How effective are atropine eye drops at reducing myopia progression in children?

Myopia is a global problem which typically shows the highest prevalence in the Far East. As the number of myopes continues to grow, worldwide, the incidence of myopia-related ocular pathology is also likely to increase. In a targeted attempt to reduce these pathologies, a range of different types of clinical interventions have been designed and administered in order to try and inhibit myopia progression in children, including the use of pharmaceutical agents such as atropine. To date, atropine has predominantly been used in studies conducted in the Far East, where it has mainly been used in an ‘off-label’ capacity.
This review paper discusses the relative strengths and weaknesses of peer-reviewed, scientific research studies investigating the efficacy of atropine, in varying concentrations, at regressing myopia progression in children. A critical appraisal of the literature is needed in order to better understand key issues with regard to the clinical administration of atropine, such as the optimum concentration to use; the optimal refractive error at which to start treatment; the longevity of the effect(s); what possible side-effects could occur; the importance of compliance with the treatment regimen, and whether atropine could be considered for use in combination with other established interventions (such as orthokeratology).
Although atropine is not yet readily available to use for the treatment of myopia progression in the UK, practising optometrists would benefit from gaining a better understanding of the efficacy of this treatment and its limitations, in the anticipation that this drug is adopted for wider clinical use, in a low concentration, in the near future.