Eye drops used to slow childhood nearsightedness affect vision differently by dose, review finds

A recent systematic review and meta-analysis found that atropine eye drops — increasingly used to slow myopia progression in children — produce dose-dependent effects on the eye's ability to focus up close, with higher concentrations causing more pronounced and consistent impairment of near vision.

Researchers analyzed data from 13 randomized controlled trials involving children and adolescents with myopia, most of them from Asian populations including China, Hong Kong, Singapore and India. The review was registered with PROSPERO and conducted in accordance with PRISMA 2020 reporting guidelines.

“By synthesising randomised controlled evidence and stratifying outcomes by dose and follow-up duration, this review clarifies discrepancies in previous studies and highlights the importance of balancing myopia control efficacy with preservation of visual function. The findings provide clinically relevant guidance for evidence-based atropine dosing in paediatric myopia management,” the review authors, led by Clara Martínez-Pérez, PhD, of the Applied Physics Department (Optometry Area), Facultade de Óptica e Optometría, Universidade de Santiago de Compostela, Santiago de Compostela, Spain stated.

What the researchers looked at

The review focused on accommodative amplitude — the eye's ability to adjust focus for near tasks — as its primary outcome, alongside secondary measures including stereoacuity, heterophoria and vergence function. Studies compared atropine at concentrations ranging from 0.01% to 1% against placebo or single-vision correction, with follow-up periods ranging from 24 hours to 36 months.

What they found, by dose

At the lowest concentration studied, 0.01%, the pooled reduction in accommodative amplitude was small (mean difference of −0.84 diopters) and inconsistent across follow-up periods. No significant effects were found on accommodative lag or stereoacuity at this concentration.

At intermediate concentrations of 0.02% to 0.025%, a statistically significant but variable reduction in accommodative amplitude was observed (MD = −0.92 D), with substantial heterogeneity across studies. The researchers described this range as a possible "functional transition range."

At 0.05%, reductions in accommodative amplitude were consistent and present from early follow-up through 36 months (MD = −1.96 D). This concentration was also associated with measurable changes in near heterophoria and negative fusional vergence — markers of binocular coordination.

At 0.1% and 0.5%, the effects were markedly larger. The pooled reduction at 0.1% was −9.63 diopters and at 0.5% was −11.30 diopters — both described by the authors as clinically significant impairments of accommodation during active treatment.

Data for 1% atropine came only from post-treatment follow-up, where no significant differences from control were found, suggesting accommodative function can recover after cessation.

Context and limitations

The authors noted that low-concentration atropine, particularly at 0.01%, has become standard of care for myopia control in several Asian countries. Recent evidence has contributed to a clinical shift toward 0.05% for progressive myopia in children. The review's findings support that shift carrying a functional trade-off: greater myopia control at higher concentrations comes with greater near-vision impact.

The authors flagged several limitations. Heterogeneity was substantial in several pooled analyses, particularly at low concentrations. Most included studies were conducted in Asian populations, which may limit generalizability. Accommodative outcomes were frequently secondary endpoints in the source trials, and measurement methods varied across studies.

The certainty of evidence was rated as moderate for both 0.01% and 0.05% atropine under the GRADE framework, downgraded from high due to inconsistency across follow-up periods.

The authors called for future large randomized trials with accommodative and binocular outcomes as prespecified primary endpoints, along with longer follow-up studies examining functional changes after treatment cessation.

Reference

1. Martínez-Pérez C, Santodomingo-Rubido J, and Villa-Collar C. Dose-dependent effects of atropine on accommodative and binocular visual function for myopia control in children: A systematic review and meta-analysis. Ophthalmic Physiol Opt. 2026. https://doi.org/10.1007/s44402-026-00093-5