Many eye doctors prefer low-dose (0.01%) instead of high-dose (0.5% or 1%) atropine for myopia control because of its lower risk of side effects. However, a recent abstract published as part of ARVO’s 2020 online meeting explored the one-year effectiveness of high- vs. low-dose atropine in myopic patients, and its results were actually more in favor of the high-dose (0.5%) regimen.

The study included children between the ages of six and 13 with bilateral progressive myopia and a spherical equivalent refraction of -0.5D to -6.0D, 128 of whom received 0.5% atropine treatment and 37 received the 0.01% formulation. At baseline, median refraction was -4.19D for 0.5% atropine and -3.75D for 0.01% atropine. Median axial length baseline measurements were 24.66mm and 24.59mm, respectively.

At six months, median refraction and axial length progression were +0.19D and 0.00mm, respectively, for 0.5% atropine, and -0.03D and 0.15mm for 0.01%. At one year, median refraction and axial length progression were +0.12D and 0.07mm, respectively, for the high-dose group and -0.25D and 0.19mm for the low-dose group. At six months, 7% of children who were on 0.5% atropine and 5% of children who were on 0.01% atropine stopped therapy.

While dropout rates were somewhat higher with high-dose therapy, the researchers noted that the vast majority of the group managed to adhere to therapy. They concluded that high-dose atropine should be an option in myopia control when strict control is needed to lower the risk of progression.

Polling JR, Tan E, Tideman W, Klaver K. Atropine for myopia progression: high dose vs. low dose in a real-world setting. ARVO 2020. Abstract 1134.