ArticleBMJ open ophthalmology2026
Predictive value of early treatment response for long-term outcomes after seven years on low-dose atropine.
Article in BMJ open ophthalmology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND/
aimsTo determine whether first-year response to low-dose atropine predicts long-term myopia control and may guide treatment escalation in myopic children.
methodsA retrospective chart review (2012-2025) identified children treated with atropine 0.01%-0.05% at a single practice with ≥54 months of treatment. Children were excluded with insufficient follow-up (<54 months of treatment), comorbidities that might affect myopia progression or concurrent baseline optical myopia-control therapy. First-year response was modelled as the spherical equivalent refraction (SER) progression rate (diopters (D)/year, continuous, positive values indicating worsening myopia) and by responder status (defined as≤0.25D total progression at 12±3 months). The primary outcome was successful control maintaining≤0.25 D/year over follow-up. Key secondary outcomes were total SER progression and time-to-treatment escalation. Eye-level models accounted for correlation between fellow eyes and adjusted for baseline age and baseline SER.
results71 children (142 eyes) had a mean follow-up of 6.8±2.0 years. First-year responders included 101/142 eyes (71%) with higher odds of successful control (adjusted OR 2.66, 95% CI 1.11 to 6.35, p=0.028) and less total SER progression (adjusted difference 0.57D, 95% CI 0.28 to 0.86, p<0.001). Each additional 0.25 D/year of year-1 progression was associated with lower odds of successful control (OR 0.73, 95% CI 0.59 to 0.89, p=0.002) and greater total progression (0.22 D more, 95% CI 0.16 to 0.29, p<0.001). Dose escalation occurred earlier in nonresponders; responders had a lower hazard of escalation (HR 0.27, 95% CI 0.14 to 0.52).
conclusionFirst-year SER change is strongly predictive of long-term outcomes; despite earlier treatment escalation in nonresponders, responders had a much higher likelihood of sustained long-term control. Early response assessment may help identify high-risk patients for closer monitoring and/or treatment intensification.
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