Recommendations for Tapering Long-term Use of Topical Low-dose Atropine

Pei-Chang Wu, MD, PhD Centre of Myopia Prevention & Treatment The objective of myopia management is to slow the rate of myopia progression significantly, preferably by 50 percent or more per year.1 That would achieve the goal of substantially reducing the prevalence of high myopia (-5.00D or greater) by up to 90 percent. To date, topical application of atropine is the only evidence-based drug found effective for myopia management. In comparison to 1 percent (high dose) atropine, low dose atropine is advantageous as there are reduced side effects (photophobia and near blur) while maintaining effective myopia control. Furthermore, the use of topical low-dose atropine for myopia control in children is beginning to be widely adopted after positive results from large scale trials (ATOM2 and LAMP studies) as well as some real-world studies.2-4
The objective of myopia management is to slow the rate of myopia progression significantly, preferably by 50 percent or more per year.
The phrase “low concentration atropine” is commonly used to refer to concentrations of 0.01 percent, 0.025 percent and 0.05 percent. In the ATOM2 study, there were three phases: a first, treatment phase of two years with three different concentrations of atropine (0.01 percent, 0.1 percent and 0.5 percent); a second washout phase of one year with discontinuation of atropine; and a third re-treatment phase for only the fast progressors with 0.01 percent atropine for two years. At the end of phase one, about half of those treated with 0.01 percent atropine progressed > 0.50D/year. In the LAMP study, amongst the three concentrations (0.05 percent, 0.025 percent and 0.01 percent) that were trialed, 0.05 percent atropine was the most effective in slowing myopia progression and axial length elongation. Over half the individuals treated with 0.01 percent atropine progressed by > 0.50D/year, whereas in contrast, less than one-third of individuals treated with 0.05 percent atropine progressed by > 0.50D/year. This indicates that there is an individual variability, and we proposed and reported on a stepwise increase of atropine dosing method to find the best concentration for myopia control for a given individual.5

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