Graduated atropine protocol effects on spherical equivalent and axial length in premyopic children

We evaluated the effects of a graduated-concentration atropine protocol on the progression of myopia in premyopic Korean children. This retrospective study included 64 premyopic children with an initial spherical equivalent (SE) between + 0.75 diopters (D) and - 0.50 D as determined by cycloplegic refraction. The graduated-concentration atropine protocol begins with an initial concentration of 0.025% or 0.05%. If the annual progression of myopic spherical equivalent (SE) exceeds 0.25 D, the concentration gradually increases to a maximum of 0.125%. SE and axial length (AL) measurements are recorded at baseline, 6 months, 1 year, and 2 years. At the 2-year follow-up, individuals were classified into the progression group, defined as an increase in myopic SE ≥ 0.5 D from baseline, and the stable group, characterized by an increase of < 0.5 D from baseline. Of the 64 patients, 41 were classified into the stable group and 23 into the progression group. At the 2-year follow-up, significant differences in SE progression were observed between the groups. Notably, the changes in SE and AL from baseline to the 1-year follow-up were also significantly smaller in the stable group than in the progression group. Changes in myopic SE ≥ 0.375 D or AL ≥ 0.220 mm within 1 year strongly predict myopic progression in the premyopic state. The graduated-concentration atropine protocol demonstrated satisfactory outcomes in 64% of premyopic children at the 2-year follow-up. These findings emphasize the efficacy of such a protocol for predicting myopia progression in premyopic children.