Objective: Myopia has reached epidemic proportions globally, with approximately 50% of the world population projected to be affected by 2050. Low-concentration atropine eye drops (0.01%, 0.025%, 0.05%) have emerged as a primary intervention for myopia control. Several meta-analyses on this topic have been published; however, none have included the most recent trials nor separately analyzed premyopia prevention outcomes. This systematic review and meta-analysis evaluates the efficacy and safety of these concentrations for myopia progression control and premyopia prevention. Methods: We searched PubMed, Web of Science, Embase, and Cochrane CENTRAL from database inception through April 2026. Randomized controlled trials (RCTs) comparing 0.01%, 0.025%, or 0.05% atropine with placebo or no treatment in children were included. Studies were screened using PICOS criteria (Population, Intervention, Comparison, Outcomes, Study design). Meta-analysis was performed using DerSimonian–Laird random-effects models. Subgroup analyses were conducted by concentration, follow-up duration, and population (myopia progression vs. premyopia prevention). Results: Of 18 full-text articles assessed, 8 RCTs (n = 1756) met all PICOS criteria and were included in the quantitative synthesis. For myopia progression, 0.01% atropine demonstrated significant efficacy at 1 year (pooled MD = +0.291 D, 95% CI: 0.199 to 0.384; p 0.025% > 0.01%). The 0.01% concentration offers a reasonable balance of efficacy and tolerability. Further independent validation of the 0.05% concentration is warranted. The premyopia prevention indication requires additional well-designed RCTs.
Wan et al. (Tue,) studied this question.