Short-Term Choroidal and Retinal Structural Changes in Myopic Children Treated with 0.05% Atropine

Yuanfang Yang,1– 5 Zhiwei Luo,3– 5 Longbo Wen,1– 3 Wenyu Gao,3– 5 Yuexiang Deng,3– 5 Xiangzhong Tang,3– 5 Zhikuan Yang,1– 7 Xiaoning Li1– 7 1Aier Academy of Ophthalmology, Central South University, Changsha, People’s Republic of China; 2Department of Optometry, Changsha Aier Eye Hospital, Changsha, People’s Republic of China; 3Research Department, Aier Institute of Optometry and Vision Science, Aier Eye Hospital Group, Changsha, People’s Republic of China; 4Hunan Province Optometry Engineering and Technology Research Center, Changsha, People’s Republic of China; 5Research Department, Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha, People’s Republic of China; 6Aier Eye Hospital, Jinan University, Guangzhou, People’s Republic of China; 7School of Stomatology and Ophthalmology, Xianning Medical College, Hubei University of Science and Technology, Xianning, People’s Republic of ChinaCorrespondence: Xiaoning Li, Aier Academy of Ophthalmology, Central South University, Changsha, People’s Republic of China, Email lixiaoning@aierchina.com Zhikuan Yang, Aier Academy of Ophthalmology, Central South University, Changsha, People’s Republic of China, Email yangzhikuan@aierchina.comPurpose: To evaluate daily 0.05% atropine’s effects on structural changes in the choroid and retina in myopic children.Methods: This prospective cohort study included 100 children aged 6– 15 years, of whom 83 completed 6-month follow-up. Participants received either nightly 0.05% atropine eyedrops or no pharmacologic treatment (all wore single-vision spectacles). Spherical equivalent (SE) and axial length (AL) were measured, and swept-source OCT angiography was used to assess choroidal thickness (CT), retinal thickness (RT), outer retinal layer (ORL), ganglion cell layer plus inner plexiform layer (GCL+IPL), inner nuclear layer (INL), peripapillary retinal nerve fiber layer (RNFL), choroidal vascular volume (CVV), choroidal vascular index (CVI), superficial and deep vascular complexes (SVC/DVC), and nerve fiber layer vascular density (NFVD).Results: Atropine reduced myopia progression compared to controls (ΔSE: 0.11 vs − 0.30 D; ΔAL: 0.01 vs 0.17 mm; P < 0.001). In the atropine group, 55.56% showed SE improvement and 42.22% exhibited AL shortening. Significant increases were observed in macular CT, CVV, RT, ORL, GCL+IPL, INL, and peripapillary RT, ORL, and RNFL, whereas CVI, SVC, DVC, and NFVD remained unchanged. Changes in macular CT, CVV, RT, and GCL+IPL were positively correlated with ΔSE and negatively with ΔAL. Increases in ORL and peripapillary RNFL were negatively correlated with ΔAL.Conclusion: Daily 0.05% atropine not only slowed myopia progression and axial elongation but also promoted thickening of choroidal and retinal layers. These structural changes suggest partial reversal of ocular growth, supporting the therapeutic role of atropine in myopia control.Trial Registration: Chinese Clinical Trial Registry (ChiCTR2100043506, https://www.chictr.org.cn/showproj.html?proj=122214, registered 21 February 2021). This study represents a secondary analysis of the registered trial; the control group was drawn from an ethically approved observational cohort.Keywords: 0.05% atropine eyedrops, myopia control, choroid, retina, OCTA