Efficacy of 0.01% Atropine Eye Drops in Controlling Myopia Progression and Axial Elongation in Children: A Meta-analysis Based on Randomized Controlled Trials

To clarify the preventive effects of 0.01% atropine eye drops against myopia progression and axial elongation in children, a meta-analysis was carried out based on data obtained from PubMed and Web of Science as of August 1, 2021. Randomized controlled trials (RCTs) that enrolled myopic children who had received atropine for at least one year were included in this study, Key search terms included myopia, children, and 0.01% or low-dose atropine. Heterogeneity was quantified by I2 statistics, and meta-analyses were performed using the fixed-effect model. Five RCTs involving 809 unique children were analyzed. One trial was excluded because of a poor Jadad score and markedly rapid myopia progression in controls. The mean effect sizes for 12 months in myopia progression and axial elongation synthesized from the remaining 4 RCTs were 0.20 (95% CI: 0.13 to 0.27) D and −0.08 (−0.11 to −0.04) mm, respectively (p<0.0001). The corresponding inhibition ratios were 28% and 19%. I2 statistics were 6% or less. Sensitivity analysis and funnel plots demonstrated the robustness of the estimation. The 0.01% atropine-induced inhibition ratio for myopia progression in Asian children was roughly half of that originally reported and did not reach the minimum requirement for clinical treatment.