The ATOM Study: Landmark Research on Atropine Eye Drops for Childhood Myopia
Childhood myopia, commonly known as short-sightedness, has become one of the fastest-growing eye health concerns worldwide. If your child has myopia, they may be able to see nearby objects clearly but struggle to focus on things in the distance. As the condition progresses, your child may need stronger glasses or contact lenses, and high levels of myopia can increase the risk of developing certain eye diseases later in life.
For many years, myopia management focused mainly on correcting vision with glasses or contact lenses. While these options helped your child see more clearly, they did not slow the underlying progression of myopia. As a result, researchers began searching for treatments that could help reduce the rate at which your child’s eyesight worsened during their growing years.
The Atropine for the Treatment Of Myopia (ATOM) study marked a major breakthrough in paediatric ophthalmology. The resea`1rch showed that atropine eye drops could significantly slow the progression of childhood myopia, giving eye specialists a new way to help protect your child’s long-term vision rather than simply correcting their eyesight.
Today, the findings from the ATOM study continue to influence myopia management around the world. If your child is developing short-sightedness, treatments based on this research may help slow its progression and reduce the risk of future eye complications. This article explains the ATOM study, its key findings and how it has shaped modern approaches to childhood myopia control.
Understanding Childhood Myopia
Childhood myopia, also known as short-sightedness, is a refractive error that makes distant objects appear blurred while nearby objects remain clear. If your child has myopia, they may struggle to see the whiteboard at school, road signs or objects in the distance, even though close-up tasks such as reading are usually much easier.
Myopia often develops during the early school years and can continue to progress as your child grows. As the condition worsens, the eyeball becomes longer than normal, causing light to focus in front of the retina instead of directly on it. This means your child may need stronger glasses or contact lenses over time to maintain clear vision.
Managing myopia progression has become an important part of children’s eye care. By identifying the condition early and using appropriate myopia control strategies, you can help slow its progression and support your child’s long-term eye health while reducing the risk of future vision problems.
Why Myopia Is Increasing
Researchers believe that childhood myopia develops because of a combination of genetic and environmental factors. If you or your child’s other parent are short-sighted, your child may have a higher chance of developing myopia. However, genetics is only part of the picture, and lifestyle habits can also influence how the condition develops.
Studies suggest that spending less time outdoors and more time on close-up activities, such as reading, using tablets or looking at digital screens, may contribute to the increasing number of children developing myopia. While these activities do not necessarily cause myopia on their own, they may increase the risk of the condition progressing, especially during the growing years.
As childhood myopia becomes more common around the world, researchers continue to investigate ways to prevent or slow its progression. By understanding the factors that may affect your child’s eyesight, you can work with your eye care professional to support healthy visual development and explore suitable myopia management options if needed.
Why Slowing Progression Matters
Slowing the progression of myopia is important because higher levels of short-sightedness are linked to a greater risk of serious eye conditions later in life. If your child’s myopia continues to worsen, they may have an increased chance of developing problems such as retinal detachment, glaucoma, cataracts and myopic macular degeneration as they get older.
By slowing myopia during childhood, you may be able to reduce these long-term risks and better protect your child’s future eye health. Although myopia control cannot reverse the condition, it can help limit how quickly the eye becomes longer, which is a key factor in disease progression.
This is why early intervention is so valuable. If your child is diagnosed with myopia, regular eye examinations and appropriate myopia management strategies can help slow its progression and support healthier vision for years to come.
What Is Atropine?
Atropine is a medication that has been used in ophthalmology for many years. When used in the eye, it can dilate the pupil and temporarily relax the eye’s focusing mechanism. It has established ophthalmic uses, including cycloplegic assessment and selected treatment for amblyopia. Researchers have also investigated atropine at different concentrations for its ability to slow myopia progression in children.
Researchers later discovered that much lower doses of atropine could do more than temporarily enlarge the pupil. These low-dose eye drops were found to help slow the progression of myopia in children, offering a new way to manage the condition rather than simply correcting vision with glasses or contact lenses.
This discovery opened an entirely new area of paediatric eye care. If your child has myopia, low-dose atropine may now be considered as part of a personalised myopia management plan to help slow the condition and support their long-term eye health.
Purpose of the ATOM Study
The ATOM study was designed to determine whether atropine eye drops could slow the progression of childhood myopia. If your child has short-sightedness, you may wonder whether treatment can do more than simply improve their vision with glasses. Researchers wanted to find out whether atropine could help slow the condition itself and better protect your child’s eyesight over time.
To investigate this, Researchers compared changes in refractive error and eye growth between the atropine-treated group and the placebo group. By following the children over time, they could measure whether your child’s eyesight might progress more slowly with atropine than without it.
The goal of the ATOM study was to provide strong scientific evidence for a new way of managing childhood myopia. The results gave eye specialists greater confidence in recommending atropine as part of a myopia control plan. If your child is developing myopia, these findings may help you and your eye specialist decide whether atropine is a suitable option to support your child’s long-term eye health.
Study Design
The original ATOM1 study was a randomised, double-masked, placebo-controlled clinical trial involving 400 children aged 6 to 12 years. Researchers compared 1% atropine with placebo treatment and monitored changes in refractive error and axial length over two years. These measurements allowed the researchers to assess whether atropine was influencing both changes in prescription and the physical elongation of the eye associated with progressive myopia.
Throughout the study, your child would have attended regular eye examinations to assess both vision and eye growth. Researchers measured changes in refractive error as well as the length of the eyeball, helping them determine whether atropine could slow myopia progression more effectively than placebo.
testing methods were used at every stage to ensure the results were reliable and consistent. This careful study design gave eye specialists confidence in the findings and helped provide strong scientific evidence that could guide your child’s myopia management both now and in the future.
Research Insight: What did ATOM1 actually find?
The original ATOM1 trial provided important controlled evidence that atropine could influence the progression of childhood myopia rather than simply correct blurred distance vision. After two years, the study reported substantially less average myopic progression in the atropine-treated eyes than in the placebo-treated control eyes. The researchers also found a marked difference in axial elongation, which is important because excessive lengthening of the eye is a structural feature of progressive myopia.
These results were important at a population level, but they do not mean that every child will respond in the same way. Treatment decisions still need to consider your child’s age, rate of progression, prescription, eye health and ability to tolerate treatment.
How Childhood Myopia Progression Is Monitored
| Assessment | What It Measures | Why It Is Useful |
| Refractive error assessment | Changes in the strength of your child’s glasses prescription | Helps show whether short-sightedness is becoming stronger over time |
| Axial length measurement | The length of the eyeball | Eye elongation is closely associated with the structural progression of myopia |
| Visual acuity testing | How clearly your child can see at different distances | Helps assess functional vision and whether current correction provides clear sight |
| Prescription history | Changes across previous eye examinations | A pattern of repeated prescription increases can help show the rate of progression |
| Treatment response review | Changes observed after starting a myopia-control strategy | Helps the eye specialist assess whether the current approach remains appropriate |
| Side-effect review | Any light sensitivity, focusing difficulty or other treatment-related concerns | Helps determine whether treatment remains comfortable and suitable for your child |
| Regular follow-up | Trends across repeated measurements rather than one isolated result | Myopia progression is best understood by comparing changes over time |
Your child’s myopia should not be assessed using one prescription measurement alone. Eye specialists may consider changes in refractive error, axial length, visual function, treatment response and the pattern of progression over time when reviewing the management plan.
Major Findings of the ATOM Study
The ATOM study showed that atropine eye drops could significantly slow the progression of childhood myopia. If your child received atropine treatment, they were generally less likely to experience the same level of worsening in their short-sightedness as children in the placebo group.
Researchers found that children using atropine eye drops experienced a slower increase in their glasses prescription over the course of the study. This suggested that the treatment was helping to slow the underlying progression of myopia rather than simply correcting your child’s vision.
These findings marked a major breakthrough in paediatric ophthalmology and changed the way childhood myopia is managed around the world. Today, if your child is developing myopia, your eye specialist may consider atropine eye drops as part of a personalised myopia control plan to help protect their long-term eye health.
Recommended approach
In the two-year ATOM1 results, average myopia progression was −0.28 dioptres in atropine-treated eyes compared with −1.20 dioptres in placebo-treated control eyes. Axial length also remained broadly stable in the atropine-treated eyes, whereas the placebo group showed measurable elongation. These findings provided important evidence that atropine was affecting both refractive progression and structural eye growth, although the original study used 1% atropine and should not be confused with later low-dose atropine trials.
Development of Low-Dose Atropine
Following the success of the original ATOM study, researchers continued to investigate whether lower concentrations of atropine could provide similar benefits for children with myopia. If your child requires myopia control, using a lower-dose formulation may help slow the progression of short-sightedness while making treatment more comfortable.
The goal was to maintain the effectiveness of atropine while reducing side effects that were more common with higher concentrations, such as light sensitivity and difficulty focusing on nearby objects. By lowering the dose, researchers hoped your child could continue treatment with fewer disruptions to everyday activities.
This research helped shape the modern approach to myopia control. Today, your eye specialist may recommend low-dose atropine because it aims to balance effectiveness with comfort, giving your child a better long-term treatment experience while helping to slow the progression of myopia.
Benefits of Low-Dose Treatment
Lower atropine concentrations are intended to reduce treatment-related effects while retaining a clinically useful effect on myopia progression. However, effectiveness and tolerability can differ between concentrations, and the most appropriate treatment needs to be selected according to your child’s individual circumstances and response.
Because side effects such as light sensitivity and difficulty focusing on nearby objects are generally less common with low-dose formulations, your child may find the treatment more comfortable to use over a longer period. This can make it a more practical option when ongoing myopia control is needed under the guidance of an eye specialist.
It is important to remember that every child responds differently to treatment. Your eye specialist will monitor your child’s vision regularly to assess how well the atropine eye drops are working and determine whether any adjustments to your child’s treatment plan are needed.
Safety Findings
The ATOM study carefully evaluated the safety of atropine eye drops alongside their ability to slow childhood myopia. If your child is being considered for atropine treatment, understanding its safety profile is an important part of deciding whether it is the right option.
Researchers found that most side effects were linked to pupil enlargement and temporary difficulty focusing on nearby objects, particularly when higher concentrations of atropine were used. Your child might also become more sensitive to bright light because the pupils remain more dilated during treatment.
Further research into lower-dose atropine has shown that many children experience fewer side effects while still benefiting from myopia control. Your eye specialist will recommend the most appropriate concentration for your child and monitor their progress regularly to ensure the treatment remains both safe and effective.
Clinical Tip: Do not change or stop atropine without professional advice
Your child’s atropine treatment should be reviewed regularly. Do not change the concentration, increase the number of drops or stop treatment without discussing the plan with the prescribing eye care professional. Monitoring is important because treatment response, side effects and progression after stopping can vary between children.
Long-Term Follow-Up
Researchers continued to monitor children after the original ATOM study to understand how atropine treatment affected myopia over the longer term. If your child begins myopia control treatment, long-term follow-up is important because it helps your eye specialist assess how well the treatment continues to work over time.
These follow-up studies looked at treatment duration, the ongoing effectiveness of atropine eye drops and what happened after the treatment was stopped. By tracking these changes, researchers gained a better understanding of how your child’s eyesight might respond during and after therapy.
The long-term evidence from these studies continues to guide modern clinical practice. Your eye specialist can use this research to decide how long your child may benefit from treatment, when regular monitoring is needed and how to manage myopia effectively as your child grows.
Importance of Regular Eye Examinations
If your child is receiving atropine treatment for myopia, regular eye examinations are an essential part of their care. These follow-up appointments allow your eye specialist to monitor your child’s vision closely and check how well the treatment is working over time.
During follow-up, your eye specialist will assess changes in your child’s prescription and may monitor axial length where appropriate, alongside treatment response, visual function and possible side effects.
Ongoing monitoring plays an important role in successful myopia management. By making sure your child attends their scheduled appointments and follows the recommended treatment plan, you can help protect their long-term eye health and support better vision as they grow.
Influence on Myopia Management
The ATOM study transformed the way ophthalmologists manage childhood myopia. In the past, treatment mainly focused on helping your child see more clearly with glasses or contact lenses. Today, the goal is not only to correct vision but also to slow the progression of myopia and help protect your child’s long-term eye health.
Thanks to the evidence provided by the ATOM study, many eye specialists now use evidence-based myopia control strategies, such as low-dose atropine eye drops, alongside other management options. If your child is diagnosed with myopia, your eye specialist may recommend a personalised treatment plan based on their age, prescription and risk of progression.
This represents a major shift in paediatric eye care. Instead of simply updating your child’s glasses prescription as their eyesight changes, you can now work with your eye specialist to actively manage the condition and reduce the risk of future eye problems associated with high myopia.
Combining Treatment Approaches
Modern myopia management may involve more than one strategy because every child’s eyes and rate of progression are different. Your eye specialist will consider factors such as age, prescription, and how quickly myopia is changing before recommending a suitable plan.
- Low-Dose Atropine: Eye drops may be included in a treatment plan to help slow myopia progression in suitable children.
- More Time Outdoors: Increased outdoor activity may form part of a wider strategy to support healthy visual development.
- Specially Designed Lenses: Myopia-control glasses or contact lenses may be recommended depending on your child’s needs.
- Personalised Combination Plan: For selected children, an eye specialist may consider combining appropriate myopia-control approaches. However, the evidence differs between treatment combinations, and using more than one treatment does not automatically mean that the result will be better. The decision should be based on your child’s progression, age, eye health and response to treatment.
Overall, myopia management works best when it is tailored to your child’s individual needs. Regular eye examinations allow the treatment plan to be reviewed and adjusted as your child grows. Following specialist advice consistently can help support long-term vision and eye health.
Current Research Into Myopia Control
The success of the ATOM study has inspired extensive research into new ways of managing childhood myopia. If your child has short-sightedness, ongoing studies are helping eye specialists develop treatments that are even more effective, comfortable and suitable for long-term use.
Researchers are continuing to investigate different atropine concentrations, combination treatment approaches and innovative optical technologies designed to slow myopia progression. These studies aim to find the best ways to help your child maintain healthy vision while reducing the risk of high myopia later in life.
Research in this field remains highly active, and new evidence continues to shape modern myopia management. As more treatments become available, your eye specialist can use the latest research to recommend the approach that is most appropriate for your child’s individual needs and long-term eye health.
Individualised Treatment Decisions
Not every child with myopia needs atropine eye drops, and treatment is not the same for everyone. If your child is diagnosed with short-sightedness, your eye specialist will first assess their individual needs before recommending the most appropriate management plan.
Several factors are considered when deciding whether atropine therapy is suitable for your child. These include your child’s age, how quickly their myopia is progressing, whether there is a family history of myopia and their overall eye health. By looking at these factors together, your eye specialist can recommend the treatment that is most likely to benefit your child.
An individual assessment is an important part of successful myopia management. Rather than using a one-size-fits-all approach, your eye specialist will develop a personalised plan that suits your child’s needs, helping you make informed decisions to support their long-term vision and eye health.
UK Guidance Note
The UK position on low-dose atropine has recently changed. Ryjunea 0.1 mg/ml has UK marketing authorisation for slowing myopia progression in children aged 3 to 14 years. The authorised treatment criteria include children with a myopia progression rate of at least 0.5 dioptres per year and myopia severity between −0.5 D and −6.0 D.
However, having a licensed treatment available does not mean that atropine is suitable for every child with myopia. Treatment decisions should still be based on an individual clinical assessment. NICE is currently evaluating the clinical and cost effectiveness of low-dose atropine within its marketing authorisation, so recommendations concerning wider NHS use are still developing.
Future Advances in Childhood Myopia
Research into childhood myopia continues to advance, giving you and your child hope for even better treatment options in the future. Scientists are working to develop new methods that can slow myopia progression more effectively while making treatment easier and more comfortable for children.
Future innovations may include improved drug formulations, more personalised treatment plans and advanced diagnostic technologies that help your eye specialist monitor your child’s eye growth with greater accuracy. These developments could make it easier to choose the most suitable treatment for your child’s individual needs.
The long-term goal is to protect your child’s vision and preserve their eye health as they grow. As new research becomes available, your eye specialist will be able to use the latest evidence to recommend the most appropriate myopia management strategy, helping your child achieve the best possible long-term outcomes.
Lasting Legacy of the ATOM Study
The ATOM study remains one of the most influential clinical trials in childhood myopia research. By showing that atropine eye drops could slow the progression of myopia, it changed the way your eye specialist approaches the management of this increasingly common condition.
Before the ATOM study, treatment mainly focused on helping your child see more clearly with glasses or contact lenses. Today, the findings from this landmark research allow your eye specialist to focus on slowing the progression of myopia, helping to protect your child’s long-term eye health rather than simply correcting their vision.
The impact of the ATOM study continues to be seen around the world. Its findings have influenced international treatment guidelines and continue to shape the care your child receives. As research builds on these results, you can expect myopia management to become even more personalised and effective in the years ahead.
Seeking Specialist Care for Childhood Myopia
If your child’s short-sightedness is progressing rapidly or their glasses prescription is changing frequently, it is important to arrange an assessment with an eye specialist. The earlier your child is evaluated, the sooner you can discuss the most appropriate myopia management options to help slow the condition’s progression.
During the assessment, your eye specialist will examine your child’s eyes, review their prescription history and consider factors such as their age, rate of progression, family history and overall eye health. This information helps you and your specialist choose a personalised treatment plan that is best suited to your child’s needs.
Early intervention can play an important role in protecting your child’s long-term eye health. By attending regular eye examinations and following your eye specialist’s recommendations, you can help reduce the risk of high myopia and support healthier vision as your child grows.
Myth vs Fact: Understanding Atropine and Childhood Myopia
Research into atropine and childhood myopia has developed considerably since the original ATOM study. However, parents may still come across misconceptions about what atropine can achieve, which children may benefit and how the treatment is monitored.
| Myth | Fact |
| Atropine eye drops can cure childhood myopia. | Atropine does not cure or reverse existing short-sightedness. The aim of treatment is to slow the rate at which myopia progresses. Your child may still need glasses or contact lenses to see clearly. |
| The original ATOM study tested the same low-dose atropine treatment commonly discussed today. | The original ATOM1 trial investigated 1% atropine. Later studies, including ATOM2 and LAMP, investigated lower concentrations and helped researchers better understand the balance between treatment effect and tolerability. |
| Low-dose atropine has no side effects. | Lower concentrations are generally intended to reduce treatment-related effects, but this does not mean that side effects are impossible. Some children may experience symptoms such as light sensitivity or difficulty with near focusing, so treatment should be prescribed and monitored appropriately. |
| Every child with myopia needs atropine treatment. | Not every child with short-sightedness will need or be suitable for atropine treatment. The decision should consider factors such as age, rate of progression, prescription, eye health and individual clinical circumstances. |
| Spending more time outdoors can reverse existing myopia. | Outdoor time is associated with a lower risk of developing myopia and remains an important part of healthy visual habits, but it does not reverse established short-sightedness. Children with progressive myopia still need appropriate eye examinations and an individual management plan. |
| Once atropine treatment starts, regular eye examinations are no longer necessary. | Follow-up remains essential. Your eye care professional may monitor changes in prescription, axial length where appropriate, treatment response and possible side effects, and review whether the management plan remains suitable as your child grows. |
Understanding these distinctions can help you have a more informed discussion with your child’s eye care professional. Atropine is an important part of modern myopia research and management, but treatment decisions should be based on your child’s individual needs rather than the assumption that one approach is suitable for every child.
Key Takeaways
- The original ATOM1 study showed that atropine could slow childhood myopia progression and axial eye growth compared with placebo.
- ATOM1 used 1% atropine; the evidence for lower concentrations came from later studies, including ATOM2 and LAMP.
- Lower-dose treatment strategies were developed partly to improve the balance between treatment effect and tolerability.
- Atropine does not cure myopia or remove the need for glasses or contact lenses.
- Treatment should be individualised and monitored regularly, including after treatment is stopped.
FAQs:
- What was the ATOM study?
The ATOM (Atropine for the Treatment Of Myopia) study was a landmark clinical trial that investigated whether atropine eye drops could slow the progression of childhood myopia. It provided strong evidence that atropine is effective in reducing the rate at which short-sightedness worsens. The study has had a lasting influence on modern myopia management. - Why is the ATOM study important?
The ATOM study changed the focus of myopia care from simply correcting vision to actively slowing myopia progression. This was important because higher levels of myopia increase the risk of serious eye conditions later in life. Its findings helped establish atropine eye drops as an evidence-based treatment option. - What are atropine eye drops used for in children?
Low-dose atropine eye drops are used to help slow the progression of myopia in children. They do not cure short-sightedness or eliminate the need for glasses, but they may reduce how quickly the condition worsens. Treatment is usually recommended for children with progressive myopia under specialist supervision. - How do atropine eye drops help control myopia?
The precise way atropine slows myopia progression is not yet fully understood. Clinical studies show that atropine can reduce refractive progression and axial elongation, while researchers continue to investigate the biological pathways responsible for these effects. Regular monitoring helps your eye care professional assess how your child is responding to treatment. - What were the main findings of the ATOM study?
ATOM1 showed that 1% atropine could substantially slow myopia progression compared with placebo. Later research, including ATOM2 and LAMP, investigated lower atropine concentrations and helped clarify the balance between treatment effect, concentration and tolerability. These findings transformed childhood myopia management. - Are low-dose atropine eye drops safe?
Low-dose atropine has generally been shown to be well tolerated by most children when prescribed by an eye specialist. Compared with higher concentrations, it is associated with fewer side effects such as light sensitivity and difficulty focusing on near objects. Regular follow-up appointments help ensure treatment remains safe and appropriate. - Does every child with myopia need atropine treatment?
No, not every child with myopia requires atropine therapy. The decision depends on factors such as the child’s age, how quickly the prescription is changing, family history, and overall eye health. An ophthalmologist or optometrist can recommend the most suitable management plan. - Can atropine eye drops be combined with other myopia treatments?
For selected children, an eye specialist may consider atropine alongside another appropriate myopia-control approach. However, evidence varies between treatment combinations, and using more than one strategy does not automatically lead to a better result. The decision should be based on your child’s age, rate of progression, prescription, eye health and response to treatment. - Why are regular eye examinations important during atropine treatment?
Regular eye examinations allow specialists to monitor changes in vision, eye growth, and treatment effectiveness. They can also check for any side effects and adjust the treatment plan if necessary. Ongoing follow-up is an essential part of successful myopia management. - What is the lasting impact of the ATOM study?
The ATOM study remains one of the most influential pieces of research in childhood myopia. It demonstrated that slowing myopia progression is possible and encouraged further studies into low-dose atropine and other control methods. Its findings continue to shape international guidelines and modern clinical practice.
Final Thoughts: How the ATOM Study Shaped Modern Childhood Myopia Care
The ATOM study marked a significant milestone in the management of childhood myopia by demonstrating that atropine eye drops could do more than simply correct blurred vision they could help slow the progression of the condition itself. Its findings changed the way eye care professionals approach myopia, shifting the focus towards protecting children’s long-term eye health rather than only updating their glasses prescription.
Today, low-dose atropine remains an important option within comprehensive myopia management, often used alongside lifestyle advice and other evidence-based treatments. Because every child’s eyes and rate of progression are different, early assessment and regular monitoring are essential to determine the most appropriate care. If you’d like to find out whether paediatric ophthalmologist in London is suitable for you, feel free to contact us at Eye Clinic London to arrange a consultation.
References:
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- Tong, L., Huang, X.L., Koh, A.L., Zhang, X., Tan, D.T.H. and Chua, W.H. (2009) ‘Atropine for the treatment of childhood myopia: effect on myopia progression after cessation of atropine’, Ophthalmology, 116(3), pp. 572–579. Available at: https://pubmed.ncbi.nlm.nih.gov/19167081/
- Chierigo, A., Ferro Desideri, L., Traverso, C.E. and Vagge, A. (2022) ‘The Role of Atropine in Preventing Myopia Progression: An Update’, Pharmaceutics, 14(5), 900. Available at: https://www.mdpi.com/1999-4923/14/5/900
- Kaiti, R., Shyangbo, R. and Sharma, I.P. (2022) ‘Role of Atropine in the Control of Myopia Progression: A Review’, Beyoglu Eye Journal, 7(3), pp. 157–166. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC9522992/
- Gong, Q., Janowski, M., Luo, M., Wei, H., Chen, B., Yang, G. and Liu, L. (2017) ‘Efficacy and Adverse Effects of Atropine in Childhood Myopia: A Meta-analysis’, JAMA Ophthalmology, 135(6), pp. 624–630. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC5710262/