Low-Dose Atropine for Pediatric Myopia: First-Year Progression as a Risk-Stratification and Management Signal

Area of Science:

• Ophthalmology
• Pediatric Optometry
• Myopia Control Research

Background:

• Myopia control aims to slow refractive progression in children.
• Atropine eye drops are a common treatment for myopia control.
• Predicting treatment response is crucial for effective myopia management.

Purpose of the Study:

• To assess if first-year refractive progression predicts long-term myopia control with atropine.
• To determine if early progression data guides treatment escalation decisions.
• To analyze how early progression influences subsequent refractive trajectories.

Main Methods:

• Retrospective cohort study of 555 children treated with low-dose atropine (0.01% or 0.02%).
• Annualized spherical equivalent refraction (SER) progression was calculated.
• Children were categorized by 12-month response (responsive, partially responsive, unresponsive) to treatment thresholds (≤0.25 D/year).

Main Results:

• Twelve-month response strongly predicted successful myopia control over the entire treatment course (OR: 5.71).
• Each 0.25 D/year increase in first-year progression reduced the odds of success (OR: 0.55).
• Escalation occurred earlier in unresponsive children, with significant slowing of progression post-escalation in initially failing eyes (0.71 to 0.28 D/year).

Conclusions:

• First-year atropine response is a robust early indicator of overall myopia control success.
• Response-guided escalation effectively manages initial treatment failures and minimizes long-term outcome differences.
• Early management signals are critical for optimizing myopia control strategies.