Parents of children with high myopia often ask which atropine strength is worth the side effects. A multicenter, double-blind randomized trial from Shanghai centers, published in Nature Communications and indexed as PMID 42957683, compared three nightly concentrations over two years.
Who was enrolled
Researchers randomized 219 children ages 6 to 12 with myopia of at least −5.0 diopters to 0.01%, 0.04%, or 0.10% atropine in both eyes once nightly. One hundred eighty-two completed the trial; analyses used the randomized groups (76, 72, and 71 children). The work was registered as NCT04699357.
Two-year spherical equivalent change
- 0.01% atropine: about −0.92 D progression
- 0.04% atropine: about −0.78 D
- 0.10% atropine: about −0.56 D
Compared with 0.01%, the 0.10% dose reduced progression by about 0.35 D (95% CI 0.12 to 0.58 D). The 0.04% dose did not differ significantly from 0.01% at 24 months, although both higher strengths looked better at the 12-month mark.
Side effects to discuss
Photophobia was the most common adverse event. At 24 months it was reported by about 7.8%, 8.1%, and 21.1% of children on 0.01%, 0.04%, and 0.10% atropine, respectively. Near blur was more noticeable early with the strongest drop and less common later. No severe adverse events were highlighted in the abstract-level report, and vision-related quality of life was described as unaffected across groups in related presentations of the same program.
How I counsel families
- Atropine is one tool alongside outdoor time, spectacle or contact options, and regular cycloplegic checks.
- Higher concentration can slow progression more in high myopes but brings more light sensitivity for some children.
- Dosing decisions belong with a clinician who follows the child’s axial length and refraction over time.
- Never share leftover drops between siblings or change strength without guidance.
Khanna Vision Institute sees children and teens for myopia evaluation and coordinates pediatric specialty care when needed. For adult eye-health reading, see laservisioncost.com.
Source: Different concentrations of atropine in children with high myopia: a 2-year multicenter double-blind, randomized controlled trial (Nature Communications / PubMed PMID 42957683, 2026). This article is an educational summary written by Khanna Vision Institute and is not a substitute for medical advice.