Atropine Dosage in Australian Population

Atropine Dosage in Australian Population – April 2023 – Myopia Profile Update


Low-concentration atropine eyedrops for myopia control in a multi-racial cohort of Australian children: A randomised clinical trialAuthors: Samantha Sze-Yee Lee, Gareth Lingham, Magdalena Blaszkowska, Paul G Sanfilippo, Adrian Koay, Maria Franchina, Audrey Chia, James Loughman, Daniel Ian Flitcroft, Christopher J Hammond, Augusto Azuara-Blanco, Julie M Crewe, Antony Clark, David A Mackey


To test the hypothesis that 0.01% atropine eyedrops are a safe and effective myopia-control approach in Australian children.Methods: Children (6–16 years; 49% Europeans, 18% East Asian, 22% South Asian, and 12% other/mixed ancestry) with documented myopia progression were enrolled into this single-centre randomised, parallel, double-masked, placebo-controlled trial and randomised to receive 0.01% atropine (n = 104) or placebo (n = 49) eyedrops (2:1 ratio) instilled nightly over 24 months (mean index age = 12.2 ± 2.5 and 11.2 ± 2.8 years, respectively). Outcome measures were the changes in spherical equivalent (SE) and axial length (AL) from baseline.


At 12 months, the mean SE and AL change from baseline were −0.31D (95% confidence interval [CI] = −0.39 to −0.22) and 0.16 mm (95%CI = 0.13–0.20) in the atropine group and −0.53D (95%CI = −0.66 to −0.40) and 0.25 mm (95%CI = 0.20–0.30) in the placebo group (group difference p ≤ 0.01). At 24 months, the mean SE and AL change from baseline was −0.64D (95%CI = −0.73 to −0.56) and 0.34 mm (95%CI = 0.30–0.37) in the atropine group, and −0.78D (95%CI = −0.91 to −0.65) and 0.38 mm (95%CI = 0.33–0.43) in the placebo group. Group difference at 24 months was not statistically significant (p = 0.10). At 24 months, the atropine group had reduced accommodative amplitude and pupillary light response compared to the placebo group.


In Australian children, 0.01% atropine eyedrops were safe, well-tolerated, and had a modest myopia-control effect, although there was an apparent decrease in efficacy between 18 and 24 months, which is likely driven by a higher dropout rate in the placebo group.

What does this mean in practice?

In this mixed-race cohort of Australian children, 0.01% atropine was well-tolerated with few side-effects but showed some varied myopia control effect: The effect was greater in the 1st year, but waned before 2yrs, likely due to drop-out of faster progressors in the control group. The effect was moderate for children of European and other / mixed ancestries. However, atropine 0.01% was not effective for children of South or East Asian ancestries. This aligns with the findings of the LAMP study where 0.01% atropine was found to give minimal myopia control benefits for East Asian children in Hong Kong China. Even though the East Asian and South Asian ethnicity children in this study lived in Australia with a potentially more outdoors-style living environment, they may still benefit from increased atropine concentration to maximise myopia control effect.

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