Comparative efficacy and safety of different concentrations of atropine for myopia control. Atropine is known to be an effective intervention to delay myopia progression. Nonetheless, no well-supported evidence exists yet to rank the clinical outcomes of various concentrations of atropine. We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov on April 14, 2021. We selected studies involving atropine treatment of at least 1 year's duration for myopia control in children. We performed a network meta-analysis (NMA) of randomized controlled trials (RCTs) and compared 8 atropine concentrations (1% to 0.01%). We ranked the atropine concentrations for the corresponding outcomes by P score (estimate of probability of being best treatment). Our primary outcomes were mean annual changes in refraction (diopters/year) and axial length (AXL; millimeters/year). We extracted data on the proportion of eyes showing myopia progression and safety outcomes (photopic and mesopic pupil diameter, accommodation amplitude, and distance and near best-corrected visual acuity [BCVA]). Thirty pairwise comparisons from 16 RCTs (3272 participants) were obtained. Our NMA ranked the 1%, 0.5%, and 0.05% atropine concentrations as the 3 most beneficial for myopia control, as assessed for both primary outcomes: 1% atropine (mean differences compared with control: refraction, 0.81 [95% confidence interval (CI), 0.58-1.04]; AXL, -0.35 [-0.46 to -0.25]); 0.5% atropine (mean differences compared with control: refraction, 0.70 [95% CI, 0.40-1.00]; AXL, -0.23 [-0.38 to -0.07]); 0.05% atropine (mean differences compared with control: refraction, 0.62 [95% CI, 0.17-1.07]; AXL, -0.25 [-0.44 to -0.06]). In terms of myopia control as assessed by relative risk (RR) for overall myopia progression, 0.05% was ranked as the most beneficial concentration (RR, 0.39 [95% CI, 0.27-0.57]). The risk for adverse effects tended to rise as the atropine concentration was increased, although this tendency was not evident for distance BCVA. No valid network was formed for near BCVA. The ranking probability for efficacy was not proportional to dose (i.e., 0.05% atropine was comparable with that of high-dose atropine [1% and 0.5%]), although those for pupil size and accommodation amplitude were dose related.

Background/Aims: To investigate the topographic relationship between macular superficial microvessel density (SMD) and macular ganglion cell-inner plexiform layer (GCIPL) thickness in eyes with glaucoma-suspect (GS) and early normal-tension glaucoma (NTG).Methods: A total of 86 eyes of 86 patients with early NTG (standard automated perimetry mean deviation >−5.5 decibels) and a total of 25 eyes of 25 patients with GS were retrospectively reviewed. All of the subjects underwent optical coherence tomography (OCT) and OCT angiography (OCTA) scan. On the OCTA scan images, macular SMD was analysed by customised software.Results: In GS and patients with early NTG, macular GCIPL thickness showed significant correlations with macular SMD in the superotemporal (ST), inferotemporal (IT) and inferoinferior (II) sectors (r=0.191, 0.373 and 0.346 for ST, IT and II sector, respectively). Additionally, circumpapillary retinal nerve fibre layer (RNFL) thickness and macular SMD showed significant correlations between the ST sector of the macula and the 1, 9 clock-hour peripapillary regions and between the IT and II sectors of the macula and the 6, 7, 8 clock-hour peripapillary regions. The IT sector macular SMD showed fair diagnostic power (area under the receiver operating characteristic curve [AUROC] = 0.758) and showed high diagnostic power when combined with IT sector macular GCIPL thickness (AUROC=0.954).Conclusions: Sectoral macular SMD showed topographic correlations with macular GCIPL thickness and circumpapillary RNFL thickness in patients with GS and early-stage NTG. Macular SMD analysis is potentially useful in the clinical evaluation of early glaucoma.