With the long established theory of reading and excess near work playing a role on myopia progression due to their close association to accommodation, several research initiatives have been directed towards eliminating this trigger. Various topical muscarinic antagonists have been investigated for their cycloplegic effect to minimize accommodative dysfunction as a stimulus to myopic development.
Under this category, atropine has shown the greatest effect at slowing the progression of myopia in several studies (Shih et al, 2001; Chua et al, 2006; Fang et al 2010). However side effects associated with its use such as photophobia, glare, and overall discomfort secondary to its mydriatic and cycloplegic mechanism of action may limit its clinical use on younger myopic patients as a form of treatment.
Research has focused on utilizing varying concentrations of atropine or alternative ocular muscarinic antagonists such as pirenzipine, and less frequently, tropicamide and scopolamine (Chia et al, 2012).