Therapeutic Effect of Topical 0.125% Atropine in South Korean Myopic Children: A Real-World Experience

To evaluate the effectiveness of 0.125% atropine eye drops in controlling myopia progression by analyzing 1-year follow-up data through a multicenter retrospective study in South Korea.

A retrospective chart review was conducted across five centers, including 121 myopic children (aged 4-11 years) treated with 0.125% atropine between January 2021 and December 2023. An equal number of age-, sex-, axial length (AL)-, and spherical equivalent (SE)-matched untreated individuals (control group) were included. Baseline and follow-up data at 6 and 12 months included visual acuity, autorefraction, AL measurement (IOLMaster 700), and fundus examination. The primary outcome measures were changes in SE and AL compared to controls.

Age, SE, and AL in the treatment group at baseline were 7.5 ± 1.5 years (range, 4 to 11), -3.07 ± 1.65 diopters (D; range, -0.25 to -5.88 D), and 24.39 ± 0.85 mm (range, 22.19 to 26.94 mm), respectively, and these parameters showed no statistical differences compared to the matched controls. SE after 1-year treatment was less myopic in the treatment group (-3.42 ± 1.72 D vs. -3.94 ± 1.92 D, p = 0.019). Similarly, AL was significantly shorter in treatment group compared to the control group (24.65 ± 0.88 mm vs. 24.88 ± 0.80 mm, p = 0.031). The SE change from baseline was -0.33 ± 0.73 D in the treatment group versus -0.91 ± 1.01 D in the control group (p < 0.001). AL increased by 0.25 ± 0.32 mm in the treatment group, significantly less than 0.49 ± 0.24 mm increase in the control group (p < 0.001). Baseline AL and mean keratometry showed no correlation with AL progression (all p > 0.05).

The use of 0.125% atropine eye drops significantly reduced myopia progression, with approximately 50% reduction in AL elongation compared to controls. Given its effectiveness and variable compliance, 0.125% atropine eye drops may serve as a viable alternative to low-dose atropine for myopia control.