Related Experiment Video
Updated: Aug 8, 2026
Inducement and Evaluation of a Murine Model of Experimental Myopia
Published on: January 22, 2019
Low-Dose Atropine for Pediatric Myopia: First-Year Progression as a Risk-Stratification and Management Signal
Soh Youn Suh1,2, Karenna Mehta3, Robert A Clark2,3
1Stein Eye Institute, University of California-Los Angeles, Los Angeles, California.
Insights
First-year myopia progression in children treated with atropine effectively predicts long-term treatment success. Early response guides treatment escalation, slowing progression in initial failures and improving overall myopia control outcomes.
Area of Science:
- Ophthalmology
- Pediatric Eye Care
- Myopia Management
Background:
- Myopia control aims to slow refractive progression in children.
- Atropine eye drops are a common treatment for myopia.
- 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 can guide treatment escalation decisions.
- To analyze how early response influences subsequent refractive trajectories.
Main Methods:
- Retrospective cohort study of 555 children treated with low-dose atropine (0.01% or 0.02%) for at least 12 months.
- Annualized spherical equivalent refraction (SER) progression was calculated.
- Children were categorized as responsive, partially responsive, or unresponsive based on 12-month progression (≤0.25 D/year threshold).
- Analyses correlated 12-month response with overall treatment outcomes and progression before/after treatment escalation.
Main Results:
- First-year myopia progression 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).
- Treatment escalation occurred earlier in unresponsive children, leading to significant slowing of progression in initial failures (0.71 to 0.28 D/year).
Conclusions:
- Twelve-month refractive progression serves as a strong early indicator for overall on-treatment myopia control.
- Response-guided escalation of atropine therapy effectively manages initial treatment failures.
- Early response assessment is a valuable signal for optimizing myopia control strategies, rather than a definitive endpoint.
Purpose:
To determine whether first-year refractive progression predicts longer-term on-treatment myopia control and whether early progression guides escalation decisions and subsequent trajectories.
Design:
Retrospective cohort, single practice.
Participants:
Five hundred fifty-five children (1107 eyes) treated with 0.01% (93.5%) or 0.02% (6.5%) atropine for ≥12 months.
Methods:
Spherical equivalent refraction (SER) progression was annualized (diopters [D]/year; positive = worse). At 12 months, eyes met or did not meet the ≤0.25 D/year threshold; children were categorized as responsive (both eyes), partially responsive (one eye), or unresponsive (neither eye). Progression was also modeled continuously (per 0.25 D/year). Escalation was defined as increasing the atropine concentration and/or adding optical therapy. Primary analyses associated 12-month response with on-treatment outcomes and progression before and after escalation. Eye-level models accounted for intereye correlation and baseline covariates. One-eye-per-subject sensitivity analyses were also performed.
Main Outcome Measures:
Successful control (≤0.25 D/year over on-treatment course) and change in SER progression around escalation.
Results:
Baseline age was 9.8 ± 2.8 years and baseline SER -2.34 ± 2.37 D. 340 (61.3%) children were responsive, 99 (17.8%) partially responsive, and 116 (20.9%) unresponsive, with successful control rates of 70%, 28%, and 17%, respectively. 12-month status strongly predicted whole-course successful control in bilateral generalized estimating equations (odds ratio [OR]: 5.71; 95% confidence interval [CI]: 3.85-8.47) and one-eye sensitivity (OR: 10.90; 95% CI: 6.32-18.80) analyses and slower whole-course progression (β -0.27 D/year, 95% CI: -0.31 to -0.23). Each +0.25 D/year of first-year progression reduced success odds (OR: 0.55; 95% CI: 0.48-0.63). Post-12-month predictive value was attenuated relative to the whole-course analyses in both the bilateral generalized estimating equations (OR: 1.32; 95% CI: 0.94-1.86; P = 0.110) and one-eye sensitivity (OR: 1.92; 95% CI: 1.23-3.01; P = 0.004) analyses. Escalation occurred in 270 (48.6%) children, earlier among unresponsive children (log-rank P < 0.001). Event-time analyses showed marked slowing after first atropine escalation in initial failure eyes (0.71 → 0.28 D/year; Δ -0.43; P < 0.001) but minimal change in initial success eyes (0.189 → 0.193 D/year; Δ +0.004; P = 0.892). With atropine monotherapy, early response modestly predicted post-12-month success (OR: 1.57; 95% CI: 1.02-2.41).
Conclusions:
Twelve-month response strongly stratifies overall on-treatment control as an early management signal, not a fixed treatment end point. Response-guided escalation slowed initial failures and attenuated post-12-month differences.
Financial Disclosures:
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Related Concept Videos
01:27Open Angle Glaucoma: Treatment
Drugs such as carbonic anhydrase inhibitors, α2- and...
01:23Ophthalmic Drug Delivery Systems
01:28Angle Closure Glaucoma: Treatment
01:11Direct-Acting Cholinergic Agonists: Therapeutic Uses