Low-dose atropine against myopia in children: the studies and the European approval

Atropine is an old acquaintance of ophthalmologists. As drops it dilates the pupil and relaxes the muscle that focuses up close, which is why for a long time it was used mainly during examinations. In recent years, at much lower concentrations, it has become one of the most studied treatments for slowing myopia in children.

In 2025 European approval also arrived: after the favourable opinion of the European Medicines Agency, a low-dose atropine eye drop was authorised in the European Union to slow the worsening of myopia in children⁹. What do the studies on atropine and myopia say, in numbers? And what do we still not know?

In this article

1. How we measure whether myopia is slowing
2. Atropine and myopia: the LAMP study
3. How much it slows, according to the Cochrane review
4. The rebound effect: what happens after stopping
5. European studies and the Union’s approval
6. Adverse effects: what is known
7. Frequently asked questions
8. Sources

How we measure whether myopia is slowing

Two things are measured in studies of myopia in children. The first is dioptres, that is, by how much myopia increases in a year. The second is the length of the eye, in millimetres, because myopia in children arises mainly from an eye that grows too long, as we explain in the article on what myopia is.

A treatment that ‘works’, in this field, does not take myopia back: it makes it increase less. A critical review from 2025 recalls that percentages (‘slows by 50%’) are a misleading way of measuring efficacy, and that the effect tends to diminish over time¹⁰: it is better to look at dioptres and millimetres.

Atropine and myopia: the LAMP study

The reference study is called LAMP: it compared three low concentrations with a placebo and then followed the same children for years^2,5.

How much it slows, according to the Cochrane review

The overall picture comes from a 2023 Cochrane systematic review, of the ‘living’ type, that is, updated as new studies come out. It brought together 64 randomised trials with 11,617 children and teenagers aged 4 to 18, 61% of them conducted in China or other Asian countries¹.

In the control groups myopia increased by 0.65 dioptres in a year (median value). With low-dose atropine this increase was about 0.38 dioptres smaller, and at two years the difference was 0.24 dioptres; the eye lengthened by 0.13 millimetres less at one year and by 0.16 at two years¹. Higher concentrations slowed it more, but already among the low concentrations the effects on the pupil and on focusing grow with the dose^1,2.

The authors are cautious: the certainty of the evidence ranges from very low to moderate, data beyond two years are few, the effect in the long term is uncertain and adverse effects were not reported uniformly¹.

The rebound effect: what happens after stopping

In the third year of the LAMP study some of the children continued the drops and others moved to a period without. In those who had used 0.05%, that year myopia increased by 0.68 dioptres in the group without drops against 0.28 in those who had continued³. The rebound was smaller in older children and with the lowest concentrations³.

After five years, among the children who had never stopped, those who started on 0.05% had accumulated on average 1.34 dioptres of myopia, against 1.97 for those who started on 0.025% and 2.34 for those who started on 0.01%⁴. Among those who had stopped in the third year, with the idea of resuming only in case of new worsening, 88% then had to start again⁴. The latest chapter, published in 2026 after eight years, compared two ways of finishing: reducing the drops gradually or stopping suddenly. Over the following three years myopia grew by 0.54 dioptres with gradual reduction and by 0.78 with an abrupt stop, with more marked differences in younger and more myopic children⁵.

Measuring the rebound, however, is less simple than it seems, and the Cochrane review still judges the evidence on this point inconclusive^1,10.

European studies and the Union’s approval

Most studies come from Asia¹, and the European ones of recent years have given less uniform results.

In the United Kingdom the CHAMP-UK study involved 289 children aged 6 to 12 in five centres, 72% of them of white origin, randomly assigned to atropine at 0.01% or to placebo. Atropine reduced the worsening by 0.33 dioptres and the lengthening of the eye by 0.14 millimetres, with no differences between age groups, origin or sex; the pupil was on average 0.36 millimetres larger and adverse events were not more frequent than with placebo⁶.

Another European study, of 250 children, found after two years no significant difference in dioptres, although with an eye that lengthened a little less (0.07 millimetres); the effect varied with origin and eye colour⁷. In Denmark, after three years, including a final period without drops, the differences from placebo were no longer significant⁸. On the lowest concentration opinions remain divided: the 2025 critical review concludes that 0.01% should not be considered a first-choice treatment¹⁰.

The 2025 European decision is based on a study of 852 children aged 3 to 14 followed for 24 months. In children whose myopia was worsening by at least half a dioptre a year, it increased by 0.34 dioptres with the eye drop and by 0.54 with placebo⁹. The authorisation covers children aged 3 to 14 with myopia between −0.5 and −6 dioptres that is worsening by at least half a dioptre a year⁹.

Adverse effects: what is known

Atropine dilates the pupil and slightly reduces focusing up close: this is where the most frequent effects come from. For the eye drop authorised in Europe the most common adverse effect is sensitivity to light, which affects more than one child in ten; eye irritation and blurred vision affect up to one child in ten⁹. In the British study there were no serious adverse events linked to the eye drop⁶.

Frequently asked questions

Does atropine make myopia go away?

No. In the studies it slows the increase in myopia and the lengthening of the eye, but does not take back the dioptres already present^1,2. To see well in the distance the child still needs glasses or lenses.

What is the difference between atropine at 0.01% and at 0.05%?

In the LAMP study 0.05% slowed myopia more: after five years of continuous treatment, the children who started on 0.05% had an increase of 1.34 dioptres, those who started on 0.01% 2.34⁴. With higher concentrations, however, the effects on the pupil and on focusing up close also grow². In European studies 0.01% has given variable results^6,7,8.

For how long has atropine against myopia been studied?

Randomised trials mostly last from one to three years¹; LAMP followed children for eight years⁵. After treatment ends a rebound is possible, smaller in older children³.

Is atropine against myopia authorised in Europe?

Yes: since 2025 a low-dose atropine eye drop has been authorised in the European Union to slow myopia in children aged 3 to 14⁹. Availability and reimbursement vary from country to country: it is a question for the ophthalmologist.

In Europe low-dose atropine has moved beyond the experimental stage⁹. The studies say that it slows myopia, not that it stops it; that the effect changes from one population to another; and that after stopping there may be a rebound^1,3,7. Alongside the drops, lenses and glasses for myopia are being studied and, even before that, time outdoors.