Stepwise Increase in Concentrations of Atropine Treatment for Myopia Control Study

SummaryBackgroundThe surge in myopia prevalence has become a pressing global health concern. Atropine eye drops have emerged as a pivotal pharmacological intervention for managing pediatric myopia. However, about 50% of children were “poor responders” to 0.01% atropine, and stepwise increase in concentrations of atropine treatment is warranted to investigation.MethodsThis prospective study enrolled 150 children aged 8 to 14 years with a spherical equivalent (SE) range of -1.00 D to -6.00 D in both eyes from April 2020 to January 2022. In phase 1 (6-month period), all children received 0.01% atropine eye drops daily in both eyes. In phase 2 (1-year period), treatment was adjusted based on myopia progression: children with less than -0.25 D progression continued with 0.01% atropine; those with progression between -0.25 D and -0.375D were shifted to 0.02% atropine; and those with progression over -0.375D were switched to 0.04% atropine. Cycloplegic refraction, axial length, pupil size, and intraocular pressure were measured at baseline, 6 months, 12 months, and 18 months.FindingsIn phase 1, mean SE 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 (P < 0.001). In the 0.02% 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 6-18 months of phase 2, no significant differences were noted in mean SE change among three groups (P = 0.273).InterpretationThis study demonstrates 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, is an effective strategy for managing pediatric myopia.