Cumulative Atropine Not Associated With Increased Risk of Ocular Events in Children With Myopia

Incidence of ocular events, although increased in children living with myopia, was not associated with a prescription of atropine being given to children with myopia when compared with children without myopia, according to a study published in JAMA Ophthalmology.¹

Cumulative use of atropine drops did not increase risk of ocular events | Image credit: Evgeniia - stock.adobe.com

High myopia is associated with ocular complications that may affect individuals later in life, such as retinal detachment, cataracts, and open-angle glaucoma, among other complications. Slowing myopia is a primary way of avoiding these complications from affecting individuals later in life. Atropine has been shown in some studies to slow the progression of myopia but the long-term effects are not known due to lack of studies.² This study evaluated children aged 8 to 15 years living in Taiwan who were prescribed atropine for myopia to learn the long-term advers effects associated with the treatment.¹

Researchers used the National Health Insurance program in Taiwan for its data on vision checks required by the country starting at the age of 4 years. The National Health Insurance program covers 99% of the population of Taiwan and therefore includes relevant data for the analysis. The study included children aged 8 to 15 years diagnosed with myopia between 2001 and 2015 during a clinic visit. A confirmed diagnosis of myopia that lasted at least 2 consecutive years and a follow-up duration of at least 5 years were required for eligibility.

Outcomes included cataract, glaucoma, and maculopathy, which were defined using diagnostic codes. Any diagnosis or treatment for these conditions was considered living with the condition. The observation period lasted from the first recorded date of myopia until the occurrence of an outcome such as cataracts, glaucoma, maculopathy, death, or withdrawal. All patients were followed through the end of 2021 unless they experienced an outcome, death, or withdrawal.

There were 1,213,846 individuals who were included in the study who had a mean (SD) age of 10.4 (1.9) years, and 52.2% were young girls. A total of 73.7% were followed up for at least 10 years, and 40.1% were followed up for at least 15 years. There were 606,923 children diagnosed with myopia in the cohort, of whom 67.0% were prescribed atropine eye drops.

There were 1258 individuals who experienced an ocular complication in the myopia group compared with 786 in the nonmyopic group. Of the myopia group, 833 were using atropine and 425 were not. There was a higher risk of ocular complications in the myopia (adjusted HR [aHR], 1.49; 95% CI, 1.36-1.64) compared with the nonmyopic group. A prescription for atropine did not increase the risk of ocular complications when compared with those who did not take the drops (aHR, 1.05; 95% CI, 0.93-1.18).

Children had increased risks for eye diseases if they had myopia (aHR, 1.44; 95% CI, 5.85-8.86), high myopia (aHR, 2.50; 95% CI, 1.73-3.60), and type 2 diabetes (aHR, 2.50; 95% CI, 1.73-3.60). Children had increased risk of ocular conditions after 3 to 5 years on atropine (aHR, 1.51; 95% CI, 1.17-1.94) and in those receiving it longer than 5 years (aHR, 1.88; 95% CI, 1.37-2.57). Dose levels did not affect risk. Children with high myopia who did not take atropine had a higher incidence rate of ocular complications compared with the cohort overall (13.47 cases vs 1.54 cases per 10,000 person-years).

There were some limitations to this study. All data came from secondary claims to estimate the actual usage of these medications in children. Using diagnosis codes alone makes the identification of outcomes uncertain. Myopia and high myopia were not measured. Individual visual outcomes could not be measured due to the design of the study. Prescriptions were used as an estimate of actual use and could over- or underestimate actual usage.

The researchers concluded that longer-term atropine prescriptions were associated with an increased risk of ocular complications in children, but the study did not find an association of cumulative doses of atropine with an increased risk of ocular complications.

“These findings support monitoring of children receiving atropine for myopia treatment if these results are confirmed by future studies that address the limitations of this investigations,” the authors wrote.

References

1. Liu YL, Tsai JY, Chiu KY, et al. Ocular risks of topical atropine prescriptions among Taiwanese children. JAMA Ophthalmol. Published online September 11, 2025. doi:10.1001/jamaophthalmol.2025.3090

2. Rauch K. Low-dose atropine for kids with myopia. American Academy of Ophthalmology. August 31, 2017. Accessed September 15, 2025. https://www.aao.org/eye-health/news/low-dose-atropine-kids-with-myopia