Trends in real‐world atropine prescribing for myopia control across evidence eras

Purpose Identify trends in atropine prescribing and concentration adjustments for pediatric myopia control across multiple U.S. academic eye centers. Methods A multicenter, retrospective chart review was conducted of children (ages 3–17 years) prescribed low‐concentration atropine for myopia management at three academic medical centers in the United States: the Casey Eye Institute, Oregon Health & Science University, the Ann & Robert H. Lurie Children's Hospital of Chicago, and the Rady Children's Hospital Orange County. Descriptive statistics were used to characterize the data and summarize prescribing patterns, concentration changes, and follow‐up rates by enrollment period and initial atropine concentration. Results A total of 435 patients were identified across all study sites. In the Early Low‐Dose Atropine Era, 0.01% atropine was the only starting concentration prescribed. Prescribing subsequently shifted toward higher concentrations. Prescribing of 0.05% atropine increased substantially, accounting for 45.7% of baseline prescriptions. Across subsequent evidence eras, changes in concentration increased in frequency, with greater concentration escalation over time, and these increases were most frequent during the Post‐LAMP Era (24.4%). Conclusions A clear shift in atropine prescribing patterns for pediatric myopia management was identified over the course of the study period. During the Early Low‐Dose Atropine Era, clinicians exclusively prescribed the lowest concentration of atropine (0.01%), and only a small proportion of patients were escalated to a higher concentration at 12 months. In the Post‐LAMP Era, there was a broader distribution of baseline dosing, with increased use of 0.02%/0.025% and 0.05% atropine and a higher proportion of patients having concentration increases. During the Contemporary Evidence Era, 0.05% became the predominant starting concentration. The shifts in prescribing patterns highlight the dynamic and responsive nature of clinical decision‐making and underscore a growing trend toward comfortability with personalized myopia management in pediatric eye care, suggesting evolving individualized titration strategies and experimental dosage management methods.