Japanese Journal of Ophthalmology

, Volume 51, Issue 1, pp 27–33 | Cite as

Topical Atropine in Retarding Myopic Progression and Axial Length Growth in Children with Moderate to Severe Myopia: A Pilot Study

  • Dorothy S. P. FanEmail author
  • Dennis S. C. Lam
  • Carmen K. M. Chan
  • Alex H. Fan
  • Eva Y. Y. Cheung
  • Srinivas K. Rao



To study the safety and efficacy of topical 1% atropine eye ointment in retarding myopic progression in children with moderate to severe myopia.


This was an interventional control study. Children (aged 5–10 years) with myopia of −3.00 diopters (D) or more were treated with 1% atropine ointment once daily for 1 year. Baseline and regular assessments of refractive errors by cycloplegic autorefraction and of axial length were done by ultrasound biometry, and the results were compared with data of control subjects.


Twenty-three children (mean age: 7.4 ± 1.6 years) with moderate to severe myopia, being treated in the Hong Kong Eye Hospital of the Chinese University of Hong Kong, were recruited into the atropine group, and 23 children from the same eye clinic were matched with the study subjects with respect to age, sex, and initial spherical equivalent refraction, as controls. The initial refractive errors were −5.18 ± 2.05 D and −5.12 ± 2.33 D in the atropine and the control groups, respectively (P = 0.934). Myopic progression was significantly less (P = 0.005) in the atropine group (+0.06 ± 0.79 D) than in the control group (−1.19 ± 2.48 D). Axial length increase was also significantly smaller in the atropine group (0.09 ± 0.19 mm) than in the control group (0.70 ± 0.63 mm) (P = 0.004). One child (4.3%) developed an allergic reaction. No other major adverse effects related to the treatment were noted.


Topical 1% atropine ointment is a safe and effective treatment for retarding myopic progression in moderate to severe myopia. Further large-scale randomised controlled study with longer follow-up seems warranted. Jpn J Ophthalmol 2007;51:27–33 © Japanese Ophthalmological Society 2007

Key words

atropine myopia myopic progression 


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  1. 1.
    Sperduto, RD, Seigel, D, Roberts, J, Rowland, M 1983Prevalence of myopia in the United StatesArch Ophthalmol101405407PubMedGoogle Scholar
  2. 2.
    Saw, SM, Katz, J, Schein, OD, Chew, SJ, Chan, TK 1996Epidemiology of myopiaEpidemiol Rev18175187PubMedGoogle Scholar
  3. 3.
    Wu, HM, Seet, B, Yap, EP, Saw, SM, Lim, TH, Chia, KS 2001Does education explain ethnic differences in myopia prevalence? A population-based study of young adult males in SingaporeOptom Vis Sci78234239PubMedCrossRefGoogle Scholar
  4. 4.
    Fan, DS, Lam, DS, Lam, RF,  et al. 2004Prevalence, incidence, and progression of myopia of school children in Hong KongInvest Ophthalmol Vis Sci4510711075PubMedCrossRefGoogle Scholar
  5. 5.
    Grossniklaus, HE, Green, WR 1992Pathological Findings in Pathologic MyopiaRetina12127133PubMedCrossRefGoogle Scholar
  6. 6.
    Celorio, JM, Pruett, RC 1991Prevalence of lattice degeneration and its relation to axial length in severe myopiaAm J Ophthalmol1112023PubMedGoogle Scholar
  7. 7.
    Pierro, L, Camesasca, FI, Mischi, M, Brancato, R 1992Peripheral retinal changes and axial myopiaRetina121217PubMedCrossRefGoogle Scholar
  8. 8.
    Kirker, GE, McDonald, DJ 1971Peripheral retinal degeneration in high myopiaCan J Ophthalmol65861PubMedGoogle Scholar
  9. 9.
    Goss, DA 1986Effect of bifocal lenses on the rate of myopia progressionAm J Optom Physiol Opt63135141PubMedGoogle Scholar
  10. 10.
    Grosvenor, T, Perrigin, DM, Perrigin, J, Maslovitz, B 1987Houston myopia control study: a randomised clinical trial. Part II. Final report by the patient care teamAm J Optom Physiol Opt64482498PubMedGoogle Scholar
  11. 11.
    Goss, DA, Grosvenor, T 1990Rates of childhood myopia progression with bifocals as a function of nearpoint phoria: consistency of three studiesOptom Vis Sci67637640PubMedCrossRefGoogle Scholar
  12. 12.
    Leung, JT, Brown, B 1999Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lensesOptom Vis Sci76346354PubMedCrossRefGoogle Scholar
  13. 13.
    Edwards, MH, Li, RW, Lam, CS, Lew, JK, Yu, BS 2002The Hong Kong progressive lens myopia control study: study design and main findingsInvest Ophthalmol Vis Sci4328522858PubMedGoogle Scholar
  14. 14.
    Chew, SJ, Saw, SM, Rajan, U 1998Rigid gas-permeable contact lenses in the control of myopia progressionTokoro, T eds. Myopia updates: proceedings of the 6th international conference on myopiaSpringer-VerlagTokyoGoogle Scholar
  15. 15.
    Grosvenor, T, Perrigin, J, Perrigin, D, Quintero, S 1989Use of silicone-acrylate contact lens for the control of myopia: results after two years of lens wearOptom Vis Sci664147PubMedCrossRefGoogle Scholar
  16. 16.
    Polse, KA, Brand, RJ, Vastine, DW, Schwalbe, JS 1983Corneal change accompanying orthokeratology. Plastic or elastic?Arch Ophthalmol10118731878PubMedGoogle Scholar
  17. 17.
    Saw, SM, Gazzard, G, Au Eong, KG, Tan, DTH 2002Myopia: attempts to arrest progressionBr J Ophthalmol8613061311PubMedCrossRefGoogle Scholar
  18. 18.
    Saw, SM, Shih-Yen, EC, Koh, A, Tan, D 2002Interventions to retard myopia progression in children: an evidence-based updateOphthalmology109415421PubMedCrossRefGoogle Scholar
  19. 19.
    Bedrossian, RH 1979The effect of atropine on myopiaOphthalmology86713719PubMedGoogle Scholar
  20. 20.
    Dyer, JA 1979The role of cycloplegics in progressive myopiaOphthalmology86692PubMedGoogle Scholar
  21. 21.
    Sampson, WG 1979Role of cycloplegia in the management of functional myopiaOphthalmology86695697PubMedGoogle Scholar
  22. 22.
    Kao, SC, Lu, HY, Liu, JH 1988Atropine effect on school myopia. A preliminary reportActa Ophthalmol185132133Google Scholar
  23. 23.
    Kennedy, RH, Dyer, JA, Kennedy, MA,  et al. 2000Reducing the progression of myopia with atropine: a long term cohort study of Olmsted county studentsBinocul Vis Strabismus Q15281304PubMedGoogle Scholar
  24. 24.
    Gimbel, HV 1973The control of myopia with atropineCan J Ophthalmol8527532PubMedGoogle Scholar
  25. 25.
    Shih, YF, Hsiao, CK, Chen, CJ, Chang, CW, Hung, PT, Lin, LL 2001An intervention trial on efficacy of atropine and multi-focal glasses in controlling myopic progressionActa Ophthalmol Scandinavica79233236CrossRefGoogle Scholar
  26. 26.
    Shih, YF, Chen, CH, Chou, AC, Ho, TC, Lin, LL, Hung, PT 1999Effects of different concentrations of atropine on controlling myopia in myopic childrenJ Ocul Pharmacol Ther158590PubMedGoogle Scholar
  27. 27.
    Yen, MY, Liu, JH, Kao, SC, Shiao, CH 1989Comparison of the effect of atropine and cyclopentolate on myopiaAnn Ophthalmol21180182PubMedGoogle Scholar
  28. 28.
    Fraunfelder, FT, Hanna, C 1973Ophthalmic ointmentTrans Am Acad Ophthalmol Otolaryngol77OP467475PubMedGoogle Scholar
  29. 29.
    Robin, JS, Ekkis, OO 1978Ophthalmic ointmentSurv Ophthalmol22335PubMedCrossRefGoogle Scholar
  30. 30.
    Carkeet, A, Saw, SM, Gazzard, G,  et al. 2004Repeatability of IOLMaster biometry in childrenOptom Vis Sci81829834PubMedCrossRefGoogle Scholar
  31. 31.
    Chiang, MF, Kouzis, A, Pointer, RW, Repka, MX 2001Treatment of childhood myopia with atropine eyedrops and bifocal spectaclesBinocul Vis Strabismus Q16209215PubMedGoogle Scholar
  32. 32.
    Chou, AC, Shih, YF, Ho, TC, Lin, LL 1997The effectiveness of 0.5% atropine in controlling high myopia in childrenJ Ocul Pharmacol Ther136167PubMedCrossRefGoogle Scholar
  33. 33.
    Syniuta, LA, Isenberg, SJ 2001Atropine and bifocals can slow the progression of myopia in childrenBinocul Vis Strabismus Q16203208PubMedGoogle Scholar
  34. 34.
    Fan, DS, Rao, SK, Ng, JS,  et al. 2004Comparative study on the safety and efficacy of different cycloplegic agents in children with darkly pigmented iridesClin Experiment Ophthalmol32462467PubMedCrossRefGoogle Scholar
  35. 35.
    Bitzer, M, Kovacs, B, Feldkaemper, M, Schaeffel, F 2006Effects of muscarinic antagonists on ZENK expression in the chicken retinaExp Eye Res2379388CrossRefGoogle Scholar
  36. 36.
    Stone, RA, Lin, T, Laties, AM 1991Muscarinic antagonist effects on experimental chick myopiaExp Eye Res52755758PubMedCrossRefGoogle Scholar
  37. 37.
    Siatkowski, RM, Cotter, S, Miller, JM,  et al. 2004Safety and efficacy of 2% pirenzepine ophthalmic gel in children with myopia: a 1-year, multicenter, double-masked, placebo-controlled parallel studyArch Ophthalmol12216671674PubMedCrossRefGoogle Scholar
  38. 38.
    Taylor, BJ, Smith, PJ, Brook, CG 1985Inhibition of physiological growth hormone secretion by atropineClin Endocrinol22497501Google Scholar
  39. 39.
    Casanueva, FF, Villanueva, L, Diaz, Y, Devesa, J, Fernandez-Cruz, A, Schally, AV 1986Atropine selectively blocks GHRH-induced GH secretion without altering LH, FSH, TSH, PRL and ACTH/cortisol secretion elicited by their specific hypothalamic releasing factorsClin Endocrinol25319323Google Scholar
  40. 40.
    Gwiazda, J, Hyman, L, Hussein, M,  et al. 2003A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression of myopia in childrenInvest Ophthalmol Vis Sci4414921500PubMedCrossRefGoogle Scholar
  41. 41.
    Tan, DT, Lam, DS, Chua, WH,  et al. 2005One-year multicenter, double-masked, placebo-controlled, parallel safety and efficacy study of 2% pirenzepine ophthalmic gel in children with myopiaOphthalmology1128491PubMedCrossRefGoogle Scholar
  42. 42.
    Seltner, RL, Weerheim, JA, Sivak, JG 1989Role of the lens and vitreous humor in the refractive properties of the eyes of three strains of goldfishVision Res29681685PubMedCrossRefGoogle Scholar
  43. 43.
    Jensen, H 1991Myopia progression in young school children. A prospective study of myopia progression and the effect of a trial with bifocal lenses and beta blocker eye dropsActa Ophthalmol200179Google Scholar
  44. 44.
    Quinn, GE, Berlin, JA, Young, TL,  et al. 1995Association of intraocular pressure and myopia in childrenOphthalmology102180185PubMedGoogle Scholar
  45. 45.
    Lee, JJ, Fang, PC, Yang, IH,  et al. 2006Prevention of myopia progression with 0.05% atropine solutionJ Ocul Pharmacol Ther224146PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Ophthalmological Society 2007

Authors and Affiliations

  • Dorothy S. P. Fan
    • 1
    Email author
  • Dennis S. C. Lam
    • 1
  • Carmen K. M. Chan
    • 1
  • Alex H. Fan
    • 1
  • Eva Y. Y. Cheung
    • 1
  • Srinivas K. Rao
    • 1
  1. 1.Department of Ophthalmology and Visual SciencesThe Chinese University of Hong Kong, Hong Kong Eye HospitalHong KongPeople's Republic of China

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