Premyopia Progression and Low-Dose Atropine Intervention in Children with Unilateral Myopia

PURPOSE: To compare refractive progression between myopic and premyopic eyes within the same children and evaluate the potential role of low-dose atropine on premyopia progression. METHODS: This 12-month randomized controlled trial enrolled children aged 4-12 years with one myopic and one premyopic eye. Participants were assigned to three groups: no atropine intervention (NI), 0.01% atropine in myopic eye (MI), or bilateral intervention (BI). Spherical equivalent (SE) and axial length (AL) were measured at 3-month intervals. Linear mixed-effects models included all randomized participants, while generalized estimating equations with multiple imputation and Cox regression assessed myopic shift (ΔSE ≤ -0.50 D/year) and myopia onset. RESULTS: < 0.001) were associated with a lower hazard of myopia onset. CONCLUSIONS: Untreated myopic eyes showed greater SE progression and AL elongation than their fellow premyopic eyes. 0.01% atropine treatment showed a potential effect in reducing myopic shift and incidence. Meanwhile, the management should be individualized according to baseline refraction and documented progression.