Real-world evidence for atropine titration in myopia control: a comparative study of three low-dose regimens in Chinese children

Purpose: To evaluate and compare the efficacy of 0.01%, 0.025%, and 0.05% atropine eye drops in slowing myopia progression among Chinese children aged 6-18 years, focusing on changes in spherical equivalent (SE) and axial length (AL). Methods: In this prospective, real world based, multi-center study, 175 children with myopia were followed for 12 months at three tertiary ophthalmic hospitals in China. Participants received nightly instillations of 0.01%, 0.025%, or 0.05% atropine in affected eyes. Primary outcomes included changes in SE and AL. Secondary outcomes involved corneal curvature, intraocular pressure, and biometric parameters. Statistical analyses included repeated-measures ANOVA, linear regression, and seemingly unrelated regression models. Results: All three concentrations demonstrated effectiveness in reducing myopia progression. At 12 months, SE progression was lowest in the 0.05% group (-0.27 ± 0.72 D), followed by 0.025% (-0.35 ± 0.59 D) and 0.01% (-0.44 ± 1.02 D), with a significant difference between 0.05% and 0.01% (P = 0.014). AL elongation was numerically lowest in the 0.025% group (0.21 ± 0.19 mm), while differences among groups were not statistically significant (P = 0.299). Regression analysis showed that AL change explained over 34% of SE variation in the 0.025% and 0.05% groups, compared to 14% in the 0.01% group. Conclusion: Low-concentration atropine is effective in controlling myopia progression in children. Among the three concentrations, 0.025% atropine offers better efficacy and tolerability, providing comparable axial elongation control to 0.05% with potentially fewer side effects. These findings support its use as a first-line pharmacologic option for pediatric myopia management in clinical practice.