Effects of atropine eyedrops at ten different concentrations for myopia control in children: A systematic review on meta-analysis

Purpose To estimate the effect of atropine eyedrops at different concentrations for myopia control in children. Methods We conducted a Bayesian random-effects network meta-analysis based on randomized controlled trials (RCT). Primary outcomes include changes in spherical equivalent error (SER) and changes in axial length (AL), mean difference (MD) together with 95% credible interval (CrI) were used to evaluate the efficacy. Results 28 RCTs (6608 children) were included in this review. Comparing ten atropine eyedrops (0.0025%, 0.005%, 0.01%, 0.02%, 0.025%, 0.05%, 0.1%, 0.25%, 0.5% and 1% concentrations) with the placebo, the MDs and 95%CrIs of changes in SER are −0.006 (−0.269, 0.256) D, 0.216 (−0.078, 0.508) D, 0.146 (0.094, 0.199) D, 0.167 (0.039, 0.297) D, 0.201 (0.064, 0.341) D, 0.344 (0.251, 0.440) D, 0.255 (0.114, 0.396) D, 0.296 (0.140, 0.452) D, 0.331 (0.215, 0.447) D, and 0.286 (0.195, 0.337) D, respectively. The MDs and 95%CrIs of changes in AL are −0.048 (−0.182, 0.085) mm, −0.078 (−0.222, 0.066) mm, −0.095 (−0.130, −0.060) mm, −0.096 (−0.183, −0.009) mm, −0.083 (−0.164, −0.004) mm, −0.114 (−0.176, −0.056) mm, −0.134 (−0.198, −0.032) mm, −0.174 (−0.315, −0.061) mm, −0.184 (−0.291, −0.073) mm, and −0.171 (−0.203, −0.097) mm, respectively.Whether evaluated by SER or AL, 1% concentration ranks first in efficacy, but the risk of photophobia is 17 times higher than 0.01% concentration. Conclusions 0.01% or higher concentration atropine eyedrops are effective for myopia control, while 0.0025% and 0.005% concentrations may not. As the concentration increases, the effect tends to increase, 1% concentration may have the strongest effect.