Myopia is surging globally, especially in East Asia, prompting urgent research into effective control strategies. A recent randomized clinical trial published in JAMA Ophthalmology offers compelling insights into three leading interventions: low-dose atropine (0.01% and 0.04%) and orthokeratology (ortho-K).
🎯 Study Overview
Conducted across two major centers in Shanghai, this 2-year trial enrolled 209 children aged 8–15 years with moderate myopia (−1.0 D to −4.0 D). Participants were randomized into three groups:
- 0.01% Atropine: Daily eye drops
- 0.04% Atropine: Daily eye drops
- Ortho-K: Overnight corneal reshaping lenses
The primary outcome was axial length (AL) growth over 96 weeks—a key marker of myopia progression.
📊 Key Findings
- 0.04% atropine was most effective, reducing AL growth by 0.30 mm, compared to 0.49 mm with 0.01% atropine and 0.41 mm with ortho-K.
- The difference between 0.04% and 0.01% atropine was statistically significant (P < .001), as was the difference between 0.04% atropine and ortho-K (P < .001).
- Age mattered: Older children showed slower progression across all groups.
- Baseline myopia influenced outcomes: More myopic children responded better to ortho-K and 0.01% atropine, while 0.04% atropine was most effective in mild cases.
⚠️ Safety and Tolerability
- Photophobia was more common with 0.04% atropine (22.9%) than with 0.01% (2.1%).
- Blurred near vision occurred in 10.4% of the 0.04% group but was absent in the 0.01% group.
- Ortho-K users experienced mild corneal staining (26.4%) but no serious adverse events.
🧠 Clinical Implications
This trial supports 0.04% atropine as a superior option for older children and adolescents with mild to moderate myopia. Ortho-K remains a viable alternative, especially for younger children or those with higher baseline myopia. Importantly, all treatments were well tolerated, with manageable side effects.
📌 Final Thoughts
As myopia rates climb, especially in urban Asia, personalized treatment strategies are essential. This study provides a robust foundation for clinicians to tailor interventions based on age, baseline refractive error, and tolerance profiles.
“These findings support 0.04% atropine as a preferred option for older children and adolescents,” the authors conclude.
🔍 Key Findings
- 0.04% atropine showed greater efficacy in slowing axial elongation compared to both 0.01% atropine and Ortho-K.
- 0.01% atropine was significantly less effective, aligning with prior studies (e.g., LAMP and PEDIG) that questioned its standalone clinical utility.
- Photophobia was more common in the 0.04% atropine group but rarely led to treatment discontinuation.
⚖️ Methodological Considerations
- The study’s design is clinically relevant, comparing pharmacologic and optical interventions.
- Limitations include:
- Small sample size (209 participants across 3 arms)
- Lack of behavioral data (e.g., outdoor time, near work)
- Potential confounding from COVID-19 lockdowns during the study period
- Questionable conclusions about age-specific efficacy due to small subgroup sizes and limited statistical power
📚 Broader Context
- Meta-analyses and real-world data support the superior efficacy of higher atropine concentrations (0.05%–1%) over 0.01%.
- The study reinforces the growing consensus that low-dose atropine (0.01%) is insufficient for effective myopia control.
Citation:
JAMA Ophthalmology. 2025;143(9):731-738. doi:10.1001/jamaophthalmol.2025.2321
