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.