Topical atropine is widely used for myopia control in children, with proven efficacy in slowing myopia progression. However, concerns remain regarding its potential effects on intraocular pressure (IOP), particularly with long-term use. This study aimed to evaluate the longitudinal effects of topical atropine on IOP in children with myopia. This retrospective, longitudinal study enrolled children using 0.125% atropine to control myopia progression and atropine non-users. IOP was measured repeatedly before and during treatment. RTVue optical coherence tomography (OCT) measured retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness. Multilevel models assessed IOP changes by adjusting age, sex, spherical equivalent, central corneal thickness, and baseline IOP. A total of 188 patients (376 eyes) in the atropine group and 188 patients (376 eyes) in the control group were included. There were 86 boys (46%) aged 8.0 ± 2.5 years. Patients in the atropine group were more myopic (−1.17 ± 1.40 versus 0.73 ± 1.83 D, P < 0.001). The central corneal thickness and baseline IOP (atropine: 17.6 ± 3.0 mmHg; control: 17.2 ± 3.6 mmHg) were similar. Over a follow-up of 18.6 months (atropine, 19.3 months; control, 18.0 months), the final IOP was higher in the atropine group (18.3 ± 3.6 versus 16.7 ± 3.2 mmHg, P < 0.001). In the multivariable multilevel models, atropine was associated with an additional 0.51-mmHg increase (95% confidence interval CI 0.36–0.67, P = 0.001) in IOP per year when adjusted for sex, age, central corneal thickness, spherical equivalent, and baseline IOP. RNFL (104.0 ± 8.8 versus 102.6 ± 7.5 µm, P = 0.475) and GCC thickness (98.1 ± 5.6 versus 96.7 ± 5.8 µm, P = 0.270) showed no significant differences between groups. Atropine use for myopia control in children was associated with a modest IOP increase without apparent impact on RNFL. Regular IOP monitoring is advisable.
Hsia et al. (Fri,) studied this question.