LONG BEACH, Calif. — Low-dose atropine drops showed potential as a noninvasive alternative for managing vitreous floaters, a small retrospective study suggested.
A majority of patients who completed 7 days of treatment (n=22) reported they were satisfied or very satisfied with atropine 0.01% eyedrops. Half of the patients said they would continue using the medication. Counting patients who did not return questionnaires being dissatisfied, the satisfaction level dropped to 29.5%, and 25% said they would continue using the drops.
Despite the study’s retrospective nature and small sample size, the results suggest that low-dose atropine eye drops might be effective for selected patients with troublesome floaters, reported Mohsin H. Ali, MD, of the Retina Group of Washington, at the American Society of Retina Specialists.
“Low-dose atropine can be a effective, noninvasive treatment option for select patients with persistently symptomatic vitreous opacities,” said Ali. “The efficacy is low, about 30-60%, but despite this, I think it is a good therapeutic option to have in the pocket, given that the other options — vitreolysis and vitrectomy — carry the risk of vision-threatening complications. “Keep in mind that this is a small sample size and lacks a control group.”
“I use it as a long-term or PRN treatment, a temporizing measure, a stepping stone to vitrectomy or a filter, to decide which of my patients have a more supratentorial origin of their symptoms,” he added. “I do not prescribe low-dose atropine for patients who have acute PVDs [posterior vitreous detachments], so as not to mask their symptoms, or who have narrow angles.”
An unidentified member of the audience from Taiwan questioned use of such a low atropine dose, adding, “That’s probably one of the reasons the satisfaction rate was low… . Have you considered using a slightly higher concentration of atropine, such as 0.05%?”
Ali agreed that some patients do not get the full effect of atropine from such a low dose, which is associated with pupil dilation of about 1 mm.
“In my anecdotal experience, I have had other patients come back and say they refuse to use the drops any longer because of the light sensitivity it caused,” he said. “That’s why I do think that even at this low dose, in adults with various other pathologies and different colored irises, you might find that there is still pupillary dilation.”
“I do not want to use a higher dose because the whole reason for this study is that these patients are already a little difficult to deal with, and if you add photophobia on top of that, it could become a nightmare,” Ali stated. “I try to keep it at the lowest dose, simply for my own sanity.”
In response to another question, Ali said he does not measure pupil size, but some patients send “selfies” after applying the drops, which has shown “significant pupillary dilation” even with low-dose atropine.
Another unidentified speaker asked about atropine’s mechanism of action with respect to floaters. Ali said, “I don’t know. I don’t quite understand the optics behind the mechanism of action.”
Ali described a retrospective case series of patients prescribed 0.01% atropine drops for vitreous floaters. Patients were asked to complete a validated questionnaire before and after a week of using the eyedrops. The primary outcome was change in satisfaction scores. Eligible patients had persistent symptomatic vitreous opacities, secondary to vitreous syneresis without a PVD or with a history of chronic PVD for at least 3 months.
The analysis included 44 patients who had a median age of 60, a mean best corrected visual acuity of Snellen equivalent 20/20, and a mean follow-up of 8.9 months.
Half the patients used the atropine drops for at least 7 consecutive days and also returned the follow-up questionnaire. The results showed that 13 of 22 (59.1%) of patients were satisfied or very satisfied with the eyedrops, and 11 of 22 (50%) said they intended to continue using the medication. An intention-to-treat analysis that included all 44 patients showed the satisfaction rate and proportion of patients who planned to continue the medication deceased by 50%.
Satisfaction did not differ by iris color, phakic status, or PVD status, said Ali. Among patients who completed the study, one subsequently had laser vitreolysis and four underwent vitrectomy. Adverse effects consisted of four patients with worsened near vision, four with worsened distance vision, and four with light sensitivity.
Disclosures
Mohsin disclosed no relationships with industry.
Primary Source
American Society of Retina Specialists
Source Reference: Ali MH, et al “Low-dose atropine 0.01% drops for symptomatic vitreous floaters. A non-invasive, safe, and effective therapeutic option” ASRS 2025.
