For decades doctors have used low concentration atropine eye drops to slow down progression of myopia (or near-sightedness) in children, but what if you could use those drops to prevent myopia from ever developing? A new study published in JAMA shows promising results!

The LAMP 2 study is an ongoing randomized, placebo-controlled, double-masked trial researching the effects of atropine on incidence and progression of myopia. In this new arm of the trial, 474 children between the ages of 4 and 9 who had no myopia at the time of the study were split into three different randomized treatment groups: placebo eye drops nightly (n=155), 0.01% atropine drops nightly (n=159), or 0.05% atropine drops nightly (n=160). At the time of enrollment, the children had a prescription between +1.00D and 0.00D and less than -1.00D of astigmatism. These children were followed over a 2 year time period with routine eye examinations to monitor any change to their prescription. 

At the end of 2 years, there was a statistically significant reduction in the incidence of myopia amongst children using low dose 0.05% atropine every night versus those using the placebo eye drop. 53% of the children using the placebo drop developed myopia; 45.9% of those using 0.01% atropine developed myopia, and only 28.4% of those using 0.05% atropine developed myopia at the end of 2 years. The incidence of myopia between 0.01% atropine users and the placebo group was not statistically significant. Axial length elongation also showed significantly lower progression in the 0.05% atropine group; 0.24 mm/year on average with 0.05% atropine versus 0.32 mm/year with 0.01% atropine and 0.35 mm/year with placebo. 

The side effects of low dose atropine were reported as very mild; in this study photophobia (or light sensitivity) was the most common reported side effect, with 12.9% of children using 0.05% atropine reporting this issue. Interestingly, 18.9% of participants using lower concentration 0.01% atropine and 12.2% of patient using placebo eye drops (which had no pupillary dilation side effect) also reported photophobia. 

The Take Home

Study authors concluded that "among children aged 4 to 9 years without myopia, nightly use of 0.05% atropine eyedrops compared with placebo resulted in a significantly lower incidence of myopia at 2 years." 

More research will continue to be reported from the ongoing LAMP 2 trial, and it will be interesting to see if this preventative effect with 0.05% atropine continues year after year. Based on this strong data, for parents who are concerned about their children being at high risk of developing myopia the use of 0.05% atropine as a preventative treatment before myopia develops is absolutely worth considering. The only FDA approved treatment options of myopia control, including MiSight soft multifocal contact lenses and orthokeratology lenses, require the child to already be myopic before starting treatment, so the incorporation of atropine as an option to use before myopia even begins is a novel new advancement for doctors in our goal to keep children's vision as clear as possible and reduce both dependence on glasses and contact lenses and the potential health risks associated with high levels of myopia.