A large UK-based clinical trial has provided new evidence supporting the use of low-dose atropine eye drops as a treatment option for controlling the progression of childhood myopia. Researchers reported that daily administration of 0.01% atropine resulted in modest but clinically meaningful reductions in myopic progression and axial eye growth compared with placebo, while maintaining a favourable safety profile.¹

Myopia has become a major public health concern worldwide, with prevalence rates rising rapidly among children and adolescents. Increasing levels of myopia are associated with a greater risk of long-term ocular complications, including retinal detachment, myopic maculopathy, glaucoma, and cataract formation.^2,3 Consequently, interventions aimed at slowing myopia progression have attracted considerable research interest.

The randomized placebo-controlled trial enrolled 289 children aged 6–12 years from five National Health Service (NHS) ophthalmology centers and academic institutions across the United Kingdom. Participants continued to use standard spectacle correction and were randomly assigned to receive either 0.01% atropine eye drops or placebo once daily over a two-year period.¹

Of the enrolled participants, 230 completed the study. Analysis demonstrated that children receiving atropine experienced slower myopia progression than those in the placebo group. After adjustment for demographic and familial risk factors, atropine treatment was associated with an average reduction of 0.38 diopters in refractive error progression and a 0.14 mm reduction in axial elongation, both recognized indicators of worsening myopia.¹

Investigators also evaluated treatment safety and tolerability throughout the study. A slight increase in pupil diameter was observed among children receiving atropine; however, no significant differences were identified in adverse events or patient-reported symptoms such as blurred vision, ocular discomfort, itching, or difficulties with near work. These findings suggest that low-concentration atropine is generally well tolerated in paediatric patients.¹

The results are consistent with previous studies conducted in East and Southeast Asia, where low-dose atropine has emerged as one of the most effective pharmacological strategies for myopia control.^4,5 The landmark Atropine for the Treatment of Myopia (ATOM) studies demonstrated that lower atropine concentrations could slow myopia progression while minimizing adverse effects commonly associated with higher doses.⁴ Subsequent investigations, including the Low-Concentration Atropine for Myopia Progression (LAMP) study, further confirmed the efficacy of atropine in reducing refractive progression and axial elongation in children.⁵

Although the UK study reported a relatively modest treatment effect, experts note that even small reductions in myopia progression during childhood may translate into lower lifetime risks of sight-threatening complications. Recent international consensus statements have emphasized the importance of early intervention strategies, particularly in younger children with rapidly progressing myopia.^6,7

The authors mentioned several limitations, including the potential influence of behavioural changes during the COVID-19 pandemic and uncertainties regarding treatment adherence outside the controlled environment of a clinical trial. Nevertheless, they concluded that low-dose atropine could represent a valuable addition to current optical approaches used for myopia management in UK children.¹

The findings are expected to guide the future clinical guidelines and healthcare policy discussions regarding the availability of atropine therapy within the NHS. As the global burden of myopia continues to increase, effective and well-tolerated interventions remain a priority for paediatric eye care providers worldwide.^2,6

References

1. Logan NS, Gilmartin B, Wolffsohn JS, et al. Low-concentration atropine eye drops for myopia control in UK children: a randomized placebo-controlled clinical trial. BMJ. 2025.

2. Holden BA, Fricke TR, Wilson DA, Jong M, Naidoo KS, Sankaridurg P, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036-42.

3. Flitcroft DI. The complex interactions of retinal, optical and environmental factors in myopia aetiology. Prog Retin Eye Res. 2012;31(6):622-60.

4. Chia A, Chua WH, Cheung YB, Wong WL, Lingham A, Fong A, et al. Atropine for the treatment of childhood myopia: safety and efficacy of 0.5%, 0.1%, and 0.01% doses (ATOM 2). Ophthalmology. 2012;119(2):347-54.

5. Yam JC, Jiang Y, Tang SM, Law AKP, Chan JJ, Wong E, et al. Low-concentration atropine for myopia progression (LAMP) study: a randomized, double-masked, placebo-controlled trial. Ophthalmology. 2019;126(1):113-24.

6. Sankaridurg P, Tahhan N, Kandel H, Naduvilath T, Zou H, Frick KD, et al. IMI impact of myopia report. Invest Ophthalmol Vis Sci. 2021;62(5):2.

7. Walline JJ, Lindsley K, Vedula SS, Cotter SA, Mutti DO, Twelker JD. Interventions to slow progression of myopia in children. Cochrane Database Syst Rev. 2020;1:CD004916.