Stepwise Increase in Concentrations of Atropine Treatment for Myopia Control Study.

PURPOSE: To explore a stepwise atropine treatment strategy for myopic control: beginning with 0.01% atropine for 6 months, followed by adjustment to higher concentrations based on treatment response.

DESIGN

Prospective study.

PARTICIPANTS

Total of 150 children aged 8 to 14 years with spherical equivalent refractive error (SER) range of -1.00 D to -6.00 D in both eyes were enrolled.

METHODS

The study was divided into 2 phases. In the initial 6-month period, children received 0.01% atropine eye drops daily in both eyes. In the subsequent 12-month switchover period, children with less than -0.25 D progression continued with 0.01% atropine; those with progression between -0.25 D and -0.375 D were shifted to 0.02% atropine; and those with progression over -0.375 D were switched to 0.04% atropine. Cycloplegic refraction, axial length (AL), pupil size, and intraocular pressure were measured at baseline, 6 months, 12 months, and 18 months.

MAIN OUTCOME MEASURES: Differences in myopia progression and axial elongation from 6 months to 18 months among 3 treatment groups.

RESULTS

In the initial 6-month period, mean SER changes for the 0.01% atropine groups, 0.02%, and 0.04% atropine switchover groups were -0.03 ± 0.18 D, -0.31 ± 0.07 D, and -0.53 ± 0.12 D, respectively, which reflect the group assignment rule. In the 0.02% atropine switchover group, myopia progression reduced from -0.31 ± 0.07 D to -0.09 ± 0.22 D (6-12 months) and -0.12 ± 0.25 D (12-18 months). The 0.04% atropine switchover group showed a reduction from -0.53 ± 0.12 D to -0.02 ± 0.18 D (6-12 months) and -0.16 ± 0.31 D (12-18 months). Between 6 months and 18 months of subsequent 12-month switchover period, the mean SER change was -0.31 ± 0.30 D, -0.21 ± 0.38 D, and -0.18 ± 0.40 D in the 0.01%, 0.02%, and 0.04% atropine groups, respectively, with a respective mean increase in AL of 0.15 ± 0.11 mm, 0.13 ± 0.11 mm, and 0.14 ± 0.10 mm.

CONCLUSIONS

This study provides preliminary evidence that a stepwise atropine treatment regimen, starting with 0.01% atropine for 6 months and then increasing to 0.02% or 0.04% based on myopia progression, appears to be a promising strategy that warrants further investigation in controlled trials.

FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.