No Link to Atropine in Higher Ocular Health Complications for Myopic Kids, Study Finds

This study did not find an association of cumulative doses of atropine with an increased incidence of ocular complications. The study team suggested that the risk of ocular complications from myopia may exceed that associated with long-term atropine use. Photo:  Getty Images. Click image to enlarge. While atropine can reduce myopia progression, its long-term safety profile remains uncertain. A recent study published in JAMA Ophthalmology examined the use of atropine for myopia control among eight- to 15-year-old Taiwanese children and investigated the potential long-term adverse effects.With at least five years of follow-up, the incidence of ocular complications (cataracts, primary open-angle glaucoma and maculopathy, in particular) was higher in the myopia group compared with the non-myopia group but was not different between atropine users and nonusers in the myopia group. No increased risk was observed with higher cumulative atropine doses. Children prescribed atropine were diagnosed with myopia at a younger age, had a slightly shorter follow-up period and had a higher rate of diagnosis of high myopia during the follow-up period compared with nonusers.1This was a retrospective, population-based cohort study using longitudinal data from Taiwan’s National Health Insurance Research Database (NHIRD). It included children ages eight to 15 with newly diagnosed myopia and matched nonmyopic control participants in the period between 2001 and 2015. Diagnoses of cataracts, primary open-angle glaucoma and maculopathy were recorded during the observation period. The research team reported incidence of ocular complications after a minimum five-year follow-up period. A total of 1,213,846 Taiwanese children (mean age at myopia diagnosis 10.4 years; 52.2% female) were included. Among 606,923 children with myopia, 67.0% were prescribed atropine.The incidence of the aforementioned ocular complications was higher in the myopia group (1.54 per 10,000 person-years) compared with the non-myopia group (0.96 per 10,000 person-years) with an adjusted HR (aHR) of 1.49. Among the children with myopia, the incidence of ocular complications was not different between atropine users and nonusers (both 1.54 per 10 000 person-years; aHR: 1.05). An increased risk of ocular complications was observed in children with a cumulative duration of atropine prescription exceeding three years (aHR: 1.51). However, this trend was not present when considering children with high myopia (aHR: 1.10). No increased risk was found among children with the highest quartile of cumulative atropine dose (aHR: 1.05).Whether the duration of medication use is associated with long-term complications requires careful exploration.“This study found that longer-term atropine prescription for myopia control was associated with an increased risk of ocular complications among school-aged children,” the study authors wrote in their paper. “However, this risk may be confounded primarily by myopia severity and warrants further investigation.”1A commentary also published in JAMA Ophthalmology noted, “While the current analysis only reports estimated cumulative incidence of high myopia, which was not clearly defined, the dataset allows estimation of the long-term effect of atropine on myopia progression.”2The commentary author took issue with the fact that the data were obtained from insurance claims, which means that practice variations across individuals, institutions, regions and time can affect the reliability of the observations. He believed that the analyses were highly susceptible to bias from unmeasured confounding. Also, he considers the assumptions made in this study to quantify atropine use and adherence were sources of measurement error that can lead to large variance in the estimates.“Databases like the NHIRD are an impressive resource for studying long-term safety, but they often lack granular data on variables necessary to adjust for confounding and to study subgroup effects,” he wrote in his commentary.Nevertheless, the commentary suggested that this study puts the spotlight on the need for a systematic review of adverse outcomes with topical ocular atropine use in children.“A systematic review of adverse outcomes with topical ocular atropine should use data from studies on all indications, include data from randomized and nonrandomized studies and synthesize findings within the context of risk of bias and certainty of evidence,” it concluded. “This may provide a more rigorous and complete picture of the evidence of safety of long-term use of atropine in children.”2 Click here for the journal source and here for the commentary. 1. Liu YL, Tsai JY, Chiu KY, et al. Ocular risks of topical atropine prescriptions among Taiwanese children. JAMA Ophthalmol. September 11, 2025. [Epub ahead of print].2. Vedula SS. Safety of long-term use of atropine for myopia in children. JAMA Ophthalmol. September 11, 2025. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.