BID Dosing of Atropine 0.01% Confers Significant Advantages in Myopia Control

Clinicians looking for better results when prescribing atropine 0.01% for myopia control might want to consider increasing the dosage rather than the concentration, researchers suggest. Photo: Getty Images. Click image to enlarge. The rising prevalence of myopia continues to be a public health concern, especially in Asia, where the rates have escalated in recent decades. Reports have shown that 0.01% atropine stands out for its minimal side effect profile alongside acceptable myopia control efficacy, earning its recommendation in guidelines for certain populations. However, the clinical efficacy of low-concentration atropine remains a subject of debate. In a recent study, authors investigated the efficacy and safety of standard 0.01% atropine at different frequencies (twice daily vs. once nightly) for myopia progression in Chinese children and adolescents; they found that twice-daily administration significantly enhances the management of axial elongation and spherical equivalent (SE) progression compared with once-nightly dosing without increasing the risk of adverse effects.A total of 70 participants between the ages of six and 13 with refractive error between -6.00D to -0.75D were randomized 1:1 to receive 0.01% atropine eye drops once nightly (QD group, n=34) or twice daily (BID group, n=36) for one year. The primary endpoint was the change in axial length (AL) after one year.The findings showed that twice-daily administration significantly enhances the management of axial elongation and SE progression compared with once-nightly dosing without increasing the risk of adverse effects such as accommodation and tear function. “Specifically, the enhanced regimen led to a statistically significant reduction in the progression of myopia, as evidenced by the changes in AL over the 12-month follow-up period,” the authors wrote in their paper.The BID group exhibited a significantly smaller increase in mean AL compared with the QD group (0.21 ±0.18mm vs. 0.32 ±0.14mm), corresponding to a 34% reduction in axial elongation. The BID regimen was 53% more effective in slowing SE progression than the QD regimen, with mean SE changes of -0.31 ±0.50D vs. -0.66 ±0.37D.The progression in refraction and axial length for the QD group was -0.66 ± 0.37D and 0.32 ± 0.14mm, which aligns closely with the second-year outcomes of the ATOM2 study, the researchers noted in their paper on the work for Eye. The BID group showed a more significant control effect, with changes in SE and AL of -0.31 ±0.50D and 0.21 ±0.18mm, which is comparable to that of the 0.05% atropine group in the LAMP study.Particularly with the BID regimen, the authors suggest that increased dosing frequency, rather than higher concentration, can enhance the efficacy of low-concentration atropine. Moreover, the BID strategy—administration both in the morning and evening—demonstrated greater efficacy in slowing myopia progression compared to the once-nightly QD regimen.“Although the mechanism underlying this enhanced effect remains uncertain, the more consistent presence of atropine throughout the day may contribute to improved therapeutic outcomes,” the authors wrote in their paper.Safety parameters, such as amplitude of accommodation, tear film stability and intraocular pressure, remained similar between the two groups. Although mesopic pupil diameter increased more in the BID group (0.65 ±0.63mm vs. 0.27 ± 0.69mm), the difference was clinically acceptable and not observed in photopic pupil diameter.Mild photophobia and near-vision challenges were reported more often in the BID group at the three-month follow-up, but these were temporary and did not restrict daily activities. No significant differences were observed in height and weight between the groups.The authors noted that this study has some limitations. Including only Chinese participants may have limited the generalizability of the findings to broader populations, and the one-year follow-up period fell short of providing a comprehensive understanding of the long-term impacts of increased dosing frequency.“Future research should aim to address the limitations of this study by incorporating larger and more ethnically diverse populations, employing double-blind placebo- controlled designs and extending follow-up periods to monitor the long-term effects of atropine on myopia progression and ocular development into adulthood,” the authors concluded in their paper.Click here for the journal source. He M, Zhang Z, Tong L, et al. Twice versus once daily application of 0.01% atropine for myopia control in children: a randomized controlled trial. Eye. October 1, 2025. [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.