Atropine slows myopia progression more in Asian than white children by meta-analysis.
OBJECTIVE
To conduct a meta-analysis on the effects of atropine in slowing myopia progression and to compare Asian and white children and randomized controlled trials (RCTs) and observational studies.


METHODS
Randomized controlled trials and observational studies that assessed the effects of all concentrations of atropine in slowing myopia progression in children were searched from MEDLINE, EMBASE, and the Cochrane Library up to April 2013. Jadad scoring was used to evaluate the quality of RCTs, and the Newcastle-Ottawa Scale was used for observational studies.


RESULTS
Four RCTs and seven cohort studies (a kind of observational study) with 1815 children aged 5 to 15 years were included. The children had a baseline refraction of -0.50 to -9.75 diopters (D) and were followed up for 22.0 months (range, 12.0 to 36.5 months). The weighted mean differences in myopia progression in RCTs and cohort studies of Asian children were 0.55 D per year (p < 0.01) and 0.54 D per year (p < 0.001), respectively, and 0.35 D per year (p = 0.01) in cohort studies of white children. Compared with placebo, the risk of fast myopia progression (>1.0 D per year) using atropine was significantly decreased in both RCTs (odds ratio [OR], 0.14; p < 0.01) and cohort studies (OR, 0.08; p < 0.01), and the benefit of slow myopia progression (<0.50 D per year) using atropine was significantly increased in both RCTs (OR, 6.73; p < 0.01) and cohort studies (OR, 22.10; p < 0.01).


CONCLUSIONS
Atropine could significantly slow myopia progression in children, with greater effects in Asian than in white children. Randomized controlled trials and cohort studies provided comparable effects.
*MD, PhD †MD ‡PhD §OD, PhD, FAAO Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China (SML, MTK, SYL, ZY, YYS, NLW); Department of Epidemiology and Health Statistics, Peking University School of Public Health, Beijing, China (SSW, SYZ); Laiwu Center for Disease Control and Prevention, Shandong Province, China (YL, SMJ); Anyang Eye Hospital, Henan Province, China (LRL, HL, WC); and School of Optometry and Vision Sciences, Cardiff University, Cardiff, Wales, United Kingdom (MM).
Shi-Ming
SM
Li
Shan-Shan
SS
Wu
Meng-Tian
MT
Kang
Ying
Y
Liu
Shu-Mei
SM
Jia
Si-Yuan
SY
Li
Si-Yan
SY
Zhan
Luo-Ru
LR
Liu
He
H
Li
Wei
W
Chen
Zhou
Z
Yang
Yun-Yun
YY
Sun
Ningli
N
Wang
Michel
M
Millodot
D000293:Adolescent; D044466:Asian People / Q000208:ethnology*; D001285:Atropine / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D009184:Mydriatics / Q000627:therapeutic use*; D009216:Myopia / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology*; D064887:Observational Studies as Topic; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D044465:White People / Q000208:ethnology*
D009184:Mydriatics; D001285:Atropine