Real‐world outcomes of low‐dose atropine therapy on myopia progression in an Australian cohort during the COVID‐19 pandemic

Abstract Background To report the outcomes of low‐dose atropine (0.01% and 0.05%) for preventing myopia progression in a real‐world Australian cohort during the COVID‐19 pandemic. Methods Records of children presenting with myopia, from January 2016 to 2022, were retrospectively reviewed at a comprehensive ophthalmic practice. Children who discontinued treatment, ages >18, and cases with hereditary conditions were excluded. The rate of progression of myopia after treatment with atropine was compared with historical data to evaluate the effectiveness of the regime. Results One hundred and one children (mean baseline spherical equivalent [SphE] [−3.70 +/− 2.09 D] and axial length [AL] [24.59 +/− 1.00 mm]) were analysed. The mean age of the children was 10.4 +/− 2.89 years and 61% were females. The average follow‐up time was 17.9 +/− 12.5 months. The mean rate of progression of AL and SphE on 0.01% atropine eyedrops was 0.219 +/− 0.35 mm and − 0.250 +/− 0.86 D/year, respectively. 68.1% of the children treated with 0.01% atropine were mild progressors (<0.5 D change/year). Non‐responders when commenced on a higher dose of atropine (0.05%) experienced a 93% ( p = 0.012) and 30% reduction in SphE and AL growth rate, respectively. Family history, higher myopia or younger age at baseline and shorter duration of treatment were associated with steeper progression ( p < 0.01). Both doses were well tolerated. Conclusions Low‐dose atropine was shown to be beneficial in a real‐world clinical setting, despite interruptions to follow‐ups secondary to COVID‐19 pandemic. A 0.05% dose of atropine may be effective in cases where 0.01% was ineffective.