On atropine drops, fewer children on the edge of myopia crossed over

On 24 October 2026 the Asia-Pacific Journal of Ophthalmology published a trial from Shanghai primary schools that asked whether atropine eye drops can keep short-sightedness (myopia) from starting at all. Between March 2023 and December 2024, 428 children aged 6 to 10 with pre-myopia — a cycloplegic refraction (measured after drops that temporarily relax focusing) between −0.50 and +0.75 dioptres — were randomly assigned to one of three low concentrations of atropine or to placebo drops. The trial was double-blind and lasted 12 months; children with eye or systemic diseases, or already using another myopia-control method, were excluded.

Three concentrations, one narrow trend

The main analysis included 395 children (92% of those randomised). Myopia, defined as −0.50 dioptres or worse in the worse eye, appeared within a year in 39.0% of the placebo group and in 29.4%, 26.9% and 25.8% of the three atropine groups, from weakest to strongest. The trend across concentrations was statistically significant, if only narrowly (p = 0.044); the summary does not report whether each concentration on its own beat placebo on this outcome. The shift in refraction toward myopia also shrank as the concentration rose, and the strongest drops differed clearly from placebo. Adverse events were reported about equally often in all four groups.

Eye length did not follow the same pattern

The researchers also measured axial length, the distance from the front to the back of the eye, as a secondary outcome. Unlike refraction, it showed no significant trend across concentrations (p = 0.418). The abstract does not explain why the two measures diverged; the authors call the evidence preliminary.

Children aged 8 to 10 showed the clearest effect

In a subgroup analysis of children aged 8 to 10, every concentration significantly reduced both new myopia and refractive progression. This was a subgroup analysis, not the trial's main question, and the abstract does not give the size of the subgroup.

A Hong Kong trial pointed the same way

The question is not new. In the LAMP2 trial, published in JAMA in 2023, 474 non-myopic children aged 4 to 9 in Hong Kong received one of two low concentrations of atropine or placebo for two years. Myopia developed in 28.4% on the higher concentration, 45.9% on the lower and 53.0% on placebo; only the higher concentration differed significantly from placebo on that outcome. The Shanghai trial tested three concentrations in a different age range (6–10 rather than 4–9 years) and for half as long.

A year of follow-up leaves the key questions open

The study ran for 12 months in children attending primary schools in one city, Shanghai. It does not show whether atropine prevents myopia or only postpones it, whether treated children end up less short-sighted as adults, or what happens after the drops are stopped. The published summary does not say who funded the trial. The authors conclude that larger, longer trials are needed before an optimal concentration can be recommended.

For now the result is a signal rather than a ready answer: in children on the edge of myopia, a year of atropine drops was followed by fewer new cases than placebo, while eye length showed no trend across concentrations. If your child's eye checks show refraction drifting toward myopia, whether drops make sense is a question to discuss with a paediatric ophthalmologist.

This material is for information only and does not replace a consultation with a doctor.

Sources

• Wang J, Jia X, Jing G, et al. Effect of 0.01%, 0.02% and 0.04% atropine eyedrops vs placebo on myopia incidence in pre-myopic children: a randomized clinical trial. Asia-Pacific Journal of Ophthalmology. 2026:100383. PMID 42918548 · DOI 10.1016/j.apjo.2026.100383

• Yam JC, Zhang XJ, Zhang Y, et al. Effect of low-concentration atropine eyedrops vs placebo on myopia incidence in children: the LAMP2 randomized clinical trial. JAMA. 2023;329(6):472-481. PMID 36786791 · DOI 10.1001/jama.2022.24162