Researchers at the US National Eye Institute report that low-dose atropine eye drops may not slow myopia progression in children any more than a placebo. The study results appeared in JAMA Ophthalmology, signaling a need to reassess strategies for managing myopia in young patients.
The randomized trial enrolled 187 children between ages five and twelve who had low to moderate bilateral myopia. Participants were assigned to receive either atropine 0.01 percent eye drops or placebo eye drops, both administered at night for a period of two years. The design aimed to determine the real-world effectiveness of this low-dose treatment compared with no active medication.
Across the treatment period and through six months after stopping the drops, researchers observed no meaningful differences between the two groups in terms of how much the myopia progressed or the change in axial length of the eye. Axial elongation is a key marker linked to the worsening of myopia, so the absence of a measurable impact raises questions about the value of this particular concentration for this age group.
Traditionally, higher concentrations of atropine in the range of 0.5 to 1.0 percent have been used by pediatric eye specialists to slow myopia progression. While these higher doses can be effective, they are associated with side effects such as light sensitivity and blurred near vision, especially when used at night. This has limited their practicality for routine long-term use in children who are still developing visual and daily functioning skills.
Lower concentrations offer a better side effect profile, which sparked investigations in diverse populations. Earlier studies in East Asia suggested some benefit with low-dose regimens, but results have not always been consistent across populations. The current findings hint at potential ethnic or regional differences that might influence how a given atropine dose performs. The authors caution that these discrepancies do not close the door on low-dose strategies, but they do signal the need for further research to identify which patients might benefit most and under what dosing regimens.
Experts involved in the study emphasized that results in the United States may differ from results observed elsewhere. They call for additional work to determine whether alternative concentrations, higher or different dosing schedules, or combination therapies could produce more reliable control of myopia in American children. The mixed results across studies underscore a broader truth: myopia is a multifactorial condition influenced by genetics, environmental factors such as near work and outdoor time, and developmental timing. Tailoring interventions to individual risk profiles could prove essential in advancing care.
In the broader context of myopia management, many children experience a slowing of progression during adolescence, and some level of natural stabilization can occur by the mid-teens. Yet a notable percentage continue to develop high myopia into adulthood. By age twenty, roughly one in ten people with myopia experience some level of visual impairment, and by age twenty four, the rate drops to about four percent. These figures highlight the ongoing importance of effective, well tolerated treatments and preventive strategies for young patients as they grow toward independence in daily activities and schooling.
Given the mixed evidence, clinicians, families, and researchers are encouraged to pursue a nuanced approach. Future work may explore different concentrations, personalized dosing plans, and long-term outcomes to clarify who benefits most from atropine therapy and how to balance efficacy with quality of life for children and their families. The path forward includes refining patient selection, monitoring needs, and potential combination therapies that could complement lifestyle measures such as time spent outdoors and reduced near work.
As the science evolves, the eye health community remains committed to identifying practical, safe, and effective strategies that help children see clearly as they grow. Ongoing investigations, cross-cultural studies, and collaborative trials will be essential in shaping how myopia is managed across diverse populations and healthcare settings. Ongoing research and thoughtful clinical application together hold promise for reducing the burden of myopia in future generations. [JAMA Ophthalmology study, NEI]
Note: the historical curiosity about how scientific questions evolve, much like attempts to solve ancient puzzles in medicine, continues to drive progress. The goal remains simple and enduring: protect vision for children as they develop and learn about the world around them.