Effects of Atropine on Accommodation and Binocular Vision are Dose-dependent

The effects of atropine on accommodative amplitude and binocular visual function in myopic children are clearly dose-dependent and time sensitive, according to this analysis. However, clinical applicability is unclear in light of several shortcomings in the analysis noted by the researchers. Photo: Nathan Cheung, OD. Click image to enlarge. There have been reports of adverse binocular outcomes, including reduced accommodative amplitude, changes in heterophoria and cases of convergence excess following topical atropine use for myopia management. It remains unclear whether these effects are transient or persistent and what the clinical implications may be. In a recent study, researchers from Spain and Japan evaluated the effect of different concentrations of atropine on accommodative amplitude and binocular visual function. They found that low-dose atropine (0.01%) is associated with only a small and inconsistent reduction in accommodative amplitude and has a favorable functional safety profile, intermediate concentrations (0.02% to 0.03%) show greater variability and 0.05% atropine consistently produces clinically meaningful reductions in accommodative amplitude and measurable changes in binocular function. The findings were reported in Ophthalmic and Physiological Optics.The team evaluated 13 studies comparing topical atropine eye drops (0.01% to 1%) with placebo, single-vision correction or no treatment; each also reported accommodative or binocular vision outcomes. The primary outcome was the change in accommodative amplitude. Secondary outcomes included accommodative lag, stereoacuity, heterophoria and fusional vergence. Low-dose atropine (0.01%) was associated with a small but statistically significant reduction in accommodative amplitude (-0.84D). However, the researchers explained in their paper, effects were highly heterogeneous, inconsistent at individual follow-up points and had no significant impact on stereoacuity, accommodative lag or most binocular parameters.Intermediate concentrations (0.02% to 0.03%) showed variable and heterogeneous effects, while atropine 0.05% produced a consistent and clinically meaningful reduction in accommodative amplitude (-1.96D) and measurable changes in binocular parameters, such as near heterophoria. Higher concentrations (≥0.1%) resulted in marked cycloplegic effects.The findings of this study align with long-term clinical trials indicating that atropine dosing must balance myopia-control efficacy with tolerability at near, the team stated. “For patients on 0.05% atropine or higher, clinicians should proactively assess near visual function and consider mitigation strategies, such as near additions, if symptoms occur,” they explained in their paper.The certainty of evidence for both 0.01% and 0.05% atropine was rated as moderate, primarily due to substantial heterogeneity across studies. “This heterogeneity likely reflects differences in atropine dosage, follow-up duration, outcome definitions and clinical methods used to assess accommodation and binocular vision across studies, as well as variability in study populations and measurement protocols,” the authors wrote in their paper. “Consequently, pooled estimates should be interpreted with caution, particularly when comparing results across different atropine concentrations and follow-up periods.”A second shortcoming: The number of trials contributing data to some of the dose-time subgroups was limited, reducing statistical power and precluding robust exploration of moderators such as age, baseline refractive error or near-work behavior.Finally, accommodative and binocular outcomes were often secondary endpoints in the trials and standardized measurement protocols were not applied consistently, potentially contributing to variability in effect estimates. In addition, most studies were conducted in Asian populations, which may limit the generalizability of the findings to other ethnic or geographic groups.Click here for the journal source. Martinez-Perez C, Santodomingo-Rubido J, Villa-Collar C. Dose-dependent effects of Atropine on accommodative and binocular visual function for myopia control in children: a systematic review and meta-analysis. Ophthalmic Phy Opt. May 18, 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.