Atropine for the Treatment of Childhood Myopia (ATOM1)

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A drop a day can keep the… glasses away? Myopia is the most common eye disorder in humans and is associated with multiple irreversible blinding conditions including retinal detachment. Prior to this study, atropine was described as an agent that could slow progression, but there had been no long-term, randomized control trials. ATOM 1 is a randomized control trial in which children aged 6-12 with refractive error between -1.00D and -6.00D were randomized to either 1% atropine sulfate or vehicle eye drops once nightly for two years. 

Key Points:

• Once-nightly dose of 1% atropine eye drops achieved a 77% reduction in progression of myopia over two years (mean progression: 1.20 +/- 0.69D in placebo vs 0.28+/- 0.92 D in atropine)
• Atropine administration also significantly slowed axial elongation (placebo: 0.38+/- 0.38 mm; atropine: 0.02+/- 0.35 mm)
• There were no serious adverse effects related to topical atropine use. Side effects included glare, photophobia due to pupillary dilatation, and blurred near vision due to induced cycloplegia 

This study was the first randomized control study to show slowing of myopia progression in children with atropine use. This study has limited extrapolation due to its limited study population (exclusively Asian children) and time course (two years). Additionally, there have been questions as to whether the effect lasted after stopping atropine, something that was examined in ATOM2 study.