High myopia is a major cause of uncorrectable visual impairment. It imposes major challenges and costs
for refractive correction, and for the treatment of associated pathological complications. In the last 60 years, there
has been a marked increase in the prevalence of high myopia in younger generations in developed countries in East
and Southeast Asia, and there are signs of similar, but less pronounced increases in North America and Europe. In
some parts of the world, 70-90% of children completing high schools are now myopic, and as many as 20% may be
highly myopic. It is now clear that myopia results from excessive axial elongation of the eye, and this greater rate
of axial elongation appears to be environmentally driven.
Experimental studies have examined the biochemical mechanisms involved in regulation of axial elongation; and, from these studies,
some options have emerged for preventing the development of myopia or slowing myopia progression. Atropine eye drops have been
quite extensively used in clinical practice in Asian countries. This long-lasting treatment could be beneficial, but has clear limitations and
complications. Recent reports suggest that a low concentration of atropine, which has less severe side-effects, is also effective. But, a decision
to use an invasive treatment such as atropine drops, even at low doses, requires careful consideration of the risk of myopia progression.
A decision to use atropine in pre-myopic patients would require even more careful consideration of the risks. Here, we review the
current literature relevant to the prevention of myopia progression with atropine drops.