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TOPLINE:

In a cohort of over 1.2 million Taiwanese children followed up for at least 5 years, those with myopia had a higher risk for ocular problems than those without the condition. However, among children with myopia, receiving a prescription for atropine eye drops was not linked to an increased risk for these complications.

METHODOLOGY:

• Researchers conducted a retrospective study using a Taiwan-based insurance database to investigate whether topical atropine prescribed to control myopia posed an increased risk for ocular complications in the long term.
• They included 606,923 children diagnosed with myopia between 2001 and 2015 and matched them to an equal number of children without the condition (mean age of whole cohort, 10.4 years; 52.2% girls); the children were required to be diagnosed with myopia for at least 2 years to be included in the analysis.
• Exposure to atropine was obtained from records of prescriptions, and the cumulative dose and duration were estimated.
• Outcomes included new diagnoses of ocular complications including cataracts, glaucoma, and maculopathy over a follow-up duration of at least 5 years.

TAKEAWAY:

• Children with myopia had a 49% higher risk for ocular complications than those without the condition (adjusted hazard ratio [aHR], 1.49; 95% CI, 1.36-1.64).
• Atropine eye drops were prescribed to 67% of children with myopia; however, their risk for ocular complications did not differ from that of children with myopia not prescribed the medication.
• The risk for ocular complications was elevated in children with myopia whose cumulative duration of atropine prescription was 3-5 years (aHR, 1.51; 95% CI, 1.17-1.94) and more than 5 years (aHR, 1.88; 95% CI, 1.37-2.57). This trend was not observed when the analysis was restricted to children with high myopia.
• A higher cumulative dose of atropine was not associated with an increased risk for ocular complications.

IN PRACTICE:

“This study found that longer-term atropine prescription for myopia control was associated with an increased risk of ocular complications among school-aged children; however, this risk may be confounded primarily by myopia severity and warrants further investigation,” the researchers reported.

“This work also puts the spotlight on the need for a systematic review of adverse outcomes with topical ocular atropine use in children, which is prescribed for myopia and other indications such as amblyopia. It is unlikely that adverse effects with a tropine will differ by the indication for which it was used,” S. Swaroop Vedula, MBBS, MPH, PhD, wrote in an invited commentary to the journal article.

SOURCE:

This study was led by Yao-Lin Liu, MD, of National Taiwan University Hospital in Taipei. It was published online on September 11 in JAMA Ophthalmology.

LIMITATIONS:

This study relied on secondary claims data for atropine prescriptions. Ocular complications were identified only using diagnostic codes. The absence of direct refractive measurements for myopia and high myopia may have impacted accuracy of classification.

DISCLOSURES:

This study received funds from the National Science and Technology Council. One author reported receiving conference support from Eyerising International and personal fees from Essilor.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.