The Drop That Slows the Fall: Real-World Atropine Strategy for High Myopia Progression in Adolescents

Abla Almalik¹, Asim Ahmed², Matteo Romano³, Giulia Ferrara⁴

Abstract

High myopia is one of the fastest growing causes of visual impairment globally, particularly among adolescents. This study evaluated the long-term effectiveness and safety of low-dose atropine therapy in slowing myopia progression in adolescents with high myopia. A prospective multicenter observational study was conducted between 2022 and 2025 across three ophthalmology clinics. A total of 524 adolescents aged 10–16 years with baseline spherical equivalent ≤ −6.00 diopters were enrolled.

Participants received nightly 0.01% atropine eye drops, and were followed for 24 months. Primary outcomes included changes in spherical equivalent (SE) and axial length (AL). Secondary outcomes included adverse effects, treatment adherence, and visual performance.

Results demonstrated that annual myopia progression decreased significantly from −0.92 ±0.41 D/year before treatment to −0.37 ±0.29 D/year during therapy, representing a 59.8% reduction in progression (p <0.001). Axial length elongation decreased from 0.36 mm/year to 0.18 mm/year (50% reduction). Treatment adherence exceeded 86%, while mild photophobia was reported in 17.4% of patients and near-vision blur in 9.2%. Only 4.6% discontinued treatment due to side effects.

Subgroup analysis showed stronger treatment response among patients aged 10–13 years, with a 63% reduction in myopia progression compared with 49% in older adolescents. No serious ocular or systemic adverse effects were recorded.

The findings support low-dose atropine as an effective and safe strategy for controlling high myopia progression in adolescents. Early initiation of treatment appears to provide the greatest benefit. Integrating atropine therapy into pediatric ophthalmology protocols may significantly reduce future risks of retinal detachment, myopic maculopathy, and glaucoma.