Atropine eye drops for myopia control in teenagers

• Atropine eye drops have multiple uses in childhood eye care, from increasing eye examination accuracy to treatment for lazy eye, to managing eye inflammation. 
• In teenagers, atropine 1% is sometimes used for the reasons described above, but atropine 0.01%, 0.025% or 0.05% is more commonly used, to slow myopia progression. 
• Atropine eye drops 0.01%, 0.025% or 0.05% for myopia control have evidence for use from age 4 to 14 at the start of treatment, and for up to 2-3 years (until age 15-16). There is no evidence for its use in older teenagers and may have side effects which could impact vision for study and driving. 

Myopia, also known as short-sightedness or near-sightedness, causes vision to become blurred in the long distance, and the need for glasses or contact lenses to bring the eye back into focus.

In most cases, myopia starts in childhood, and then progressively increases throughout the teenage years, typically up until early adulthood when it stabilizes.¹ Myopia is a lifelong condition and increases risk of potentially sight threatening conditions in later life, causing the World Health Organization to classify myopia as a global health concern.²

'Myopia control' has become the increasingly adopted term to describe any approach that aims to slow progression of myopia. Myopia control is particularly important in children, because this is the stage in life when myopia is most likely to progress or worsen quickly.³

Myopia control is also important in teenagers as their vision can still be worsening, albeit at a slower rate than in younger children. Around half of teenagers reach stability of their myopia progression around age 16,¹ but this means half are still progressing, so ideally myopia control treatment should continue into early adulthood.

Atropine is used in general medicine, and also as an eye medicine or eye drop. As an eye drop, atropine 1% is used to dilate (enlarge) the pupil and stop the eye’s focusing mechanism, which can be used for testing the vision and treating amblyopia (lazy eye) in younger children, and also for managing some eye diseases in kids and adults.⁴

The first studies using atropine eye drops to slow myopia progression in children and teenagers used 1% atropine, but these had significant side effects – enlarged pupils made a child sensitive to light, and blurred their close-up vision.⁵

Newer studies have investigated lower concentrations of 0.01% up to 0.05%, which have minimal side effects. Atropine eye drops for myopia control are used once per day, at night time.⁶

Myopia control is defined as using treatments to slow down the typical progression, or worsening, of myopia in children and teenagers. Treatments include special types of spectacles, contact lenses or atropine eye drops. Standard types of spectacles and contact lenses, called single vision, do not slow down myopia progression.³

Atropine has been investigated for myopia control in concentrations of 0.01% through to 1%. Concentrations of 0.1% to 1% have significant side effects of increased light sensitivity (due to enlarged pupils) and blurred near vision (due to relaxing the eyes' focussing lens).^5,7 These side effects can be managed with spectacle lens treatments, but are a less appealing option for teenagers with more visual demands than children.

Atropine 0.01% to 0.05% has been shown to have minimal side effects in children who were 4 to 12 years of age at the start of treatment. Atropine 0.05% was most effective in this study, followed by 0.025% and then 0.01% as least effective. This study lasted for three years, meaning that children up to age 15 participated and showed good safety, tolerance and treatment effect.⁶

Another study found 0.02% was more effective than 0.01% in children aged 6 to 14 at the start of treatment, and followed for two years. This means that children up to age 16 were included in that study.⁸

Most evidence for myopia control treatments tends to include children up to 15-16 years of age at the end of these studies. There is little evidence for effective myopia control strategies in older teens and young adults. This is partly because myopia stabilizes for about half of myopes by age 16, so treatments are aimed at younger children who are experiencing faster myopia progression.¹

Atropine 0.01% was reported to be the most effective concentration with minimal side effects back in 2016,⁷ but newer studies since have shown it is not as effective for myopia control as stronger concentrations of 0.02% to 0.05%, which also have minimal side effects.^6,8

Atropine 0.02% and 0.025% have been shown to slow myopia progression by about one-third, and atropine 0.05% by about one-half, compared to children and teens on placebo treatment.^6,8 Keep in mind that the evidence only extends to children aged 15-16 years.

Compared to other treatments for myopia control, atropine appears to work similarly to the best spectacle, contact lens and ortho-k options.⁹ The ideal myopia control treatment for your teenager will depend on a number of factors, including their eye measurements, capabilities, activites and more.

Atropine 0.01% combined with ortho-k contact lens wear has been shown to have a boosted myopia control effect in children up to age 13. There is no evidence yet that this combination will work similarly in teenagers.¹⁰ Read more in our article ortho-k for myopia control.

There are no myopia control treatments that can promise to stop myopia progression, but they can help to slow it down.³ Atropine treatment will be working, firstly, if your teenager can see clearly with their spectacles or contact lenses and are tolerating the treatment well with minimal side effects.³

Myopia progression can be measured either by measuring change to refraction prescription or change in the axial length of the eye, and compared to research data to determine success of a myopia control treatment.

1. Hou W, Norton TT, Hyman L, Gwiazda J; COMET Group. Axial Elongation in Myopic Children and its Association With Myopia Progression in the Correction of Myopia Evaluation Trial. Eye Contact Lens. 2018 Jul;44(4):248-259. (link)
2. The impact of myopia and high myopia. Report of the Joint World Health Organization-Brien Holden Vision Institute Global Scientific Meeting on Myopia. 2015 (link)
3. Gifford KL, Richdale K, Kang P, Aller TA, Lam CS, Liu YM, Michaud L, Mulder J, Orr JB, Rose KA, Saunders KJ, Seidel D, Tideman JWL, Sankaridurg P. IMI - Clinical Management Guidelines Report. Invest Ophthalmol Vis Sci. 2019 Feb 28;60(3):M184-M203. (link)
4. McLendon K, Preuss CV. Atropine. [Updated 2021 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: (link)
5. Chua WH, Balakrishnan V, Chan YH, Tong L, Ling Y, Quah BL, Tan D. Atropine for the treatment of childhood myopia. Ophthalmology. 2006 Dec;113(12):2285-91. (link)
6. Yam JC, Zhang XJ, Zhang Y, Wang YM, Tang SM, Li FF, Kam KW, Ko ST, Yip BHK, Young AL, Tham CC, Chen LJ, Pang CP. Three-Year Clinical Trial of Low-Concentration Atropine for Myopia Progression (LAMP) Study: Continued Versus Washout: Phase 3 Report. Ophthalmology. 2022 Mar;129(3):308-321. (link)
7. Chia A, Lu QS, Tan D. Five-Year Clinical Trial on Atropine for the Treatment of Myopia 2: Myopia Control with Atropine 0.01% Eyedrops. Ophthalmology. 2016 Feb;123(2):391-399. (link)
8. Cui C, Li X, Lyu Y, Wei L, Zhao B, Yu S, Rong J, Bai Y, Fu A. Safety and efficacy of 0.02% and 0.01% atropine on controlling myopia progression: a 2-year clinical trial. Sci Rep. 2021 Nov 15;11(1):22267. (link)
9. Brennan NA, Toubouti YM, Cheng X, Bullimore MA. Efficacy in myopia control. Prog Retin Eye Res. 2021 Jul;83:100923. (link)
10. Tan Q, Ng AL, Cheng GP, Woo VC, Cho P. Combined 0.01% atropine with orthokeratology in childhood myopia control (AOK) study: A 2-year randomized clinical trial. Cont Lens Anterior Eye. 2022 May 30:101723. (link)