The prevalence of myopia, or nearsightedness, among children worldwide, and particularly within the European population, has been rising at an alarming rate over recent decades. This trend is no longer viewed merely as a simple refractive error that can be easily corrected with spectacles or contact lenses. Progressive myopia, which is accompanied by an abnormal increase in the axial length of the eye, significantly raises the risk of developing severe ophthalmic pathologies in adulthood, such as myopic maculopathy, retinal detachment, cataract, and glaucoma. Consequently, identifying interventions that can effectively slow down the progression of nearsightedness in children has become a paramount priority for the ophthalmic community. Low-concentration atropine eye drops represent one of the most promising and extensively studied pharmacological agents in this field.
Historically, high-concentration atropine (0.5% or higher) was recognized as a powerful tool for myopia control; however, its routine clinical use was nearly impossible due to pronounced side effects. Patients suffered from persistent photophobia caused by pupillary dilation, paralysis of accommodation leading to blurred near vision during reading, and various allergic reactions. To overcome these barriers, researchers began investigating much lower concentrations of atropine—specifically 0.01%—assessing both its efficacy and safety, which laid the foundation for numerous large-scale clinical trials worldwide.
The most recent and critical evidence on this topic comes from a multicenter, double-masked, placebo-controlled, randomized clinical trial conducted in the United Kingdom (CHAMP-UK), the results of which were published in the prestigious medical journal, The BMJ. This study enrolled 289 myopic children aged 6 to 12 years. The participants were randomly assigned to two groups, where the intervention group applied 0.01% atropine eye drops once daily at bedtime for two years, while the control group received a placebo.
The trial results demonstrated that low-concentration atropine was statistically and clinically significantly more effective compared to the placebo. At the end of the two-year period, evaluations of the spherical equivalent refractive error showed a clear slowing of myopia progression in the atropine group. Furthermore, and most importantly from a pathophysiological standpoint, the use of atropine significantly reduced the rate of increase in central axial length. Prespecified subgroup analyses indicated that the protective effect of the drug was not influenced by the patients’ age, sex, ethnicity, or baseline myopia severity, pointing to its universal therapeutic potential.
In addition to its high efficacy, the CHAMP-UK study confirmed the excellent safety profile and tolerability of low-concentration atropine. No differences were observed between the therapeutic and placebo groups in measures such as best-corrected distance and near visual acuity, reading speed, or the patients’ quality of life. Although pupil diameter was slightly larger in the atropine group, this did not lead to clinically significant photophobia or discomfort in daily activities. Serious adverse events related to the trial medication were not reported at all.
At the same time, broader medical literature, including studies and meta-analyses accessible on platforms like ResearchGate, emphasizes that despite the generally accepted positive role of low-concentration atropine, slight variability in treatment response is sometimes observed between Western and Asian populations. Early trials conducted in Asian countries demonstrated very high efficacy, whereas results in European populations have occasionally been more moderate. This could be attributed to genetic factors, differences in ocular pigmentation, or lifestyle differences, such as the amount of time spent outdoors. Despite these minor nuances, rigorously controlled European trials like CHAMP-UK provide a solid foundation for the widespread implementation of this drug in Western healthcare practices.
In conclusion, low-concentration atropine eye drops represent a safe, accessible, and effective strategy for managing myopia in children. Its ability to delay both the deepening of the refractive defect and the anatomical elongation of the eyeball protects patients from potentially irreversible vision loss in adulthood. This discovery will contribute significantly to public health and pediatric ophthalmology, providing clinicians with a powerful tool to combat the global epidemic of nearsightedness.
