High Dose Atropine Curbs Myopia in Kids Despite Side Effects

TOPLINE:

According to a secondary analysis of the 24- Month Myopia Outcome Study of Atropine in Children (MOSAIC) trial, 0.05% atropine eye drops were more effective in controlling myopia progression and axial elongation than placebo eye drops in children despite causing blurred vision and photophobia in some participants.

METHODOLOGY:

• Researchers conducted a secondary analysis of the 3-year results of the MOSAIC trial to investigate the efficacy and safety of different atropine regimens in treatment-naive children aged 6-16 years with a spherical equivalent ≤ −0.50 diopters (D).
• They analyzed data of 199 children in Europe with myopia (mean age, 13.9 years; 60.8% girls) who were randomly assigned to either group 1 (nightly placebo for 2 years followed by 0.05% atropine eye drops for 1 year; n = 66) or group 2 (nightly 0.01% atropine eye drops for 2 years followed by another random assignment to nightly placebo, tapering placebo, or tapering of 0.01% atropine eye drops for 1 year; n = 133).
• The nightly and tapered placebo groups were combined as a single treatment group for the sake of analysis.
• The primary outcome measures included observed changes in the progression of myopia, assessed using cycloplegic spherical equivalent refraction and axial length from month 24 to month 36.

TAKEAWAY:

• Children in the 0.01% atropine then placebo groups showed greater spherical equivalent progression (adjusted difference, −0.13 D; P = .01) and axial elongation (adjusted difference, 0.06 mm; P = .008) than those in the placebo then 0.05% atropine group.
• Children in the placebo then 0.05% atropine group also experienced less axial elongation (P = .04) than those in the 0.01% atropine then tapering 0.01% atropine group.
• Among participants using 0.05% atropine, 15% reported blurred near vision and 8% reported photophobia, whereas 3% reported blurred near vision and 0% reported photophobia in the 0.01% atropine then tapering 0.01% atropine group.
• Despite experiencing adverse events, no participants in the placebo then 0.05% atropine group discontinued treatment, with 92% completing the 36-month visit and 81% adhering to the treatment regimen.

IN PRACTICE:

“Recognizing a 2-year delay in treatment initiation in the group of children originally assigned to placebo, 0.05% atropine eyedrops slowed both myopia progression and axial eye growth over the course of a 1-year period,” the authors of the study wrote.

SOURCE:

This study was led by James Loughman, PhD, of the Centre for Eye Research Ireland in Dublin, Ireland. It was published online on January 9, 2025, in JAMA Ophthalmology.

LIMITATIONS:

Limitations included smaller sample sizes across treatment groups in year 3 and potential carry-over effects for participants transitioning from 0.01% atropine to placebo or tapered dosing. Because the study lacked an untreated control group, rebound myopia progression could be measured based only on the expected 3rd-year results from the 0.01% atropine then placebo groups. The age of participants during the 3rd year may have affected the ability to detect rebound progression.

DISCLOSURES:

This study was supported partly by a grant from the Health Research Board; Fighting Blindness, Ireland; and Vyluma. Some authors reported receiving grants, nonfinancial support, or consultant fees or having several other ties with Vyluma and other sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.