Advances in Low-Concentration Atropine and Optical Interventions for Myopia Control

Authors

  • Weixing Xu People's Hospital of Zhengzhou University Author
  • Yan Zhang The Second Affiliated Hospital of Nanjing Medical University Author

DOI:

https://doi.org/10.71204/h4ject27

Keywords:

Myopia Control, Low-concentration atropine, Orthokeratology, Defocus Incorporated Multiple Segments (DIMS), Combination Therapy

Abstract

Myopia has become a global public health challenge, with its prevalence reaching epidemic proportions in recent decades, particularly in East Asian countries. This comprehensive review synthesizes recent evidence from clinical studies and meta-analyses to examine the efficacy and safety of low-concentration atropine and optical interventions for controlling myopia progression in children and adolescents. We show that low-concentration atropine (specifically 0.01%, 0.025%, and 0.05%) effectively slows myopia progression with a favorable safety profile. Furthermore, we evaluate optical interventions including orthokeratology (Ortho-K), Defocus Incorporated Multiple Segments (DIMS) spectacles, and peripheral progressive addition lenses. Emerging evidence suggests that combination therapy, integrating low-concentration atropine with an optical intervention, may yield superior effects compared to either modality alone. This review also discusses key issues such as treatment personalization, long-term adherence, and future research directions, providing evidence-based insights for clinicians managing childhood myopia.

References

Arumugam, B., & McBrien, N. A. (2012). Muscarinic antagonist control of myopia: Evidence for M4 and M1 receptor-based pathways in the inhibition of experimentally induced axial myopia in the tree shrew. Investigative Ophthalmology & Visual Science, 53, 5827–5837.

Bullimore, M. A., & Brennan, N. A. (2019). Myopia control: Why each diopter matters. Optometry and Vision Science, 96, 463–465.

Chia, A., Lu, Q. S., & Tan, D. (2016). Five-year clinical trial on atropine for the treatment of myopia 2: Myopia control with atropine 0.01% eyedrops. Ophthalmology, 123, 391–399.

Chua, W. H., Balakrishnan, V., Chan, Y. H., Tong, L., Ling, Y., Quah, B. L., & Tan, D. (2006). Atropine for the treatment of childhood myopia. Ophthalmology, 113, 2285–2291.

Flitcroft, D. I. (2012). The complex interactions of retinal, optical and environmental factors in myopia aetiology. Progress in Retinal and Eye Research, 31, 622–660.

Holden, B. A., Fricke, T. R., Wilson, D. A., Jong, M., Naidoo, K. S., Sankaridurg, P., Wong, T. Y., Naduvilath, T. J., & Resnikoff, S. (2016). Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology, 123, 1036–1042.

Jiang, Y., Zhu, Z., Tan, X., Kong, X., Zhong, H., Zhang, J., Xiong, R., Yuan, Y., Zeng, J., Morgan, I. G., & He, M. (2022). Effect of repeated low-level red-light therapy for myopia control in children: A multicenter randomized controlled trial. Ophthalmology, 129, 509–519.

Lam, C. S. Y., Tang, W. C., Tse, D. Y., Lee, R. P. K., Chun, R. K. M., Hasegawa, K., Qi, H., Hatanaka, T., & To, C. H. (2020). Defocus incorporated multiple segments (DIMS) spectacle lenses slow myopia progression: A 2-year randomised clinical trial. British Journal of Ophthalmology, 104, 363–368.

Lee, S. H., Tsai, P. C., Chiu, Y. C., Wang, J. H., & Chiu, C. J. (2024). Myopia progression after cessation of atropine in children: A systematic review and meta-analysis. Frontiers in Pharmacology, 15, 1343698.

Perea-Romero, J., Signes-Soler, I., Badenes-Ribera, L., & Tauste, A. (2025). Efficacy of spectacle lenses specifically designed for myopia control: Systematic review and meta-analysis. Graefe's Archive for Clinical and Experimental Ophthalmology, 263, 909–924.

Sun, Y., Xu, F., Zhang, T., Liu, M., Wang, D., Chen, Y., & Liu, Q. (2015a). Correction: Orthokeratology to control myopia progression: A meta-analysis. PLoS ONE, 10, e0130646.

Sun, Y., Xu, F., Zhang, T., Liu, M., Wang, D., Chen, Y., & Liu, Q. (2015b). Orthokeratology to control myopia progression: A meta-analysis. PLoS ONE, 10, e0124535.

Tan, Q., Ng, A. L., Cheng, G. P., Woo, V. C., & Cho, P. (2019). Combined atropine with orthokeratology for myopia control: Study design and preliminary results. Current Eye Research, 44, 671–678.

Tedja, M. S., Wojciechowski, R., Hysi, P. G., Eriksson, N., Furlotte, N. A., et al. (2018). Genome-wide association meta-analysis highlights light-induced signaling as a driver for refractive error. Nature Genetics, 50, 834–848.

Wu, P. C., Chuang, M. N., Choi, J., Chen, H., Wu, G., Ohno-Matsui, K., Jonas, J. B., & Cheung, C. M. G. (2019). Update in myopia and treatment strategy of atropine use in myopia control. Eye, 33, 3–13.

Xu, S., Wang, M., Qu, Y., Wang, Y., Jiang, J., Zhou, F., Zhao, W., Zheng, B., Chen, W., Lei, X., Li, Z., Hu, Y., & Yang, X. (2025). Twice-daily administration improves the effectiveness of 0.01% atropine for controlling myopia in slowing axial elongation and refractive progression. Ophthalmic and Physiological Optics, 45, 1856–1866.

Yam, J. C., Jiang, Y., Tang, S. M., Law, A. K. P., Chan, J. J., Wong, E., Ko, S. T., Young, A. L., Tham, C. C., Chen, L. J., & Pang, C. P. (2019). Low-concentration atropine for myopia progression (LAMP) study: A randomized, double-blinded, placebo-controlled trial of 0.05%, 0.025%, and 0.01% atropine eye drops in myopia control. Ophthalmology, 126, 113–124.

Yam, J. C., Li, F. F., Zhang, X., Tang, S. M., Yip, B. H. K., Kam, K. W., Ko, S. T., Young, A. L., Tham, C. C., Chen, L. J., & Pang, C. P. (2020). Two-year clinical trial of the low-concentration atropine for myopia progression (LAMP) study: Phase 2 report. Ophthalmology, 127, 910–919.

Yam, J. C., Zhang, X. J., Zaabaar, E., Wang, Y., Gao, Y., Zhang, Y., Li, X., Kam, K. W., Tang, F., Chu, W. K., Zhou, X., Zhang, W., He, X., Wu, P. C., Rose, K. A., Morgan, I., He, M., Ohno-Matsui, K., Jonas, J. B., Zhang, M., Tham, C. C., Chen, L. J., & Pang, C. P. (2025). Interventions to reduce incidence and progression of myopia in children and adults. Progress in Retinal and Eye Research, 109, 101410.

Yam, J. C., Zhang, X. J., Zhang, Y., Wang, Y. M., Tang, S. M., Li, F. F., Kam, K. W., Ko, S. T., Yip, B. H. K., Young, A. L., Tham, C. C., Chen, L. J., & Pang, C. P. (2022). Three-year clinical trial of low-concentration atropine for myopia progression (LAMP) study: Continued versus washout: Phase 3 report. Ophthalmology, 129, 308–321.

Zhang, Y., & Wildsoet, C. F. (2015). RPE and choroid mechanisms underlying ocular growth and myopia. Progress in Molecular Biology and Translational Science, 134, 221–240.

Zheng, N. N., & Tan, K. W. (2022). The synergistic efficacy and safety of combined low-concentration atropine and orthokeratology for slowing the progression of myopia: A meta-analysis. Ophthalmic and Physiological Optics, 42, 1214–1226.

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Published

2026-02-26

How to Cite

Advances in Low-Concentration Atropine and Optical Interventions for Myopia Control. (2026). Advances in World Medical Research, 2(1), 21-29. https://doi.org/10.71204/h4ject27