Atropine eye drops may be the key to treating the rapid progression of myopia in children. The results of this 5-year clinical trial showed that low concentrations of atropine drops significantly slowed the progression of myopia in children and had fewer side effects than higher concentrations. The findings suggest that atropine may be an effective treatment in the face of rapidly increasing global myopia. The number of people with myopia has skyrocketed worldwide over the past few decades, and myopia remains the leading cause of visual impairment. In the United States, the proportion of myopia patients in the total population has increased from 25% in the 1970s to 42% today. In developed Asian countries, 80 to 90 percent of young people suffer from myopia. Although vision can be corrected with the help of glasses or corneal contact lenses, severe myopia can cause many complications, such as increasing the risk of retinal detachment, macular degeneration, immature cataracts, and glaucoma. To address this public health problem, researchers in Singapore have studied the drug atropine and myopia, a drug commonly used to treat amblyopia. The study, which began in 2006, randomized 400 myopic children aged 6 to 12 years into three groups and administered different daily doses of atropine. The three groups were given 0.5%, 0.1%, and 0.01% of atropine drops per night for 2 years, followed by 12 months of discontinuation. For children with increased myopia (-0.5 D or more) at the end of drug treatment, treatment with 0.01% atropine was continued again for 2 years. The researchers finally found that: (1) After 5 years of drug treatment, treatment with 0.01% atropine had the fewest remaining children with myopia compared to the other relatively high atropine treatment groups. (2) The progression of myopia was delayed by 0.01% atropine in approximately 50% of children treated with atropine compared to children not treated with medication in the previous study. (3) Although additional study results are still needed to confirm this, 0.01% atropine appears to be sufficient for safe use for 5 years in children aged 6 to 12 years. Low concentrations of atropine minimize the pupillary dilation effect (less than 1 mm) and reduce the sensitivity to light when using high concentrations of atropine. In addition, low concentrations of atropine minimize the loss of near vision. Atropine can inhibit myopia-induced eye axis growth. However, the mechanism of action of the drug is not clear. The use of high concentrations of atropine can also cause some side effects. For example, the concentration of the drug used to treat amblyopia can dilate the pupil. This can lead to photophobia and blurred vision when looking at close objects. Children treated with high concentrations of atropine often need to wear bifocals and sunglasses as a result. In addition, high concentrations of atropine can cause allergic conjunctivitis and dermatitis. These shortcomings are why atropine is not currently used frequently in the United States to treat myopia. This situation has now been resolved. Lower concentrations of atropine appear to have a similar effect of slowing myopia progression without causing side effects. This latest 5-year follow-up study suggests that the long-term benefits of low concentrations of atropine outweigh the risks, according to the researchers. However, the researchers also emphasized that because about 9 percent of children in the low-concentration atropine treatment group did not improve their myopia during the first 2-year treatment period, they need additional findings to determine which children are better candidates for treatment, when it is safer to start treatment, and how long a course of drug therapy is needed. Additional studies to be conducted in Europe and Japan on atropine to slow myopia progression will help address these questions. Dr. Donald T. Tan, FRCS, FRCOphth, is a principal investigator and professor at the Singapore Eye Institute and the Singapore National Eye Centre. He said, “We have always known that atropine drops can stop the progression of myopia to some extent. Now we have data to show that atropine is not only effective but also safe. Combined with the results of other studies, atropine therapy will be a beneficial weapon in the treatment of myopia-induced visual impairment in children worldwide.”