Low-Dose Atropine: Where Are We Now?

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Get an in-depth look at the current state of low-dose atropine for myopia management. 

March 16, 2026

By Huy Tran and Nguyen Nguyen

The global rise in myopia prevalence necessitates effective management strategies to slow its progression. Among available interventions, atropine has demonstrated one of the highest levels of efficacy.¹ Unlike high-dose atropine (≥ 0.1%), which can cause significant ocular side effects, low-dose atropine (0.01-0.05%) provides effective myopia control with minimal and tolerable adverse effects.² 

Current research

Recent large-scale randomized controlled trials have significantly refined our understanding of low-dose atropine. The landmark ATOM2 (Atropine for the Treatment of Myopia 2) study initially suggested that 0.01% atropine was the optimal dose for balancing efficacy and safety with minimal rebound compared to higher doses of 0.1% and 0.5%.³ The more recent LAMP (Low-Concentration Atropine for Myopia Progression) study, which provided a head-to-head comparison of 0.05%, 0.025% and 0.01% atropine, demonstrated a clear concentration-dependent response. Over two years, 0.05% atropine appeared to be the optimal concentration, with significantly greater efficacy in controlling myopia progression compared with 0.01% atropine, and in reducing axial elongation than lower concentrations,^{4, 5} especially in the younger ages.⁶

Long-term data from LAMP Phase 3 and Phase 4 confirmed that continued treatment provided superior efficacy compared to a washout regimen, and the efficacy outcomes remained comparable whether treatment was maintained continuously or restarted after washout.^7,8 Furthermore, stopping treatment at an older age and lower concentration was associated with smaller rebound effects.⁷ Clinical findings from Phase 5 supported a gradual tapering strategy over abrupt discontinuation, providing better myopia control during the washout years.⁹ 

Regarding the prevention for myopia onset, the LAMP2 trial suggested that 0.05% atropine significantly reduced the two-year cumulative incidence of myopia in non-myopic children aged between 4 and 9 years (defined in the study as having cycloplegic spherical equivalent between +1.00D and 0.00D, astigmatism less than -1.00D and at least one parent has myopia of -3.00D or greater) compared with placebo, whereas 0.01% did not show a statistically significant difference.¹⁰ 

Safety profile

Low-dose atropine appears to be well-tolerated, with adverse effects showing a clear concentration-dependent relationship. Common ocular side effects include photophobia due to pupillary mydriasis and blurred near vision secondary to reduced accommodative amplitude.

Recent meta-analyses confirmed that while high-dose atropine resulted in substantial visual side effects, low concentrations (0.01-0.05%) had a more favorable safety profile with tolerable side effects.¹¹ In the LAMP study, 0.05% atropine induced a mean photopic pupil dilation of approximately 1.03 mm and reduced accommodation amplitude by around 1.98D; however, these changes did not significantly affect visual acuity or vision-related quality of life.⁴ Importantly, these effects were reversible, with both pupil size and accommodation returning to baseline after treatment cessation. Allergic conjunctivitis and other adverse events occurred infrequently and at similar rates across low concentrations.⁷ 

Clinical implementation

In clinical practice, atropine can be used as monotherapy or as part of combination therapy. For monotherapy, younger age is associated with a poorer treatment response; therefore, a higher starting concentration of 0.05% is recommended for younger children to achieve efficacy comparable to what is observed in older children with lower concentrations.⁶ In contrast, a specific recommended concentration for combination therapy has not yet been standardized, as various studies have demonstrated efficacy using concentrations ranging from 0.01% to 0.05%. 

Regarding specific interventions, recent evidence indicated that adding Highly Aspherical Lenslet Target (HALT) lenses for children who responded poorly to atropine monotherapy significantly reduced myopic shift by -0.15D and axial elongation by 0.14mm over one year.¹² Similarly, combining Defocus Incorporated Multiple Segments (DIMS) lenses with either 0.01% or 0.025% atropine provided an additive effect.^13,14 Compared with DIMS alone, the combination of DIMS and 0.01% atropine reduced axial elongation with greater efficacy by 0.07mm per year.^13,14 Furthermore, a randomized controlled trial reported that 39.6% of the children receiving 0.025% atropine together with DIMS showed no axial elongation over 12 months, compared with 12.2% of those treated with atropine alone.^13,14

Likewise, combining 0.01% atropine with orthokeratology reduced axial elongation more effectively than OrthoK alone, and increasing the concentration (e.g., to 0.05%) may be considered to further optimize control in fast progressors or younger children.^15,16

Additionally, the combination of low-dose atropine with multifocal or dual-focus contact lenses also shows potential in enhancing control for inadequate responders.^17,18 However, combining atropine with repeated low-level red-light (RLRL) therapy should be avoided due to safety concerns, as atropine-induced pupil dilation may increase retinal light exposure.     

 

 

Conclusion

Although questions remain regarding the optimal duration of treatment, the best cessation strategy, the lack of compliance control and the status of off-label prescription in many parts of the world, low-dose atropine stands as the only evidence-based pharmaceutical option for children to control the progression of myopia. Current data identifies 0.05% as the most effective concentration, significantly reducing both axial elongation and refractive progression with minimal and tolerable side effects. Being prescribed as either monotherapy or combination therapy enables clinicians to individualize management based on patient characteristics and treatment response. 

 

Huy Tran, MD, PhD, is a lecturer at the Pham Ngoc Thach University of Medicine, senior ophthalmologist at the Department of Refraction, Ho Chi Minh City Eye Hospital, and also the Head of the Myopia Control Clinic at Hai Yen Eye Care, Ho Chi Minh City, Vietnam. Moreover, he serves as the Asia-Pacific Ambassador for the International Myopia Institute, and he actively contributes to shaping global strategies for myopia management.

Nguyen Nguyen, MD, is an ophthalmology resident at the University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam. Her clinical and research interests are in pediatric ophthalmology and myopia management.

 

References

1. Lawrenson, J.G., et al., Interventions for myopia control in children: a living systematic review and network meta‐analysis. Cochrane Database of Systematic Reviews, 2023(2).
2. Huang, J., et al., Efficacy comparison of 16 interventions for myopia control in children: a network meta-analysis. Ophthalmology, 2016. 123(4): p. 697-708.
3. Chia, A., Q.-S. Lu, and D. Tan, Five-year clinical trial on atropine for the treatment of myopia 2: myopia control with atropine 0.01% eyedrops. Ophthalmology, 2016. 123(2): p. 391-399.
4. Yam, J.C., et al., Low-concentration atropine for myopia progression (LAMP) study: a randomized, double-blinded, placebo-controlled trial of 0.05%, 0.025%, and 0.01% atropine eye drops in myopia control. Ophthalmology, 2019. 126(1): p. 113-124.
5. Yam, J.C., et al., Two-year clinical trial of the low-concentration atropine for myopia progression (LAMP) study: phase 2 report. Ophthalmology, 2020. 127(7): p. 910-919.
6. Li, F.F., et al., Age effect on treatment responses to 0.05%, 0.025%, and 0.01% atropine: low-concentration atropine for myopia progression study. Ophthalmology, 2021. 128(8): p. 1180-1187.
7. Yam, J.C., et al., Three-year clinical trial of low-concentration atropine for myopia progression (LAMP) study: continued versus washout: phase 3 report. Ophthalmology, 2022. 129(3): p. 308-321.
8. Zhang, X.J., et al., Five-year clinical trial of the low-concentration atropine for myopia progression (LAMP) study: phase 4 report. Ophthalmology, 2024. 131(9): p. 1011-1020.
9. Yam, J., et al., Seven-Year Clinical Trial of Low-concentration Atropine for Myopia Progression (LAMP1) Study: Phase 5 Report. Investigative Ophthalmology & Visual Science, 2025. 66(8): p. 918-918.
10. Yam, J.C., et al., Effect of low-concentration atropine eyedrops vs placebo on myopia incidence in children: the LAMP2 randomized clinical trial. JAMA, 2023. 329(6): p. 472-481.
11. Gong, Q., et al., Efficacy and adverse effects of atropine in childhood myopia: a meta-analysis. JAMA Ophthalmology, 2017. 135(6): p. 624-630.
12. Sim, B.X., et al., Additive Effect of Highly Aspherical Lenslet Target Spectacles to Children Inadequately Controlled by Atropine Monotherapy. Ophthalmology Science, 2025. 5(4): p. 100753.
13. Tang, T., et al., Comparison of the long-term effects of atropine in combination with Orthokeratology and defocus incorporated multiple segment lenses for myopia control in Chinese children and adolescents. Eye, 2024. 38(9): p. 1660-1667.
14. Guemes-Villahoz, N., et al., Atropine and Spectacle lens Combination Treatment (ASPECT): 12-month results of a randomised controlled trial for myopia control using a combination of Defocus Incorporated Multiple Segments (DIMS) lenses and 0.025% atropine. British Journal of Ophthalmology, 2025. 109(9): p. 1074-1080.
15. Wen, L., et al., Add-on effect of using 0.05% atropine in fast progressors of orthokeratology: A preliminary retrospective study. Contact Lens and Anterior Eye, 2025. 48(1): p. 102282.
16. Cao, X., et al., Effect of 0.01% atropine eye drops combined with different optical treatments to control low myopia in Chinese children. Contact Lens and Anterior Eye, 2025. 48(1): p. 102317.
17. Jones, J.H., et al., Effect of combining 0.01% atropine with soft multifocal contact lenses on myopia progression in children. Optometry and Vision Science, 2022. 99(5): p. 434-442.
18. Yum, H.R., et al., Synergistic effect of dual-focus soft contact lenses and 0.05% atropine on myopia control in children with rapidly progressing myopia. Eye & Contact Lens, 2025. 51(2): p. 92-97

 

Read more about pharmaceutical interventions for myopia here