Atropine for Myopia Control in Children: Concentration-Dependent Efficacy and Rebound

Abstract

Introduction: Low-dose atropine (0.01-0.05%) slows myopia progression in children. Rebound after cessation and optimal concentration remain debated. Methods: Systematic review of 12 RCTs (n=2,156) comparing atropine 0.01%, 0.025%, 0.05% versus placebo over 2 years, followed by 1-year washout. Primary outcome: change in spherical equivalent (SE, diopters/year). Secondary: axial length (AL) elongation (mm/year). Results: All concentrations slowed progression versus placebo. 0.05% was most effective (SE progression -0.18 D/year vs placebo -0.71 D/year, p<0.001), but had highest photophobia (28% vs 5%). 0.01% had minimal side effects but less efficacy (-0.48 D/year). Rebound effect after cessation was dose-dependent: 0.05% group lost 0.24 D in first washout year; 0.01% lost 0.08 D. Discussion: Higher concentration gives better control but more side effects and rebound. Tapering (alternating day) may reduce rebound but unproven. Conclusion: Atropine 0.025% offers optimal balance of efficacy, tolerability, and rebound for pediatric myopia control.