Abstract
Background
Particularly in children, atropine eye drops have demonstrated encouraging results in reducing the progression of myopia. Nevertheless, there is insufficient data regarding the single dose atropine 0.05% eye drop’s ability to stop the progression of myopia, despite several studies published in various treatment types and combined comparisons of myopia progression controls. Randomized clinical trial studies measuring spherical equivalent and axial length change outcomes in school-age myopic children without any other health issues that used atropine 0.05% therapy with a placebo control group were eligible for this review.
Objective
to synthesize evidence on the effectiveness and safety of atropine 0.05% versus spectacle eye glass to control myopia progression among children with 6 to 12 years of age, 2025.
Methods
This review followed the PRISMA 2020 guidelines, and JBI SUMARI software was used to carry out the step-by-step procedures from the research topic to data extraction and analysis, including the methodological quality assessment using the JBI critical appraisal check list. The Cochrane GRADEpro evaluation was used to evaluate the degree of certainty in the evidence. The mean difference, inverse I square, and 95% confidence interval were used to express the effect magnitude. The publishing bias was analysed using a funnel plot using STATA 16 software.
Results
A total of 1967 children from eleven studies were included in this study. When compared to a placebo group, atropine 0.05% eye drop has demonstrated a statistically significant decrease in the progression of myopia; the pooled mean SE and AL reduction of myopia progression was − 0.49 dioptres per year (-0.32, -0.57) and 0.18 millimetres per year (0.12, 0.23), respectively. The mean SE reduction with atropine 0.05% eye drop was − 0.41Ds/yr (-0.30, -0.52) in Asian studies and − 0.65Ds/yr (-0.14, -1.16) in non-Asian studies, according to subgroup analysis.
Conclusion
Atropine 0.05% eye drops had a significant effect on slowing the progression of myopia over spectacle, given the lack of generalizability and greater heterogeneity across the trials examined in this review. This review has been registered in PROSPERO since 04 November 2024 with registration ID: CRD42024604462.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12886-026-04633-y.
Keywords: Children, Myopia, Myopia progression control, RCT, Refractive error
Introduction
Particularly in children, atropine eye drops have demonstrated encouraging results in reducing the progression of myopia [1–5]. Research shows that the muscarinic antagonist atropine applied topically can successfully lessen the elongation of the eyeball, which is a major contributing factor to the development of myopia [6]. the mechanism of Atropine to slow the progression of myopia still not clear, however choroid thickening occurred after atropine treatment in recent findings [7].
Over 2.6 billion people worldwide suffer from myopia, one of the WHO’s top concerns [8]. Myopia will worsen with axial elongation if the proper treatment is not applied, which is often linked to serious pathological retinal and choroidal problems [9]. Very little research has been carried out on myopia progression and treatment controls. However, atropine and myopia progression have different characteristics depending on the dose and ethnic variation [10], causing it difficult to quickly understand the characteristics of myopia progression and control management. The effects of atropine 0.05% on different settings will be briefly explained in this study.
Atropine 0.05% eye drop is the optimum treatment for myopia progression control, according to several studies published in various treatment types and combined comparisons of myopia progression controls [11–13] however, there is insufficient evidence regarding the pooled effect of the single dose atropine 0.05% eye drop’s on slowing the progression of myopia. Since, most studies and reviews reported on varying dosages or in combination with other forms of treatment, which resulted in a lack of insight regarding the treatment’s isolated pooled effects. Atropine eye drop for myopia progression control is the most feasible for children in low socio economic community; who luck a treatment for myopia progression. Measuring the pooled effect of this optimum dose of atropine and analyse the safety will provide a clear and precise information for clinical and research decisions.
Furthermore, understanding how atropine 0.05% eye drops affect axial elongation and spherical equivalent myopia progression is crucial for managing myopia progression. It appears that the most significant ocular biometric factor causing the pathological complication of myopia is axial length. Analysing the treatment’s impact on slowing the elongation of the eyeball is advisable [14].
There are no current or ongoing systematic reviews on the subject were found after a preliminary search of PROSPERO, MEDLINE, the Cochrane Database of Systematic Reviews, and the JBI Evidence Synthesis. The evidence that was available focused on atropine concentrations that did not measure the 0.05% pure action of atropine. The purpose of this review was to evaluate the effect of atropine 0.05% eye drops on the progression of myopia in school children aged 6 to 12 years with spectacle correction in comparison to a placebo group.
Inclusion criteria
This study included RCTs on atropine 0.05% treatment with a placebo control group that examined spherical equivalent and axial length change outcomes in myopic schoolchildren aged 6 to 12 years who had no other health issues. However, our study eliminated studies with non-RCT designs, non-primary research, lack of a placebo or standard treatment comparison, and articles published in languages other than English.
Outcome(s)
Studies comparing the effects of atropine 0.05% eye drops administered every night for a year with a control group receiving sham treatments, such as various sterile artificial tears or regular saline, have been included in this review. Both group has been wearing standard spectacle eye glass for the correction of the myopia. The mean spherical equivalent and axial length change evaluated using cycloplegic refraction and standard biometry techniques were the outcomes of the research included in this systematic review. The influence on axial length change has been estimated from the remaining nine articles; the axial length result is missing from two eligible studies.
Methods
This review adhered to the JBI methodology for systematic reviews of effectiveness evidence and solely considered randomized controlled trials. To find literature on the subject, an initial search was conducted using MEDLINE (PubMed) and CINAHL (EBSCO). A comprehensive search technique for EMBASE, PubMed, and Google Scholar was developed using the text words found in the titles and abstracts of pertinent publications as well as the index keywords used to characterize the articles. For every database and/or information source that was incorporated, the search strategy—which included all detected keywords and index terms—was modified. Every incorporated source of evidence’s reference list was examined for further research. PICO based search term ((((school children OR myopic children) AND (Myopia progression control OR spherical equivalent OR axial length)) AND (Atropine 0.05% eye drop OR atropine eye drops OR low dose atropine OR)) was used in different databases. Studies published only in English were included because no eligible study was found in any other language.
Following a pilot test, titles and abstracts were screened by two or more independent reviewers for assessment against the inclusion criteria for the review. After duplicated cites were removed, potentially relevant studies were retrieved in full and their citation details imported into the JBI System for the Unified Management, Assessment and Review of Information (JBI SUMARI) [15]. The full text of selected citations was assessed in detail against the inclusion criteria by two or more independent reviewers. Any disagreements that arose between the reviewers at each stage of the selection process were resolved through discussion, or with an additional reviewer/s. The results of the search and the study inclusion process were reported and presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA2020) flow diagram.
Assessment of methodological quality
Using standardized critical appraisal tools from JBI for experimental, quasi-experimental, and observational research, two independent reviewers evaluated the methodological quality of eligible studies (Table 1). Discussions were used to settle some disputes. Eleven eligible studies were taken into consideration for data extraction and synthesis.
Table 1.
A JBI critical appraisal checklist results of A randomized controlled trial studies on the effect of Atropine 0.05% eye drops to control myopia progression among school children,2025
| Citation | Q1 | Q2 | Q3 | Q4 | Q5 | Q6 | Q7 | Q8 | Q9 | Q10 | Q11 | Q12 | Q13 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Li FF et al. 2020. | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y |
| Yam JC, et al. 2019 | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y |
| Yam JC, et al. 2020 | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y |
| Gonçalvs et al., 2025 | N | N | Y | N | N | N | Y | Y | Y | Y | Y | N | N |
| Yam JC, et al. 2022 | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y |
| Yang Y, et al. 2024 | Y | Y | Y | Y | Y | N | Y | Y | Y | Y | Y | Y | Y |
| Zhu Q, et al. 2023 | Y | Y | Y | Y | N/A | N/A | Y | N | Y | Y | Y | Y | Y |
| Botros M, et al. 2025. | N | Y | Y | Y | N | N | Y | N/A | Y | Y | Y | Y | N |
| Moon J-S, Shin SY 2018 | N | N | Y | N | N | N | Y | Y | Y | Y | Y | N | U |
| Zhang H, et al. 2024 | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y |
| Saxena R, et al. 2025 | N | Y | Y | N | N | N | Y | Y | Y | N | Y | Y | N |
| % | 69.2 | 84.6 | 100 | 76.9 | 61.5 | 53.8 | 100 | 84.6 | 92.3 | 92.3 | 100 | 84.6 | 69.2 |
Q1- true randomization used for assignment of participants
Q2- concealed allocation of treatments
Q3-similarity in baseline characteristics
Q4-participants blind to the treatment assignment
Q5-treatment dispensers blind to treatment assignment
Q6-outcome assessors blind to treatment assignment
Q7-treatment groups treated identically other than the intervention of interst
Q8-complete follow up and incomplete follow up between groups described and analysed
Q9-participants analysed in the groups to which they were randomized
Q10-similarity in outcome measurement
Q11-relaible outcome measurement
Q12-appropriate statistical analysis used
Q13-approprite trial design and consideration in the analysis if deviated from standard RCT
Data extraction
Two independent reviewers used the standardized JBI data extraction tool to extract data from the studies that were part of the review. Tables and narrative summaries were employed to gather and convey the study features and pertinent data needed for analysis. No disagreement between the reviewers was reported.
Data synthesis
JBI SUMARI was used to pool the studies for statistical meta-analysis; effect sizes were expressed as final post-intervention mean differences and their 95% confidence intervals were calculated for analysis; statistical analyses were carried out using the random mixed effect model and inverse variance estimation; subgroup analyses were performed based on region/ethnicity; sensitivity analyses were executed and the results were compared by including and removing each single study (Table 2); heterogeneity was statistically assessed using the standard chi-squared and I squared tests; a funnel plot was created to assess publication bias; and statistical tests for a small study effect (Egger test) were performed using STATA 16 software (Fig. 5).
Table 2.
A sensitivity analysis result on the SMD effect of A single study on the overall effect size, heterogeneity and test significance
| Studies included | Pooled effect size (95% CI) | Heterogeneity | Tests for overall effect |
|---|---|---|---|
| All 11 studies | -1.26(-0.69, -1.84) | 97% | P = 0.000 |
| Zhang H. 2024 removed | -1.26(-0.62, -1.90) | 97% | P = 0.000 |
| Yang et al., 2024 removed | -1.30(-0.66, -1.93) | 97% | P = 0.000 |
| Li et al., 2020 removed | -1.29(-0.65, -1.93) | 97% | P = 0.000 |
| Yam et al., 2019 removed | -1.29(-0.65, -1.93) | 97% | P = 0.000 |
| Yam et al., 2020 removed | -1.34(-0.73, -1.95) | 97% | P = 0.000 |
| Yam et al., 2022 removed | -1.29(-0.66, -1.93) | 97% | P = 0.000 |
| Zhu et al., 2023 removed | -1.27(-0.63, -1.91) | 97% | P = 0.000 |
| Gonsalves et al., 2025 removed | -1.36(-0.76, -1.95) | 97% | P = 0.000 |
| Botros et al., 2025 removed | -1.09(-0.57, -1.62) | 96% | P = 0.000 |
| Saxena et al., 2025 removed | -1.03(-0.63, -1.43) | 93% | P = 0.000 |
| Moon and Shin SY. 2018 removed | -1.27(-0.62, -1.91) | 97% | P = 0.000 |
Fig. 5.
A funnel plot presentation of studies to observe a publication bias
Assessing certainty in the findings
The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach for grading the certainty of evidence were followed and a Summary of Findings (SoF) were created using GRADEpro GDT (McMaster University, ON, Canada). Two independent reviewers worked on this at the outcome level. According to the GRADEpro evaluation, there was a moderate degree of assurance regarding the evidence compiled by those studies, considering the SE and AL effect size. However, the result showed a high certianity of evidence regarding the low incidence of side effects following use of atropine 0.05% (Fig. 1).
Fig. 1.
Interactive summary of finding result of the certainty of the pooled estimate mean SE and AL change with atropine 0.05% eye drops with GRADEpro assessment
Results
Study inclusion
A total of 5618 papers were found after a thorough search of reputable databases; studies with different treatment interventions and non-RCT designs were excluded (n = 5545), while the remaining 73 studies were included in the JBI SUMARI software for title and abstract screening; studies with similar treatment interventions but with different doses and measured different outcomes were excluded (n = 62); and studies reviewed in the full text screening were eligible (n = 11) (PRISMA2020 flow chart).
Methodological quality
The JBI critical appraisal checklist was used to evaluate the methodological quality of the studies. Four studies had a methodological fallacy related to the lack of randomization, blinding, and comparison control group, which may lead to selection and misclassification bias and affect the outcome measurement; however, the sensitivity analysis did not show a significant difference in the outcome with each study (Table 2). Overall, most of the studies demonstrated excellent quality, which may provide a precise and reliable report (Table 1).
A PRISMA 2020 flow chart on the selecting, assessing and searching strategy of articles on the effect of atropine 0.05% eye drop for myopia progression.
Critical appraisal results
Characteristics of included studies
Eleven studies with comparable characteristics were deemed eligible using the PRISMA2020 checklist; these included institution/hospital-based clinical trials on school-age children with baseline spherical equivalent myopia (-2.00 to -6.00Ds) to assess the impact of atropine 0.05% eye drop on the spherical equivalent and axial length change in comparison to a placebo treatment (Appendix I). Only the effect difference between the atropine 0.05% eye drop and placebo group on spherical equivalent and axial length change after a year was evaluated in this study, despite the fact that most of the studies (n = 7) had more than two comparison or treatment groups. The result from LAMP program were considered as different studies and the result taken for each different year. Although cycloplegic refraction was used in every study, the review did not evaluate the compliance rate. Seven studies were in china and the other four were in Egypt, India, Portugal and south Korea with the sample size range of 40 to 424 [1–3, 14, 16–22].
Review findings
In comparison to a placebo group, atropine 0.05% eye drop has demonstrated a statistically significant reduction in myopia progression. A subgroup analysis based on region and/or ethnic difference was carried out by classifying Asian and non-Asian studies; seven studies with 1241 children in the Asian group and 4 studies with 626 children in Non-Asian group were allocated. The pooled mean spherical equivalent reduction of myopia progression with atropine 0.05% eye drop was − 0.49Ds/yr (-0.32, -0.67) (Fig. 2). In subgroup analysis, the mean spherical equivalent reduction with atropine 0.05% eye drop was − 0.41Ds/yr (-0.30, -0.52) in Asian studies and − 0.65Ds/yr (-0.14, -1.16) in non-Asian studies (Fig. 3).
Fig. 2.
A forest plot with pooled effect size of mean SE change reduction with atropine 0.05% eye drops and summary statistics
Fig. 3.
A forest plot with a pooled effect size of mean SE change reduction with atropine 0.05% eye drops after sub group analysis between ASIAN studies and NON-ASIAN studies
Better study homogeneity (I2 = 81%) and a precise effect size with a smaller CI were observed in the Asian group. However, there was high heterogeneity (I2 = 98%) and a large CI in the effect size in non-Asian studies. When compared to a placebo group, the pooled mean axial length elongation reduction was 0.18 mm/yr (0.12, 0.23) (Fig. 4).
Fig. 4.
A forest plot with a pooled effect size of mean AL change reduction with atropine 0.05% eye drop
Few studies departed from the graph that might have had a publication bias in the spherical equivalent effect size, according to the funnel plot (Fig. 5). Nevertheless, the Eggers test revealed no significant single study effect or bias on the effect size. (p > 0.4009). The greater variety among research in terms of demographic, area, and study quality could be the cause of some studies’ deviations. The effect size and heterogeneity change with a single study effect were negligible, according to sensitivity analysis (Table 2). The adverse side effects of using atropine 0.05% eye drops to treat myopia progression are only reported in six studies. Temporary photophobia (30%) blurred vision (25%), and difficulties reading (4.4%) were the most frequently reported side effects.
Discussion
Following a step-by-step process in JBI SUMARI software, eleven studies with comparable characteristics on atropine 0.05% eye drop treatment versus placebo eye drop to observe the effect of halting myopia progression among school-aged children using RCT design were eligible for this systematic review. The pooled mean reduction of SE and AL change was assessed using the random effect meta-analysis with restricted maximum likelihood model. When compared to placebo treatments, the atropine 0.05% eye drop significantly reduced the mean SE and AL change, with pooled estimates of -0.49Ds/yr (-0.32, -0.67) and 0.18 mm/yr (0.12, 0.23).
Subgroup analysis based on region was carried out, and greater heterogeneity between studies was seen (I2 = 98%) in the SE mean reduction. The studies had been divided into two categories: Asian and non-Asian. Research on Asian children alone was classified as Asian, while research on other ethnic groups or combinations was classified as non-Asian. Consequently, even though there was more heterogeneity, the non-Asian groups had a greater SE change reduction (-0.65Ds/yr (-0.14, -1.16). Since the Asian groups exhibited comparatively superior homogeneity (I2 = 81%), the heterogeneity of the chosen studies was caused by non-Asian research (I2 = 97%). Furthermore, compared to Asian research, the pooled effect size in the non-Asian groups has a large confidence interval.
The results of the reviews conducted in 2023 and 2025 has a similar finding with this review, where the pooled effect sizes of mean SE and AL change reduction with atropine 0.05% eye drop were − 0.54Ds/yr (-0.38, -0.70) and 0.21 mm/yr (0.14, 0.28) [10]. Additionally, the pooled mean SE change reduction was greater than the effects of other myopia progression treatments including orthokeratology (-0.24 (-0.33, -0.15)), soft contact lenses (-0.34 (-0.35, -0.33)), and other low-dose atropine groups (-0.12 (-0.15, -0.08)) [23].
Similarly, the mean reduction in Atropine 0.05% eye drop was higher than different treatments types of MPC (orthokeratology (-0.20 (-0.29, -0.11)), moderate dose (-0.53 (-0.19, -0.87)) and low dose atropine (0.01%) (-0.36(-0.16, -0.55)) in network meta-analysis done in 2022, except, higher dose atropine (0.5% and 1%) which was higher than this review (-0.80 (-0.62, -0.97)). The pooled estimate was higher than other MPC because in this review single treatment was analysed however on those studies many treatment groups were compared. Moreover, the effect of atropine was measured with no treatment that could make the result higher and indicates it has a significant effect to reduce the myopia progression [24].
A rebounding effect following discontinuation, particularly on a higher dose, was the most frequently reported side effect of atropine eye drops for controlling the progression of myopia. The atropine 0.05% eye drop has a lower rebound effect than higher dose atropine, according to the results of a few clinical trials reviewed herein. Atropine 0.05% eye drops had an age-dependent rebound effect that was greater in younger kids. In a recent clinical experiment, the inhibitory effect of atropine 0.05% eye drop was maintained after stopping, and a withdrawal group’s myopia progression was less than that of a control group [3, 5, 25, 26].
Low dose atropine groups in general showed a minimum rebound effect, although the adequate reduction effect especially in AL elongation with minimum rebound effect were achieved by atropine 0.05% eye drop [25].
This evaluation’s strength was that it adhered to JBI guidelines for a rigorous study selection and review process. To determine the pure effect of atropine 0.05% eye drop, the combined effects of other therapies were eliminated from this systematic review study.
The limitation of this review was the methodological quality of a few studies raised some issues with the JBI critical appraisal check list, which could lead to high heterogeneity and a large CI in the pooled estimate size. Most of the studies were from Asia and Europe, which could not be generalizable, especially for African children. The control group in the entire papers was not a pure placebo; in a few studies, there was a certain kind of treatment, such as a washout period or prior atropine treatment, which may underestimate the mean progression in the control group. Even if, there is a placebo effect currently their previous exposure to atropine treatment could have effect on their progression level. In addition, this review has considered articles published only in English that could have a selection bias.
Conclusions
Atropine 0.05% eye drop had a greater effect on the reduction of mean SE and AL change compared with a placebo eye drop and standard eye glass; given the lack of generalizability and higher heterogeneity between studies analysed in this review, this significant effect with minimal re-bounding and side effects could make this treatment one of the first options for controlling myopia progression.
Recommendations for practice or policy
To control the progression of myopia, which is one of the latest significant visual burdens for children, it is better to start this treatment as soon as possible.
Recommendations for research
Closing the data gap on the effects of atropine 0.05% eye drops in African children through high-quality, advanced research could offer significant insights for clinical practice and strategies to reduce the progression of myopia.
Supplementary Information
Below is the link to the electronic supplementary material.
Acknowledgements
We would like to acknowledge the HUCSH public health service directorate, authors for their guidance and support. Special thanks for Jimma and EPHI JBI training centres for giving a comprehensive training on systematic review and access for JBI SUMARI software and, for Mr. Desalegn Tsegaw for participating as a second reviewer.
Abbreviations
- AL
Axial Length
- CI
Confidence Interval
- JBI
Joanna Briggs Institution
- MPC
Myopia Progression Control
- RCT
Randomized controlled trial
- SE
Spherical Equivalent
- SUMARI
System for the Unified Management, Assessment and Review of Information
- WHO
World Health Organization
Author contributions
All the authors were involved in a manuscript, such as designing the analysis, contributing or collecting the data, performing the analysis and writing the manuscript.
Funding
This review does not have any financial fund.
Data availability
The studies excluded, data extracted from included studies, the Grade PRO summary of tables and any other materials used in the review will be available.
Declarations
Ethics approval and consent to participant
Not applicable.
Consent for publication
An ethical clearance from HUCSH institution review board has been obtained.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.Yam JC, Jiang Y, Tang SM, Law AK, Chan JJ, Wong E, et al. 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. 2019;126(1):113–24. [DOI] [PubMed] [Google Scholar]
- 2.Yam JC, Li FF, Zhang X, Tang SM, Yip BH, Kam KW, et al. Two-year clinical trial of the low-concentration Atropine for myopia progression (LAMP) study: phase 2 report. Ophthalmology. 2020;127(7):910–9. [DOI] [PubMed] [Google Scholar]
- 3.Yam JC, Zhang XJ, Zhang Y, Wang YM, Tang SM, Li FF, et al. Three-year clinical trial of low-concentration Atropine for myopia progression (LAMP) study: continued versus washout: phase 3 report. Ophthalmology. 2022;129(3):308–21. [DOI] [PubMed] [Google Scholar]
- 4.Yam JC, Zhang XJ, Zhang Y, Yip BHK, Tang F, Wong ES, et al. Effect of Low-Concentration Atropine Eyedrops vs placebo on myopia incidence in children: the LAMP2 randomized clinical trial. JAMA: J Am Med Association. 2023;329(6):472–81. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Loughman J, Lingham G, Nkansah EK, Kobia-Acquah E, Flitcroft DI. Efficacy and safety of different Atropine regimens for the treatment of myopia in children: three-year results of the MOSAIC randomized clinical trial. JAMA Ophthalmol. 2025;143(2):134–44. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Li FF, Zhang Y, Zhang X, Yip BHK, Tang SM, Kam KW, et al. Age effect on treatment responses to 0.05%, 0.025%, and 0.01% Atropine: low-concentration Atropine for myopia progression study. Ophthalmology. 2021;128(8):1180–7. [DOI] [PubMed] [Google Scholar]
- 7.Cho H, Seo Y, Han S-H, Han J. Factors related to axial length elongation in myopic children who received 0.05% Atropine treatment. J Ocul Pharmacol Ther. 2022;38(10):703–8. [DOI] [PubMed] [Google Scholar]
- 8.Brien A, Holden TRF, Wilson DA, Jong M, Naidoo KS, Sankaridurg P, Tien Y, Wong TJ, Naduvilath. Serge Resnikoff. Global prevalence of myopia and high myopia and Temporal trends from 2000 through 2050. Am J Ophthalmol. 2016;123:6. [DOI] [PubMed] [Google Scholar]
- 9.Kobia-Acquah E, Lingham G, Flitcroft DI, Loughman J. Two-year changes of macular choroidal thickness in response to 0.01% atropine eye drops: Results from the myopia outcome study of atropine in children (MOSAIC) clinical trial. Acta Ophthalmol. 2025;103(8):984–997. 10.1111/aos.17429 Epub 2024 Dec 29. PMID: 39737658; PMCID: PMC12604447 [DOI] [PMC free article] [PubMed]
- 10.Jiang H, Liu Y. Meta-analysis of low-concentration Atropine eye drops for the management of myopia: evaluating the limit of 0.05% concentration. Asian J Surg. 2025;48(2):1446–9. [DOI] [PubMed] [Google Scholar]
- 11.Akagün N, Altıparmak UE. Combination therapy with Atropine 0.05% and Myopi-X® glasses: is it effective in myopia control? Turkish J Ophthalmol. 2025;55(1):1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Akdemir SC, Akalın I, Günay BÖ. One-Year results of 0.01% and 0.05% Atropine eye drops in childhood myopia progression. J Pediatr Ophthalmol Strabismus. 2025;62(4):297–302. [DOI] [PubMed] [Google Scholar]
- 13.Wen L, Liu H, Xu Q, Pan W, Lin Z, Xiao Z, et al. Add-on effect of using 0.05% Atropine in fast progressors of orthokeratology: A preliminary retrospective study. Contact Lens Anterior Eye. 2025;48(1):102282. [DOI] [PubMed] [Google Scholar]
- 14.Li FF, Kam KW, Zhang Y, Tang SM, Young AL, Chen LJ, et al. Differential effects on ocular biometrics by 0.05%, 0.025%, and 0.01% atropine: Low-Concentration Atropine for myopia progression study. Ophthalmology. 2020;127(12):1603–11. [DOI] [PubMed] [Google Scholar]
- 15.Munn ZAE, Tufanaru C, Stern C, Porritt K, Farrow J. The development of software to support multiple systematic review types: the Joanna Briggs Institute system for the unified Management, assessment and review of information (JBI SUMARI). Int J Evid Based Healthc. 2019;17(1):7. [DOI] [PubMed] [Google Scholar]
- 16.Botros MM, Sultan MA, Seif BS, Aboud SAM. Efficacy and safety of low concentration Atropine eye drops for control of childhood myopia. J Egypt Ophthalmological Soc. 2025;118(3):218–24. [Google Scholar]
- 17.Moon J-S, Shin SY. The diluted Atropine for Inhibition of myopia progression in Korean children. Int J Ophthalmol. 2018;11(10):1657–62. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Saxena R, Gupta V, Thakur H, Dhiman R, Velpandian T, Phuljhele S, et al. Atropine (0.05%) for rapid progressive childhood myopia (ARM study). Indian J Ophthalmol. 2025;73(3):358–61. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Yang Y, Xue M, Hao J, Lin Z, Xi X, Wu H, et al. Frequency-dependent effects of 0.05% Atropine Eyedrops on myopia progression and peripheral defocus: a prospective study. Eye Vis. 2024;11(1):26. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Zhang H, Yang P, Li Y, Zhang W, Li S. Effect of Low-Concentration Atropine eye drops in controlling the progression of myopia in children: A One- and Two-Year Follow-Up study. Ophthalmic Epidemiol. 2024;31(3):240–8. [DOI] [PubMed] [Google Scholar]
- 21.Zhu Q, Tang G-Y, Hua Z-J, Xue L-P, Zhou Y, Zhang J-Y, et al. 0.05% Atropine on control of myopia progression in Chinese school children: a randomized 3-year clinical trial. Int J Ophthalmol. 2023;16(6):939. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Gonçalves MS, Brízido M, Aerts F, Ching F, Azevedo AR, Almeida AC. Prevention of myopia progression with 0.05% topical atropine: 2-Year results in a portuguese cohort. Revista Sociedade Portuguesa de Oftalmologia; 2025.
- 23.Lanca C, Pang CP, Grzybowski A. Effectiveness of myopia control interventions: A systematic review of 12 randomized control trials published between 2019 and 2021. Front Public Health. 2023;11:1125000. 10.3389/fpubh.2023.1125000 [DOI] [PMC free article] [PubMed]
- 24.Hou-Ren Tsai J-HW, Chen H-KHT-L, Chen P-W. Cheng-Jen Chiu. Efficacy of Atropine, orthokeratology, and combined Atropine with orthokeratology for childhood myopia: A systematic review and network meta-analysis. J Formos Med Assoc. 2022;121:10. [DOI] [PubMed] [Google Scholar]
- 25.Jason Y, Zhang X, Zhang Y, Kam KW, Tang F, Ling X, et al. Five-Year clinical trial of Low-concentration Atropine for myopia progression (LAMP) study: phase 4 report. Investig Ophthalmol Vis Sci. 2024;65(7):426. [DOI] [PubMed] [Google Scholar]
- 26.Usmani E, Callisto S, Chan WO, Taranath D. Real-world outcomes of low‐dose Atropine therapy on myopia progression in an Australian cohort during the COVID ‐19 pandemic. Clin Exp Ophthalmol. 2023;51(8):775–80. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The studies excluded, data extracted from included studies, the Grade PRO summary of tables and any other materials used in the review will be available.