Benefits and limitations of the low dose atropine use

Abstract Atropine is an anti‐muscarinic agent and can be used as a monotherapy or as a combination to slow the progression of myopia. It has been advocated as the first line of treatment in children with lower cost compared with other therapies, and it is a good option for children intolerant to contact lenses and when other treatment options are rejected by parents. The major limitations of topical atropine therapy include the adverse effects with higher concentrations (0.1% and higher), such as reduced amplitude of accommodation and photophobia, and the need for daily dosing. Efficacy of low‐dose atropine treatment has been confirmed by several meta‐analysis showing reduced SE progression and decreased axial elongation. The results from the Low‐Concentration Atropine for Myopia Progression (LAMP) study (3‐year RCT results) in Chinese children showed that 0.05% atropine conferred the best efficacy compared with 0.025% and 0.01%. However, it was postulated that the use of 0.05% topical atropine in Caucasian children may lead to more side effects compared to 0.01%, which can compromise parent's acceptance or children's compliance. The efficacy and safety of 8 atropine concentrations for myopia control in children was reported in a recent network meta‐analysis, in which the 0.05% was found the most beneficial for control of overall myopia progression. It is generally believed that the atropine dose should be adjusted based on the risk factors and progression.