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Qianwen Gong, Longqian Liu, Miroslaw Janowski; Efficacy vs. Side Effects of Atropine in Myopia: a Meta-analysis. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2388.
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Presentation of atropine efficacy in the context quantified side effects across many studies in a form of meta-analysis, which was previously not performed, but is instrumental to form practical guidelines on the use of atropine, including dosing, in therapy of myopia in children.
Data were obtained from PubMed, Embase, and etc from inception up to April, 2016. Randomized controlled trials (RCTs) and cohort studies of patients with myopia who received atropine were included in the analysis. The primary outcome was a difference in efficacy and the presence of side effects in different doses of atropine versus control groups. The secondary outcomes were the differences in side effects between Asians and Caucasians. Data analyses were performed using Review Manager 5.3, Stata 12.0 and SAS 9.4.
Nineteen studies involving 3,137 children were included in the analysis. RCT and cohort studies were combined together to provide a larger sample of the different doses. The weighted mean differences between the atropine groups and controls in myopia progression were 0.50, 0.57 and 0.62 D per year (P < .001 for low- [0.01%], moderate- [0.01% < dose < 0.5%] and high-dose [0.5% and 1%]), which translated to a high effect size: Cohen d=0.97, 1.76 and 1.94 (Figure 1). No difference in changes of refraction among various doses of atropine was observed (P = .15).The higher doses of atropine produced more side effects (Figure 2). The incidence of photophobia with low, moderate, and high-dose atropine was 6.3%, 17.8%, and 43.1%, respectively, giving a strong trend toward the increase the rate of side effects along the dose escalation (P = .07) and, the incidence of photophobia strongly correlated with the dose of atropine (r=0.56, P = .03). The incidence of poor near visual acuity was also more frequent in moderate and high-dose atropine group (P = .01). In addition, there was no significant difference in the incidence of side effects between Asians and Caucasians.
The efficacy of atropine is dose independent, while the side effects are dose dependent. Thus at the current stage of knowledge we recommend using the lowest dose of atropine for therapy of myopia. The search for more suitable therapeutic options for children with myopia is still warranted.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Forest graph and the overall estimates of the effect of atropine on refraction
The difference of incidence of side effects between various doses of atropine
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