What are the benefits of using atropine in low concentrations for myopia control

How does atropine work in combination with other myopia treatments

Atropine enhances myopia control when combined with optical treatments like orthokeratology or specialized contact lenses by targeting both biochemical and structural pathways. Here’s how these combinations work and their efficacy.

Mechanism of Synergy

Atropine slows axial elongation by inhibiting muscarinic receptors in the eye, reducing growth signals, and altering retinal biochemistry. When paired with optical treatments, which modify peripheral defocus or corneal shape, the combined approach addresses both biochemical drivers of eye growth and light-focusing mechanisms.

Key Combination Therapies

1. Atropine + Orthokeratology (Ortho-K)

Efficacy:

• A 2024 meta-analysis found combining 0.01% atropine with Ortho-K reduced axial elongation by 0.09 mm/year compared to Ortho-K alone. Over two years, children using both treatments had 50% less axial elongation (0.17 mm vs. 0.34 mm).

• Higher-dose atropine (0.05%) with Ortho-K showed even greater short-term effects (0.14 mm/year vs. 0.27 mm/year for Ortho-K alone).

Mechanism: Ortho-K flattens the cornea to reduce peripheral hyperopic defocus, while atropine directly inhibits eye growth.

2. Atropine + Dual-Focus Contact Lenses

Efficacy:

• A 2025 study found adding MiSight lenses to 0.05% atropine reduced progression in children with rapid myopia (axial elongation slowed by ~0.25 mm/year).

• However, combining 0.01% atropine with MiSight showed no significant additive effect in one study, though limitations (e.g., lack of axial length data) warrant further research.

Mechanism: Dual-focus lenses create myopic defocus to slow elongation, complementing atropine’s biochemical action.

3. Atropine + Defocus-Incorporated Spectacle Lenses (DIMS)

Efficacy:

• DIMS lenses + 0.025% atropine reduced axial elongation by 0.07 mm/year compared to atropine alone, with 39.5% of children showing no progression.

Mechanism:

• DIMS lenses provide peripheral defocus control, while atropine suppresses growth signals.

Factors Influencing Efficacy

Atropine Concentration:

• Low-dose (0.01%) balances efficacy and side effects, while 0.05% offers stronger control but may cause photophobia.

• High-dose (0.5–1%) atropine alone matches combination efficacy but is rarely used due to side effects.

Age and Myopia Severity:

Younger children and those with low/moderate myopia benefit more from combinations (e.g., axial elongation reduced by 36% in under-10s).

Treatment Duration:

Synergistic effects peak in the first 6–12 months, with potential adaptation over time.

Recent Breakthroughs in Myopia Management

Significant advances have occurred in myopia control and treatment over the past year, spanning pharmaceuticals, optical devices, digital therapies, and genetic research. Here is a summary of the most notable breakthroughs:

1. Pediatric Eye Drops Approved in India

• In April 2025, India approved its first pediatric eye drops specifically designed to slow the progression of myopia in children. This marks a major milestone, as these drops will be available strictly by prescription and represent a new pharmaceutical option for pediatric myopia management.

2. SightGlass Vision’s Diffusion Optics Technology (DOT) Lenses

• The FDA granted Breakthrough Device Designation to SightGlass Vision’s DOT spectacle lenses in early 2024. These lenses use thousands of light-scattering microdots to mimic natural light conditions, slowing myopia progression by disrupting the retinal signal for eye elongation. Clinical trials (CYPRESS study) showed a 59% reduction in myopia progression over two years, with results sustained over four years.

3. Digital and Light-Based Therapies

• Dopavision’s MyopiaX is a noninvasive, child-friendly digital platform delivering photobiomodulation (light stimulation) via consumer electronics. A 6-month proof-of-concept trial across Europe showed the therapy was safe, well-tolerated, and effective in slowing myopia progression in children, adding a promising new digital option to the treatment landscape.

• Low-level red light (LLRL) therapy, already used in China and approved in some European countries and Australia, has shown up to 80% reduction in myopia progression in clinical studies. However, concerns about long-term retinal safety remain, and the therapy is not FDA-approved in the United States.

4. Atropine Eye Drops: Optimized Dosage

• Recent research has refined the optimal concentration of low-dose atropine eye drops. A 2025 JAMA study found that 0.02% atropine achieves a 60% reduction in myopia progression with minimal side effects, improving on previous dosing strategies.

• While atropine remains the most studied pharmaceutical, new neuroprotective eye drops and combination therapies are under investigation for enhanced efficacy.

5. Advanced Contact Lenses

• MiSight 1 Day contact lenses continue to show robust evidence, with a 2025 study confirming a 59% reduction in myopia progression compared to standard lenses. Other soft multifocal and peripheral defocus lenses are demonstrating similar effectiveness.

• Orthokeratology (Ortho-K) lenses, now made with new high-oxygen materials, offer improved comfort and safety, with long-term studies showing a 50% reduction in myopia progression in children.

6. Genetics and Personalized Medicine

• Breakthroughs in genetic research are identifying specific genes linked to myopia, paving the way for future gene-based therapies and AI-driven risk prediction for high myopia in children.

7. Imaging and Diagnostics

• New imaging techniques have uncovered detailed patterns in the sclera (white of the eye) of highly myopic patients, potentially leading to better understanding and earlier intervention strategies.

• Artificial intelligence is increasingly used for early detection and monitoring of myopia progression, enabling more personalized treatment plans.

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