Tapering low-dose atropine may reduce myopia progression vs abrupt discontinuation

A study from 7 institutions in Hong Kong reported that tapering of low-dose atropine before the drug was discontinued had more beneficial results for children with myopia. The investigators reported their results in JAMA Ophthalmology.¹ He is from the Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.

This study sheds light on the use of 0.05% atropine, which has been reported to be effective against myopia progression in some but not all studies. However, as first author Yuzhou Zhang, PhD, and colleagues pointed out, the managing the discontinuation of atropine is unclear.

To taper or to stop, that is the question

Zhang and colleagues evaluate tapering and stopping low-dose atropine in a randomized clinical trial. The children in the study were age 4 to 12 years and had been followed for 8 years in the Low-Concentration Atropine for Myopia Progression (LAMP) study.²

After completing 5 years of follow-up, children treated with atropine were randomized 1:1 to either the taper or stop group.

Before atropine was discontinued, in year 6, the patients randomized to tapering received 0.05% atropine for 6 months and then 0.025% atropine for another 6 months; those in the stop group were treated with 0.05% atropine eye drops for a full year. During years 7 and 8, the discontinuation period, all patients stopped atropine treatment and were monitored for 2 years.

The three main study outcomes were the myopia progression in both groups over 3 years, the proportion of a good response to discontinuation of atropine, and factors associated with myopia progression over 3 years. The investigators defined a good response to treatment discontinuation as spherical equivalent progression (SEP) of −0.5 diopter (D) or more in both eyes during the discontinuation period, they explained.

What did the analysis of the management of atropine show?

The investigators reported that 246 children (139 males, 107 females; mean age, 13.47 years) completed the 5 years of follow-up, and 180 children (73.2%) completed the 8 years of follow-up.

“Over 3 years, the SEP and axial length (AL) elongation were faster in the stop group than in the taper group: –0.78 diopter (D) vs. –0.54 D, respectively (difference, −0.24 D; 95% confidence interval [CI], −0.46 to −0.03 D; P = 0 .02) and 0.44 mm vs. 0.33 mm, respectively (difference, 0.11; 95% CI, 0.03 to 0.19 D; P = 0.01),” they reported.

They also found that the patients in the taper group fared better than the patients in the stop group in the good response to treatment discontinuation, ie, 65.1% vs. 42.6%, respectively; P = 0 .003).

In addition, younger patient age and more myopic spherical equivalent/longer AL during the period before atropine discontinuation were associated with faster SEP and AL elongation over 3 years. “Notably, the younger the age and the more myopic the spherical equivalent, the greater the estimated mean differences of SEP/AL elongation between the taper and stop groups,” they said.

Zhang and colleagues concluded, “This study found that over 3 years, the participants in the taper group had less myopia progression than in the stop group, particularly in children who were younger and had more myopia. However, to our knowledge, the clinical relevance of this approximately 0.25-D difference between treatment groups is not well understood from the current medical literature.”

References:

1. Zhang Y, Zhang XJ, Zaabaar E, et al. Discontinuation approach and follow-up of low-concentration atropine for myopia progression: eight-year results of the LAMP Randomized Clinical Trial. JAMA Ophthalmol. 2026; published online March 26. doi:10.1001/jamaophthalmol.2026.0436

2. Yam JC, Jiang Y, Tang SM, 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;126:113-24. doi:10.1016/j.ophtha.2018.05.029