S.Ed.

Eye & Contact Lens: Science & Clinical Practice: January 2016 - Volume 42 - Issue 1 - p 16–23
doi: 10.1097/ICL.0000000000000189
Review Article

Objective: The most effective strategy to reduce myopia-related complications is to prevent myopia progression during childhood. This review article examines the latest published evidence on the use of atropine in childhood myopia control and discusses practical aspects of applying the findings to clinical practice. Future directions including possible forms of combination therapy are examined.

Methods: A literature search with a focus on randomized controlled trials (RCTs) and meta-analyses on the subject was conducted. Observational studies with control groups were also reviewed to discuss issues regarding feasibility of using atropine for myopia control in clinical practice.

Results: Five RCTs and 2 meta-analyses were found. The studies all found beneficial effects of atropine in myopia control, as well as a clear but perhaps clinically insignificant dose-response relationship between atropine and myopia progression rates. Available evidence however is focused on predominantly Chinese populations, and there is a current lack of guidance on timing of therapy initiation, duration of therapy, and treatment cessation. For future directions, combining atropine with other forms of myopia control would be worth considering.

Conclusions: Atropine is robust option for childhood myopia control. Further evidence including RCTs in different populations as well as the upcoming 5-year atropine for the treatment of myopia 2 trial results will provide much needed answers for wider acceptance of its use.

Department of Ophthalmology (K.C.S., T.C.-Y.C., A.L.-K.N., J.S.-M.L., W.W.-T.L., A.C.-K.C., D.S.-P.F.), LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Department of Ophthalmology (T.C.-Y.C.), Hong Kong Eye Hospital, Hong Kong, China; Department of Ophthalmology (W.W.-T.L., A.C.-K.C., D.S.-P.F.), Hong Kong Sanatorium and Hospital, Hong Kong, China; and Department of Ophthalmology and Visual Sciences (A.C.-K.C., D.S.-P.F.), The Chinese University of Hong Kong, Hong Kong, China.

Address correspondence to Dorothy Shu-Ping Fan, F.R.C.S.Ed., Department of Ophthalmology, Hong Kong Sanatorium and Hospital, 2 Village Road, Happy Valley, Hong Kong, China; e-mail:

The authors have no funding or conflicts of interest to disclose.

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Accepted July 20, 2015

© 2016 Contact Lens Association of Ophthalmologists, Inc.