Atropine for myopia control: An evidence‑based review

Abstract

Atropine eye drops reduce myopia progression during childhood in a dose dependent manner, with greatest effect documented with lower concentrations (0.01-0.05%) and most consistent efficacy with 0.05% in longitudinal RCTs like LAMP and consistent benefits seen in ATOM and CHAMP programs. At low concentrations, the adverse effects are benign, consisting of mild pupil dilation and a small degree of accommodation loss, while higher concentrations are associated with more severe photophobia, more pronounced near fixation blur, and more substantial rebound effects on myopia progression. Continuous treatment is more effective than a treatment break (washout) during the primary school years and rebound effect can be improved by higher ages, lower concentrations, and tapering off. LAMP phase 3 and meta-analytic data provide a rationale for easing and lengthening the intervals between treatments. Practical recommendations from various countries are based on individualized (most often starting at 0.05% for fast progressors) multi-metric treatment plans and prolonged monitoring of refractive myopia and axial length, recognizing country specific regulatory frameworks and off label compounding where it applies.