Low-Dose Atropine for Pediatric Myopia: First-Year Progression as a Risk-Stratification and Management Signal

Purpose: To determine whether first-year refractive progression predicts longer-term on-treatment myopia control and whether early progression guides escalation decisions and subsequent trajectories. Design:Retrospective cohort, single practice.Participants: 555 children (1,107 eyes) treated with 0.01% (93.5%) or 0.02% (6.5%) atropine for 12 months.Methods: Spherical equivalent refraction (SER) progression was annualized (D/year; positive=worse).At 12 months, eyes met or did not meet the ≤0.25 D/year threshold; children were categorized as responsive (both eyes), partially responsive (one eye), or unresponsive (neither eye).Progression was also modeled continuously (per 0.25 D/year).Escalation was defined as increasing the atropine concentration and/or adding optical therapy.Primary analyses associated 12-month response with on-treatment outcomes and progression before and after escalation.Eye-level models accounted for inter-eye correlation and baseline covariates.One-eye-per-subject sensitivity analyses were also performed. Main OutcomeMeasures: Successful control (≤0.25 D/year over on-treatment course) and change in SER progression around escalation.Results: Baseline age was 9.8±2.8years and baseline SER -2.34±2.37D. 340 (61.3%) children were responsive, 99 (17.8%)partially responsive, and 116 (20.9%) unresponsive, with successful control rates of 70%, 28%, and 17%, respectively.12month status strongly predicted whole-course successful control in bilateral GEE (OR 5.71; 95% CI 3.85-8.47)and one-eye sensitivity (OR 10.90; 95% CI 6.32-18.80)