Review: Atropine 0.05% May Be Optimal Dose to Slow Myopia

Female optometrist putting eye drop in young patient eyes in ophthalmology clinic
Researchers reviewed the findings or 10 studies into the anticholinergic blocking agent’s role in reducing disease progression.

An analysis published in BMC Ophthalmology compiled data from 10 high-quality studies to further build a consensus on the effectiveness, safety, and optimal dosage for atropine eye drops to battle the progression of myopia.

“This meta-analysis verified that the effectiveness of atropine in controlling myopia progression was closely related to the dose,” according to the researchers. “0.05% atropine might be the optimal dose which could slow the myopia progression and had the least adverse effects and rebound after discontinuation.”

Researchers at Aier Eye Hospital of Wuhan University, and the Department of Gastroenterology at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology in Wuhan, Hubei Province, China examined data from several major databases.

Criteria to narrow down eligible studies included the use of atropine for 1 year or longer, study participants were less than 18 years of age, the annual rate of myopia progression was measured for at least one year, and myopia was diagnosed as “spherical equivalent refraction more than -0.25 D measured by cycloplegic autorefraction.” Of the 542 retrieved studies, 10 fulfilled the meta-analysis standards. The 10 studies all assessed change in spherical power between patients treated with atropine and a placebo. A reduction in myopia progression was observable in the 0.05% atropine group (MD, -0.54; 95% CI, -0.69 to -0.39; P <0.05), 0.5% atropine group (MD, -0.89; 95% CI, -1.04 to -0.75; P <.05), and 1% atropine group (MD, -0.75; 95% CI, -1.20 to -0.30; P <.05), compared with the control.

Of the 10 studies, 7 considered axial change, with atropine exhibiting a limiting effect. “Less axial elongation was also shown in the (overall) atropine treatment group,” according to investigators. Additionally, 5 of the studies reported adverse effects (AE) of the treatment, with photophobia being the most common. Although other side effects included allergy, reading problems, headache, blushing, and gastrointestinal upset, no serious AE occurred at any dosage of the medication. In studies that addressed rebound, higher doses of atropine were more strongly associated with a rebound effect.

A limitation of this meta-analysis is that investigators were unable to uncover an eligible study using a 0.01% dose. Also, some of the studies lacked a complete assessment of AEs, or did not measure progression of myopia after atropine therapy ended. Researchers concluded that the data confirms atropine’s role in managing the progression of myopia. Further, they affirmed its effectiveness may be closely dose-related, with 0.05% as optimal.


Zhao C, Cai C, Ding Q, Dai H. Efficacy and safety of atropine to control myopia progression: a systematic review and meta-analysisBMC Ophthalmol. Published online December 7, 2020. doi: 10.1186/s12886-020-01746-w.