Atropine Research Update: Optimal Dosing

Research continues to refine our understanding of atropine for myopia control, particularly regarding optimal dosing.

The ATOM Studies Legacy

The landmark ATOM studies established:

• Low-dose atropine is effective
• 0.01% has minimal side effects
• Higher doses more effective but more side effects
• Rebound effect occurs after stopping

Recent Dosing Research

LAMP Study (Hong Kong)

Compared 0.05%, 0.025%, and 0.01%:

• 0.05% most effective (67% reduction)
• 0.025% good balance (43% reduction)
• 0.01% least effective but best tolerated

LAMP2 Follow-up

• Sustained efficacy over 2 years
• 0.05% maintained advantage
• Acceptable side effect profile

Emerging Consensus

Current thinking suggests:

• Start with 0.01% for most children
• Increase if inadequate response
• 0.025-0.05% for fast progressors
• Individualize based on response

Long-Term Outcomes

Studies following children for 5+ years show:

• Continued benefit during treatment
• Some rebound after stopping
• Tapering may reduce rebound
• Earlier treatment = better outcomes

Combination with Other Treatments

Research on atropine combinations:

• Atropine + Ortho-K: additive benefit
• Atropine + MiSight: being studied
• May allow lower atropine doses

Practical Implications

For clinicians and parents:

• Low-dose atropine is safe and effective
• Dose can be adjusted based on response
• Long-term treatment likely needed
• Monitor and adjust as needed

Future Directions

Ongoing research exploring:

• Optimal starting age
• Best stopping strategies
• Genetic factors in response
• New formulations