Tapering Myopes Off Atropine Lessens Rebound Effect

Subjects who abruptly stopped atropine progressed an additional quarter-diopter more than those who were tapered off in this study. Photo: Getty Images. Click image to enlarge. Myopic children who were tapered from 0.05% to 0.025% low-concentration atropine before full discontinuation experienced less myopia progression over three years than those who stopped treatment abruptly, according to a recent Hong Kong study.Following a cohort of 246 participants aged four to 12 from their previous Low-Concentration Atropine for Myopia Progression (LAMP) study, researchers randomized the children into taper and stop groups at a one-to-one ratio, and stratified them by age, sex and spherical equivalent. They detailed in their JAMA Ophthalmology paper that “the taper group received 0.05% atropine daily in the first six months followed by 0.025% atropine daily for the following six months, and the stop group received 0.05% atropine daily for a full year,” after which both groups stopped receiving treatment in the next two years.The average age of participants was 13.5 years; 56.5% were boys 43.5% were girls. All participants were ethnically Chinese. Among the taper group, 65.1% patients out of 86 demonstrated positive responses to the tapering of eye drops; among the 94 patients in the immediate-stop group, 42.6% showed a positive response. The researchers defined a “good response” to treatment as spherical equivalent refraction progression of -0.5D or more in both eyes during the discontinuation period. They reported that in the eighth year, “changes in spherical equivalent were -0.54D in the taper group and -0.78D in the stop group,” with an additional 0.33mm change in axial length (AL) among the taper group and 0.44mm in the stop group. They did not find changes in axial length or SEP before discontinuing patients’ treatments.The researchers noted an association between faster progression and an initial “younger age and more myopic spherical equivalent/longer AL at prediscontinuation.” Patients of a younger age and with more severe myopia also displayed a greater average progression and AL difference between the taper and stop groups.In addition to these findings, authors of an invited commentary on the study, also published in JAMA Ophthalmology, expressed criticism about the potential presence of bias despite the randomization of studied patients. They stated that while “randomization reduces many forms of potential bias,” many aspects of randomized controlled trials “may still inadvertently introduce bias.” They used the possibility of patients being lost to  follow-up as an example, as the original study’s authors reported “that dropout rates over three years were similar between the taper and stop groups.” Loss to follow-up, noted the authors, “is also problematic if there are major imbalances in baseline factors between completers and noncompleters, particularly if those factors might influence outcomes.” They encouraged the study’s researchers to consider reasons that patients may have dropped out and to better account for it happening in the future, as well as to “do everything possible to avoid loss to follow-up and thereby maintain advantages of the original random allocation of treatment assignment.”Click here for the journal source and here for the commentary. Zhang Y, Zhang X, Zaabaar E, et al. Discontinuation approach and follow-up of low-concentration atropine for myopia progression: eight-year results of the LAMP randomized clinical trial. JAMA Ophthalmol. March 26, 2026. [Epub ahead of print].Holmes JM, Beaulieu WT. Weaning from atropine—possible bias despite randomization. JAMA Ophthalmol. March 26, 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.