Short-term side effects often hinder the adoption of low-dose atropine in myopia management. Evidence from long-term observations and guidance on optimal dosing frequency is needed to inform clinical practice. This study aims to evaluate the effects of 0.05% atropine on near-work-related effects, accommodation, and binocular vision over 1 year of treatment. Chinese children with myopia (aged from 6 to 14 years, cycloplegic spherical equivalent ≤ −1.00 D in both eyes) were enrolled between March 2021 and August 2023 at Changsha Aier Eye Hospital. Participants were randomly assigned to three regimen groups of 0.05% atropine: once daily (Qd), twice per week (Tw), and once per week (Qw) groups. Reported visual quality related side effects, the change of near work parameters, including visual acuity, reading distance, accommodation and binocular vision under the use of 0.05% atropine during 12 months were the main study outcomes. A total of 205 children were included in the study, 76 in Qd group, 70 in Tw group, and 59 in Qw group. Self-reported side-effects remained low in all groups, but showed frequency dependence. No cases of strabismus were reported or diagnosed. The most complaint side-effect was photophobia and blur at near (7.9% and 7.9%) at week 2 in Qd group, and both dropped to 3.9% at month 12. Pupil size under both photopic and mosopic, and viewing distance when reading consistently enlarged compared with baseline. All groups showed short-term changes in accommodation, and binocular vision, but gradually returned to baseline level by month 12. Mean (SE) of accommodation convergence to accommodation ratio (AC/A) in Qd group was 5.13(0.15), 5.82(0.16), 5.33(0.17), 5.22(0.17) Δ/D at baseline, week 2, month 6, and month 12, respectively; 5.09(0.16), 5.48(0.19), 5.42(0.19), 5.22(0.16) Δ/D in Tw group; and 4.90(0.19), 5.32(0.20), 5.17(0.19), 5.17(0.18) Δ/D in Qw group. Long-term use of 0.05% atropine appears to be safe in children with myopia. Although short-term visual function changes and side effects were associated with higher dosing frequency, these effects were largely transient and resolved over time.
Pan et al. (2025) studied this question.