Retardation of myopic progression and axial length growth by atropine in children

Abstract

Aim: To determine the effect of atropine on axial length elongation by prospectively examining axial lengths and measures of refraction in atropine-treated and untreated eyes of myopic children.

Patients and methods: 492 children with myopia participated in this randomized prospective clinical trial. Initial examination for both the treated and control groups included cycloplegic refraction (initial refraction between -0.50 and -3.50 D), tonometry, keratometry, and axial length measurement by A-scan ultrasonography. Atropine-treated eyes received 1 drop of atropine sulfate 1% daily in both eyes at night. Measurements were repeated every 6 months for 2 years.

Results: The control eyes showed steady myopic progression, with mean refractive error changes of -0.25 D after 6 months, -0.56 D after 1 year, and -0.93 D after 2 years. The atropine-treated eyes demonstrated statistically significant mean refractive error changes of +0.30 D after 6 months, +0.09 D after 1 year, and -0.50 D after 2 years. The control eyes demonstrated steadily increasing axial lengths (+0.13 mm in 6 months, +0.35 mm in 1 year, and +0.45 mm in 2 years). The atropine-treated eyes showed virtually no axial length elongation after 6 months, significantly reduced axial length elongation (0.18 mm vs 0.35 mm) after 1 year, and no significant difference compared with control eyes after 2 years.

Conclusions: Daily atropine for children with myopia retards myopic progression and axial length elongation. A non-selective antimuscarinic blocker, atropine seems to retard myopic progression by a combination of deep cycloplegia and reduction of fibroblast proliferation in the sclera.