Nightly use of atropine 0.05% eyedrops significantly lowered the incidence of myopia and the percentage of participants with fast myopic shift at 2 years compared with placebo, according to the results of the LAMP2 trial. A lower concentration (0.01%) was statistically similar to placebo. “Further research is needed to replicate the findings, to understand whether this represents a delay or prevention of myopia, and to assess longer-term safety,” the investigators conclude. “Low-concentration atropine is one of the few interventions that can be initiated in high-risk children without myopia to delay the potential onset of myopia. Of note, the results in this study could not be interpreted as prevention or decreasing future risk of myopia, because the study duration was only 2 years.”
Conducted at the Chinese University of Hong Kong Eye Centre, the study included children ages 4 to 9 years with cycloplegic spherical equivalent between +1.00 D to 0.00 D and astigmatism less than −1.00 D. Randomization to 0.05% atropine, 0.01% atropine, or placebo had these effects on a primary outcome of the 2-year cumulative incidence rate of myopia (cycloplegic spherical equivalent of at least −0.50 D in either eye) and the percentage of participants with fast myopic shift (spherical equivalent myopic shift of at least 1.00 D): “Of the 474 randomized patients (mean age, 6.8 years; 50% female), 353 (74.5%) completed the trial. The 2-year cumulative incidence of myopia in the 0.05% atropine, 0.01% atropine, and placebo groups were 28.4% (33/116), 45.9% (56/122), and 53.0% (61/115), respectively, and the percentages of participants with fast myopic shift at 2 years were 25.0%, 45.1%, and 53.9%. Compared with the placebo group, the 0.05% atropine group had significantly lower 2-year cumulative myopia incidence (difference, 24.6% [95% CI, 12.0%-36.4%]) and percentage of patients with fast myopic shift (difference, 28.9% [95% CI, 16.5%-40.5%]). Compared with the 0.01% atropine group, the 0.05% atropine group had significantly lower 2-year cumulative myopia incidence (difference, 17.5% [95% CI, 5.2%-29.2%]) and percentage of patients with fast myopic shift (difference, 20.1% [95% CI, 8.0%-31.6%]). The 0.01% atropine and placebo groups were not significantly different in 2-year cumulative myopia incidence or percentage of patients with fast myopic shift. Photophobia was the most common adverse event and was reported by 12.9% of participants in the 0.05% atropine group, 18.9% in the 0.01% atropine group, and 12.2% in the placebo group in the second year.”
Editorial: “The LAMP2 study expands our knowledge of the ability of low-concentration atropine to delay the onset of myopia,” editorialists write. “These results indicate that low-concentration atropine does delay the onset of myopia, but a concentration higher than 0.01% atropine should be used. It is not yet known whether delaying the onset of myopia will reduce the final degree of myopia as an adult or whether it simply postpones the typical myopia progression to later years and thus does not decrease the long-term risk associated with higher degrees of myopia. It is also unknown whether decreasing the myopic shift in refractive error and eye growth by initiating treatment prior to myopia onset amplifies the benefit or whether a similar reduction can be achieved by initiating treatment early after onset. Answering these questions will require longer follow-up; this study plans to continue following up the participants for a total of 6 years.”