Background: Myopia prevalence among school-aged children has reached epidemic levels globally, with projections estimating that nearly 5 billion people will be affected by 2050. Low-dose atropine (0.01%–0.05%) has emerged as a promising pharmacological intervention for slowing myopia progression. This systematic review and meta-analysis evaluates the current evidence regarding the efficacy, safety, and optimal dosing of low-dose atropine for myopia control in pediatric populations. Methods: A comprehensive literature search was conducted across PubMed, Cochrane Library, Embase, and Web of Science for randomized controlled trials (RCTs) published between January 2010 and December 2024. Primary outcomes included change in spherical equivalent refraction (SER) and axial length (AL). Meta-analysis was performed using a random-effects model. Heterogeneity was assessed using the I² statistic. Results: Twenty-three RCTs comprising 4,856 participants (mean age 9.2 ± 2.1 years) were included. Low-dose atropine demonstrated statistically significant reductions in myopia progression compared to placebo: pooled mean difference in SER change was +0.52 D/year (95% CI: 0.41–0.63, p < 0.001) and axial elongation was reduced by 0.24 mm/year (95% CI: 0.18–0.30, p < 0.001). The 0.025% concentration showed the most favorable balance between efficacy and side effects. Photophobia was reported in 8.3% of participants, with near-vision difficulties in 5.1%. Conclusions: Low-dose atropine is an effective and well-tolerated treatment for slowing myopia progression in children. The 0.025% concentration appears to offer an optimal efficacy-to-safety profile. Long-term follow-up studies are recommended to assess sustained efficacy and rebound effects after treatment cessation.
Sharma et al. (Tue,) studied this question.