Study demonstrates 0.025% atropine balancing efficacy and tolerability in Chinese pediatric patients

A prospective, multicenter study conducted across three tertiary eye hospitals in China found that low-dose atropine eye drops reduced myopia progression in children aged 6 to 18 years. The study followed 175 participants over 12 months, comparing nightly use of 0.01%, 0.025%, and 0.05% atropine, with outcomes focused on changes in spherical equivalent (SE) and axial length (AL) in the evaluation of the effectiveness of low-dose atropine.

The study was led by first author Hui-Xia Li of the Department of Refractive Surgery at Inner Mongolia Chaoju Eye Hospital in Hohhot, China.

All 3 concentrations were associated with reduced myopia progression. At 12 months, the 0.05% group showed the smallest change in SE (−0.27 ± 0.72 D), followed by the 0.025% group (−0.35 ± 0.59 D) and the 0.01% group (−0.44 ± 1.02 D). The difference between the 0.05% and 0.01% groups was statistically significant (P = 0.014). Axial elongation was lowest in the 0.025% group (0.21 ± 0.19 mm), though differences between groups were not statistically significant (P = 0.299).

“These findings support 0.025% atropine as a clinically optimal concentration for routine myopia management in school-aged children,” the study authors stated.

Regression analysis indicated that axial length changes were a significant predictor of refractive progression across all groups, explaining more than 34% of SE variation in the 0.025% and 0.05% groups, compared with 14% in the 0.01% group. Corneal curvature and other biometric parameters did not show significant changes over time.

No serious adverse events were reported. Photophobia was the most common side effect, occurring more frequently in the 0.05% group. A small number of cases of allergic conjunctivitis were observed, and no participants reported near vision blur.

The findings align with prior clinical trials, including the ATOM and LAMP studies, which have demonstrated a dose-dependent response to atropine in myopia control. In this real-world cohort, 0.05% atropine was associated with the greatest reduction in refractive progression, while 0.025% showed the lowest axial elongation.

“Despite compelling evidence from multi-ethnic trials, data specific to Chinese pediatric populations under real-world conditions remain limited. Furthermore, the relative effectiveness and safety profile of these concentrations across diverse clinical settings require further validation,” the study authors stated.

The study was non-randomized, with treatment allocation based on physician recommendation and parental preference. The authors note that this design may introduce selection bias and that the 12-month follow-up period may not capture long-term outcomes. They suggest that further randomized, controlled studies with longer follow-up are needed to confirm optimal dosing strategies.

Reference:

1. Li HX, Wu P, Qi WP, et al. Real-world evidence for atropine titration in myopia control: A comparative study of three low-dose regimens in Chinese children. Front Pharmacol. 2026;17. https://doi.org/10.3389/fphar.2026.1716698