Childhood myopia rates have skyrocketed globally, yet treatment responses vary dramatically across populations in ways that could reshape how eye care professionals approach vision correction. This meta-analysis reveals striking ethnic disparities that may explain why some children respond better to intervention than others.
Analyzing 34 randomized controlled trials spanning multiple continents, researchers found atropine eye drops consistently slowed myopia progression across all tested concentrations, but with profound ethnic differences. East Asian children showed the strongest response, with vision deterioration slowing by 0.63 diopters annually compared to untreated controls. South Asian children experienced moderate benefits at 0.40 diopters per year, while white European children showed minimal improvement at just 0.18 diopters annually—a three-fold difference between highest and lowest responding groups.
Dose-response patterns emerged clearly, with higher atropine concentrations above 0.5% delivering superior myopia control compared to ultra-low doses below 0.1%. The drug reduced axial eye length elongation most effectively in East Asians, suggesting biological mechanisms underlying myopia development may vary substantially across ethnic groups.
These findings challenge the one-size-fits-all approach currently dominating pediatric ophthalmology. The data suggests genetic, environmental, or physiological factors specific to different populations influence atropine's mechanism of action. For clinicians treating myopic children, ethnicity may need consideration alongside traditional factors like age and baseline refraction when selecting optimal treatment protocols. However, this represents analysis of existing studies rather than prospective trials designed to investigate ethnic differences, limiting definitive clinical guidance until targeted research addresses these disparities directly.