Author: Claude (AI), from PubMed abstracts · Reviewed by: Dr Mina Abdelmseih · Reviewed: 2026-11-15 · Review due: 2027-11-15

Educational content only. Not personalised medical advice. Clinical decisions remain the responsibility of the treating clinician.

Low-dose atropine for myopia control

Atropine eye drops slow myopia progression in children, with a concentration-dependent effect in randomised trials [S2] [S3]. Low concentrations have few side effects, but the effect of 0.01% is modest and the certainty of evidence for low-dose atropine is very low in the 2025 Cochrane review [S10]. Treatment lasts years, and progression can rebound after stopping [S7] [S8].

Key points - In the LAMP trial (2019), 0.05%, 0.025% and 0.01% atropine reduced progression in a concentration-dependent way; 0.05% was most effective over 1 year [S2]. - A 2022 network meta-analysis ranked 0.05% atropine close to high-dose atropine (1% and 0.5%) for efficacy, while pupil and accommodation effects rose with dose [S3]. - 0.01% atropine reduced progression versus placebo in a UK multicentre RCT (mean difference 0.33 D over 2 years) [S12], but did not prevent myopia onset in non-myopic children in LAMP2 [S5]. - Photophobia and blurred near vision are the most common adverse events; severe adverse events were 0.0% in a pooled analysis [S6]. - Stopping causes rebound, greater in younger children and after shorter treatment [S7]; tapering produced less progression than abrupt stopping [S11].

Evidence last checked: 2026-10-17 (PubMed abstracts).

Red flags

• Fast progression despite treatment. A guideline defines progression as more than 0.50 D per year in spherical equivalent, or axial elongation of more than 0.3 mm (until age 10) or 0.2 mm (above 11) [S9]; combinations may be needed for uncontrolled cases [S9].
• Abrupt cessation in a young child. Rebound is greater in younger children and after shorter treatment [S7].
• Allergic reaction to the drops. Allergic conjunctivitis and dermatitis occurred with 0.1% and 0.5% atropine but not with 0.01% in ATOM2 [S1].

Recognise it: who may benefit

• Trials enrolled children aged 4 to 12 years with myopia of at least -1.0 D (LAMP) [S2], 6 to 12 years with at least -2.0 D (ATOM2) [S1], and 6 to 12 years with -0.50 to -10.0 D (CHAMP-UK) [S12].
• In a trial from India, children aged 5 to 15 years with myopia over 2 D were treated with 0.01% atropine at night [S4].
• Most trials in the Cochrane review were conducted in China or other Asian countries (66.3%) [S10]; the UK trial found no subgroup differences by age, ethnicity, sex or severity [S12].

Confirm it: baseline and monitoring

• The Brazilian guideline recommends corneal topography, cycloplegic refraction every 6 months and annual optical biometry, with 6-monthly biometry for fast progressors [S9].
• Trials measured cycloplegic refraction and axial length as outcomes [S2] [S12].

Manage it

Before acting on this section, check the national and local guidelines, product information and regulatory approvals that apply where you practise. See the medical disclaimer.

Tier A (primary care / no specialist)

• Refer children with myopia for a cycloplegic refraction and discussion of myopia control where available [S9].
• Atropine is one of several options alongside environmental measures, defocus spectacles, contact lenses and orthokeratology [S9].

Tier B (general eye clinic)

1. Choice of concentration. Doses below are as reported in the trials, not a prescription; follow local formularies and product availability. - 0.05% nightly: mean SE change -0.27 D vs -0.81 D with placebo at 1 year, as reported in [S2]. - 0.01% nightly: -0.59 D vs -0.81 D at 1 year in LAMP [S2]; mean difference 0.33 D vs placebo at 2 years in CHAMP-UK [S12]; -0.30 D vs -0.88 D at 2 years in the Indian RCT [S4]. - In ATOM2, 0.5%, 0.1% and 0.01% gave -0.30, -0.38 and -0.49 D over 2 years; the authors judged the differences clinically insignificant, with fewer side effects at 0.01% [S1].
2. Pooled estimates. The Cochrane review (very low-certainty evidence) gave a 1-year mean difference of 0.25 D and -0.10 mm for low-dose atropine (<0.1%), 0.55 D for medium dose (0.1% to <0.5%) and 0.90 D for high dose (≥0.5%, moderate certainty) [S10].
3. Duration. The guideline advises treatment for at least 2 years [S9]. Over 5 years in LAMP, continued treatment groups that started on 0.05%, 0.025% and 0.01% progressed -1.34 D, -1.97 D and -2.34 D [S8].
4. Side effects to explain. Pooled incidence of adverse events was 5.9%: photophobia 9.1%, blurred near vision 2.9% [S6]. Lower doses had fewer adverse events [S6]. In LAMP, 0.05% reduced accommodation by 1.98 D and increased photopic pupil size by 1.03 mm; visual acuity and quality of life were not affected [S2].

Tier C (specialist centre)

• Combination with orthokeratology. Ortho-K plus low-dose atropine probably reduces axial elongation more than ortho-K alone (MD -0.12 mm, moderate certainty) [S10].
• Prevention in pre-myopes. In LAMP2, 0.05% nightly reduced 2-year myopia incidence (28.4% vs 53.0% placebo); 0.01% did not differ from placebo [S5]. The authors call for replication and longer-term safety data [S5].
• Stopping. In LAMP, 87.9% of children who stopped at year 3 needed re-treatment; restarting 0.05% achieved similar efficacy to continued treatment [S8]. Tapering (0.05% then 0.025% for 6 months each) before stopping gave less progression over 3 years than stopping from 0.05% (-0.54 D vs -0.78 D), though the clinical relevance of the 0.24 D difference is unclear [S11].

Refer when

Pitfalls

• Expecting 0.01% atropine to prevent myopia onset: LAMP2 found no difference from placebo [S5].
• Assuming all concentrations work equally: effect was concentration-dependent in LAMP [S2] [S3].
• Stopping early without follow-up: rebound is greatest in the first 6 months after cessation [S7].
• Overstating certainty: low-dose atropine evidence is very low certainty and heterogeneous [S10].

Evidence notes

• The Cochrane networks were poorly connected, and estimates rely mainly on direct comparisons; adverse events and adherence were inconsistently reported [S10].
• LAMP-series trials come from one centre in Hong Kong [S2] [S5]; the UK trial adds evidence from a mainly white population [S12].
• ATOM2 compared against historical placebo data from ATOM1, not a concurrent placebo [S1].
• Rebound evidence comes partly from interventional, non-randomised studies [S7].
• Not covered by these sources: cost, compounded versus commercial preparations, and treatment in adults.

Related articles

• Optical myopia control: spectacle lenses, contact lenses and orthokeratology
• Outdoor time and the prevention of myopia
• Repeated low-level red-light therapy for myopia

References

See the numbered source list below. Each marker [S#] links to its PubMed and DOI record.