The ATOM Trials
The Atropine for the Treatment of Myopia (ATOM) trials in Singapore have found effective results with atropine, Dr. Tan said.1,2
The first ATOM trial began in 1999 and included 400 children from six to 12 years old with myopia ranging from –1 to –6 D. For 2 years, the children received 1% atropine at night in one eye, while the second eye served as a control. A second group of patients received vehicle eye drops in one eye and control drops in the other eye.
“There was a 77% reduction in the mean progression of myopia, with a strong correlation with axial length,” Dr. Tan said.
There were no serious adverse effects.
One surprise was the rebound effect in year 3.
“The moment we stopped treatment—bang—we could see a sharp descent,” Dr. Tan said. “That was a bit disappointing.”
That led to the development of the ATOM2 trial. ATOM2 was a double-masked controlled trial over 5.5 years. There were 400 children between six and 12 years old who were randomly assigned to receive 0.5%, 0.1%, or 0.01% atropine as bilateral treatment for 2 years. Year 3 was a washout year; treatment commenced if necessary in years 4 and 5.
The study found that the dosing effects were similar among all potencies, suggesting that lower concentrations could be used. Side effects included allergic conjunctivitis (4%), loss of more than one line of best-corrected visual acuity (13%, but it recovered on the cessation of drops), and glare (1%). There was no change in IOP and no cataract formation. Researchers found the treatment had no effect on retinal function.