This article was originally published in a sponsored newsletter.

I recently co-authored a short paper stating that when it comes to myopia, “an ounce of prevention is worth a pound of cure.”¹ Earlier onset of myopia is associated with an increased likelihood of higher levels of myopia and, thus, a heightened risk of visual impairment. A patient’s final level of myopia may be lowered by myopia control after onset, but delaying onset by one year has potential to lower the final level myopia by 0.75D or more. That’s equivalent to two to three years of myopia control with existing modalities.

Thus, the publication of a clinical trial showing that low-concentration atropine delays myopia onset is exciting, especially when it’s in the Journal of the American Medical Association.² The authors report a two-year randomized, placebo-controlled, double-masked trial conducted in Hong Kong. They enrolled 474 children, 4 to 9 years old with cycloplegic spherical equivalent between plano and +1D. Participants were randomized to receive 0.05% atropine, 0.01% atropine, or placebo, with the eyedrops applied once nightly in both eyes. Recruitment took three years.

Of those randomized, 353 (74%) completed the trial. In the placebo group, the two-year cumulative incidence of myopia of –0.50D or worse was 53%. That number is alarmingly high. Remarkably, in the 0.05% atropine group, the incidence was almost halved to 28%. Photophobia was the most common adverse event, but it was reported by 13% of participants in the 0.05% atropine group and 12% in the placebo group.

A close look at the data reveals that the one-year incidence of myopia in the placebo group was 30%, similar to the two-year incidence of myopia in the 0.05% atropine group. In other words, a well-tolerated drug with an established safety profile delayed myopia onset by a year.

1. Bullimore MA, Brennan NA. Myopia: An ounce of prevention is worth a pound of cure. Ophthalmic Physiol Opt. 2023 Jan;43:116-121.

2. Yam JC, Zhang XJ, Zhang J, et al. Effect of Low-Concentration Atropine Eyedrops vs Placebo on Myopia Incidence in Children: The LAMP2 Randomized Clinical Trial. JAMA. 2023;329:472-481. Availalble at jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2022.24162. Accessed on Feb. 14, 2023.