Myopia progression following 0.01% atropine cessation in Australian children: Findings from the Western Australia – Atropine for the Treatment of Myopia (WA‐ATOM) study

Abstract Background A rebound in myopia progression following cessation of atropine eyedrops has been reported, yet there is limited data on the effects of stopping 0.01% atropine compared to placebo control. This study tested the hypothesis that there is minimal rebound myopia progression after cessation of 0.01% atropine eyedrops, compared to a placebo. Methods Children with myopia ( n = 153) were randomised to receive 0.01% atropine eyedrops or a placebo (2:1 ratio) daily at bedtime during the 2‐year treatment phase of the study. In the third year (wash‐out phase), all participants ceased eyedrop instillation. Participants underwent an eye examination every 6 months, including measurements of spherical equivalent (SphE) after cycloplegia and axial length (AL). Changes in the SphE and AL during the wash‐out phase and throughout the 3 years of the study (treatment + wash‐out phase) were compared between the treatment and control groups. Results During the 1‐year wash‐out phase, SphE and AL progressed by −0.41D (95% CI = −0.33 to −0.22) and +0.20 mm (95% CI = −0.46 to −0.36) in the treatment group compared to −0.28D (95% CI = 0.11 to 0.16) and +0.13 mm (95% CI = 0.18 to 0.21) in the control group. Progression in the treatment group was significantly faster than in the control group ( p = 0.016 for SphE and <0.001 for AL). Over the 3‐year study period, the cumulative myopia progression was similar between the atropine and the control groups. Conclusions These findings showed evidence of rapid myopia progression following cessation of 0.01% atropine. Further investigations are warranted to ascertain the long‐term effects of atropine eyedrops.