What are atropine eye drops for myopia control and are they safe?

TLDR: Low-dose atropine eye drops (0.01 to 0.05 percent) are an evidence-based myopia control treatment that slows axial elongation by 50 to 77 percent with minimal side effects, and they are considered safe for long-term use in children when monitored by a qualified optometrist.

What Is Atropine and How Is It Used for Myopia?

Atropine is a muscarinic receptor antagonist — a medication that blocks a class of nerve receptors (muscarinic receptors) throughout the body. In ophthalmology, full-strength atropine (1 percent concentration) has been used for decades as a dilating agent for eye exams and as a treatment for amblyopia (lazy eye) in the fellow eye. At 1 percent concentration, it produces maximal pupil dilation and complete relaxation of the eye's focusing system (cycloplegia), lasting several days.

More recently, atropine has been repurposed in much lower concentrations specifically for myopia control. Research beginning in the 1990s and accelerating through the ATOM (Atropine for the Treatment of Myopia) studies conducted in Singapore established that even very low doses of atropine — 0.01 to 0.05 percent — can meaningfully slow myopia progression in children without the significant side effects associated with full-strength atropine.

The mechanism by which atropine slows myopia is not yet fully understood, which is somewhat unusual for a medication in widespread clinical use. Early theories focused on the accommodation system (blocking accommodation to reduce near-work stress on the eye), but studies have shown that atropine controls myopia even in eyes that cannot accommodate (such as eyes after certain surgeries), suggesting the mechanism is retinal or scleral rather than purely accommodative. Current research points to effects on the retina's dopamine system and on the biomechanics of the sclera — the outer coating of the eyeball — as likely mechanisms.

The Evidence Base: ATOM and LAMP Studies

The clinical evidence for low-dose atropine in myopia control is substantial and growing. The ATOM2 study, conducted in Singapore, compared concentrations of 0.5 percent, 0.1 percent, and 0.01 percent atropine over two years, followed by a washout period. Results showed that 0.01 percent atropine slowed myopia progression by approximately 50 percent compared to placebo over two years, with minimal side effects and — critically — no significant rebound when treatment was stopped, unlike the higher concentrations.

The LAMP (Low-concentration Atropine for Myopia Progression) study, conducted in Hong Kong, compared 0.05 percent, 0.025 percent, and 0.01 percent atropine. After one year, the 0.05 percent group showed the strongest effect — approximately 67 percent reduction in progression and 51 percent reduction in axial elongation compared to placebo. The LAMP2 study confirmed the 0.05 percent dose as the most effective low-dose option, balancing efficacy with side effects. These studies have made low-dose atropine — particularly 0.05 percent — a leading option in myopia control protocols worldwide.

Safety and Side Effects

The safety profile of low-dose atropine is one of the most reassuring aspects of its use in children. At the 0.01 to 0.05 percent range, side effects are generally mild and manageable. The most common effect is mild pupil dilation — less than 1 mm increase at 0.01 percent — and a slight decrease in near focusing ability. Most children using these concentrations do not require bifocal glasses to compensate for near blur, and light sensitivity is usually minimal.

At 0.05 percent, some children experience slightly more pupil dilation and near blur, and photochromic (light-reactive) glasses or sunglasses may be helpful for outdoor light sensitivity. These effects are dose-dependent — they are greater at higher concentrations and minimal at the lowest doses.

Long-term safety data is reassuring. Studies with up to five years of follow-up have not shown any concerning cumulative effects on the retina, pupil reactivity, or intraocular pressure. The drops are used once daily at bedtime, which further minimizes daytime visual side effects since the peak pupil effect occurs during sleep. Regular monitoring by an optometrist is standard practice to ensure ocular health is maintained throughout treatment.

How Atropine Is Used in Practice

Low-dose atropine is typically prescribed as one drop in each eye at bedtime, seven nights per week. The drops are commercially available in some countries; in the United States and Canada, they are most often compounded by specialized pharmacies to the prescribed concentration (0.01 percent, 0.025 percent, or 0.05 percent). The compounded drops require refrigeration and have a limited shelf life, typically 30 to 90 days.

Atropine is frequently used in combination with other myopia control strategies — orthokeratology, MiSight lenses, or Stellest glasses — particularly in children with rapidly progressing myopia. The combination approach has been shown in some studies to produce additive benefits beyond either treatment alone. The decision to use atropine alone or in combination depends on the child's rate of progression, current prescription, age, and the family's preferences.

Follow-up visits every 6 months are standard during atropine therapy to measure axial length (the gold standard measure of myopia progression), monitor vision, assess side effects, and adjust the concentration if needed. If progression is well-controlled, the same concentration is continued. If progression continues despite treatment, the concentration may be increased or a second modality added.

Is Atropine Right for Your Child?

Low-dose atropine is appropriate for a wide range of myopic children, including those who are not candidates for contact lens-based myopia control (due to age, lens intolerance, or parental preference), those who need additional control on top of another modality, and those with rapidly progressing myopia who require the most aggressive management available.

The prescription and monitoring of atropine for myopia control should be guided by a knowledgeable optometrist who specializes in myopia management. The choice of dose, whether to combine with another treatment, and how long to continue therapy are all individualized decisions that require clinical judgment and regular re-evaluation. When used appropriately, low-dose atropine is one of the most effective tools in the pediatric optometrist's toolkit for protecting children's long-term eye health.

Ready to Protect Your Child's Vision?

At Lumen Vision, we specialize in pediatric optometry, vision therapy, and myopia control. Our team is passionate about catching vision problems early and giving every child the visual foundation they need to thrive. We proudly serve families across the region with comprehensive, compassionate eye care.

Call us at 701-404-9096, visit us online at www.lumen.vision, or schedule your child's appointment directly at scheduleyourexam.com/v3/index.php/6654.