Eight-Year Results From the LAMP Trial

Share

Tweet

Share

Share

Email

April 1, 2026

By Kevin Chan, OD, MS, FAAO, IACMM

Low-dose atropine (LDA) has emerged as a cornerstone pharmacologic therapy for controlling pediatric myopia progression, with a growing body of randomized clinical trial evidence demonstrating its efficacy, safety and durability when used over multiple years. In particular, LDA at 0.05% has shown the most consistent benefits in regulating axial length growth in longitudinal studies like the Low-Concentration Atropine for Myopia Progression (LAMP) clinical trials. 

Nevertheless, abrupt cessation of LDA therapy has been associated with rebound phenomenon characterized by accelerated myopia progression and axial elongation, particularly in younger patients and those with higher baseline myopia. Emerging long-term data indicates that gradual, stepwise tapering of atropine prior to discontinuation can affect recalibration of muscarinic receptors in the eye, resulting in less rebound effects compared with sudden withdrawal. This suggests that modulation of LDA therapy can potentially impact certain levels of the growth signaling pathway of the retina and sclera. In other words, tapering is increasingly viewed as an integral step for long-term LDA management for patients.  

Objectives

Zhang et al. aimed to investigate the following key questions: 

1. Does atropine at 0.05% warrant a tapering regimen for patients, particularly those at high risk? 
2. How do the results differ between the tapered group vs. the sudden withdrawal group? 
3. What clinical impact does the research show in terms of refractive and axial length growth over time? 

Clinical Design and Methodology

• Randomized controlled clinical trial that followed children aged 4 to 12 years originally enrolled in the LAMP study (n=246).
• After completing five consecutive years of atropine treatment, participants who were still receiving atropine were randomized in a 1:1 ratio into either a “Taper” or “Complete withdrawal” group (data were stratified by age, sex and spherical equivalent).
• “Taper” group – This group was administered 0.05% atropine daily in the first six months starting in year six This was followed by 0.025% atropine daily for the following six months. 
• “Cessation” group – This group was administered 0.05% atropine daily for a full year in year six, followed by abrupt cessation.
• Both groups received no treatment for the next two years (year seven and eight). 
• 180 subjects (73.2%) were followed up through year eight. 

Key Measuring Outcomes 

Changes in spherical equivalent (SE) and axial length (AL) elongation were examined. Outcomes were assessed over the three-year period encompassing pre- and post-discontinuation follow-up. In the study, the author defined a “good response” to discontinuation as “less than −0.50 diopters of SE progression in both eyes” during the discontinuation period.

Clinical Results

This study represents the LONGEST (spanned eight years) randomized clinical trial of atropine cessation strategies in pediatric myopia thus far. Children in the “Taper” group demonstrated significantly less changes in SE (−0.54D) compared with the “Cessation” group (−0.78D), and axial length elongation was also slower in the taper group (0.33 mm vs 0.44 mm; 95% CI, −0.19 to −0.03 mm; P = .01).

In general, a greater proportion of participants in the “Taper” group met criteria for a good response to treatment discontinuation compared with the stop group (65.1% vs 42.6%). Notably, patients of younger age and with greater severity of myopia, or longer axial length at the pre-cessation stage, were associated with faster progression after cessation in both groups.

Upon the eighth  year of follow-up in the study, the data revealed that a longer treatment duration with 0.05% atropine has been protective for myopia progression, with each additional year of treatment associated with 0.22D less SEP (95% CI, 0.04-0.41, P = .02) and 0.07 mm less AL elongation (95% CI, −0.13 to −0.02, P = .01) over eight years.

 

 

Clinical Pearls and Practical Merits

1. Tapering low-concentration atropine prior to cessation resulted in LESS rebound myopia progression compared to abrupt cessation. (i.e. Tapering regimen is strongly advised for at-risk patients.)
2. Children of younger age and with greater severity of myopia tend to show more rapid progression; therefore, they  benefit more from the taper approach.
3. The decision to stop an atropine regimen is crucial and should be PERSONALIZED, but not age-based alone. Prudent conversation with patients and their families and strategic follow-up for a minimum of two years is highly warranted. 

Caveats

Despite robust statistical significance, the between-group difference in myopia progression over three years was 0.24–0.25D, which can be considered as inadequate clinically. The authors did acknowledge that the clinical relevance of this magnitude can be uncertain, particularly when weighed against treatment burden, cost and adherence considerations.

The proportions of the enrolled participants in the study that completed the entire eight-year follow-up was shown to be less than 80%. This can raise the uncertainty of whether children with faster progression or poorer adherence could be underrepresented in the later stage of the follow-up period. 

Interestingly, there was no parallel untreated control group used between year six to eight. In other words, the absolute magnitude of rebound relative to natural history cannot be precisely determined; rather, only the relative difference between discontinuation strategies were examined. 

In addition, there was also limited generalizability since the participants in this study were predominantly Chinese children recruited from a single geographic and health care setting. Further exploration is warranted for children of other ethnicities. 

Abstract

Discontinuation Approach and Follow-Up of Low-Concentration Atropine for Myopia Progression: Eight-Year Results of the LAMP Randomized Clinical Trial

Yuzhou Zhang, PhD; Xiu Juan Zhang, PhD; Ebenezer Zaabaar, PhD, et al.

Importance

Some but not all clinical trials have found 0.05% atropine effective for myopia control; however, discontinuation management remains unclear.

Objective

To evaluate a taper vs stop treatment discontinuation approach.

Design, Setting and Participants

This randomized clinical trial involved children aged 4 to 12 years originally from the Low-Concentration Atropine for Myopia Progression (LAMP) study who were followed up for 8 years. All children who completed year 5 follow-up and were receiving atropine treatment were randomized into taper and stop groups at a 1:1 ratio.

Interventions

During the pre-discontinuation period (year 6), participants in the taper group received 0.05% atropine for 6 months and then 0.025% atropine for another 6 months, while the stop group received 0.05% atropine eye drops for a full year. During the discontinuation period (years 7 and 8), all participants stopped the treatment and were monitored for 2 years.

Main Outcomes and Measures

Myopia progression in the taper and stop groups over 3 years; proportion of good response to treatment discontinuation, defined as spherical equivalent (SEP) progression −0.5 diopter (D) or more in both eyes during the discontinuation period; and associated factors with myopia progression over 3 years.

Results

Among 246 children who completed the year 5 follow-up, 180 children (73.2%) went on to complete 8 years of follow-up. The mean (SD) age was 13.47 (1.63) years; there were 139 male children (56.5%) and 107 female (43.5%). Over 3 years, SEP and axial length (AL) elongation were faster in the stop group than in the taper group: –0.78 D vs –0.54 D, respectively (difference, −0.24 D; 95% CI, −0.46 to −0.03 D; P = .02) and 0.44 mm vs 0.33 mm, respectively (difference, 0.11; 95% CI, 0.03 to 0.19 D; P = .01). The proportion of good response to treatment discontinuation in the taper group was greater than in the stop group (65.1% vs 42.6%, respectively; P = .003). Younger age and more myopic spherical equivalent/longer AL at prediscontinuation were associated with faster SEP and AL elongation over 3 years. Notably, the younger the age and the more myopic the spherical equivalent, the greater the estimated mean differences of SEP/AL elongation between the taper and stop groups.

Conclusions and Relevance

This study found that over 3 years, the participants in the taper group had less myopia progression than the stop group, particularly in children who were younger and had more myopia. However, to our knowledge, the clinical relevance of this approximately 0.25-D difference between treatment groups is not well understood from the current medical literature.

DOI: 10.1001/jamaophthalmol.2026.0436

 

Read more of the latest myopia research here