Key Takeaways

  • A systematic review and meta-analysis of 13 randomized controlled trials found that atropine's effects on accommodation and binocular vision are dose-dependent
  • Atropine 0.01% was associated with minimal effects on accommodative amplitude and binocular visual function, supporting its favorable tolerability profile 
  • Concentrations of 0.05% and higher were linked to clinically meaningful reductions in accommodative amplitude

A new systematic review and meta-analysis published in Ophthalmic and Physiological Optics examines how atropine concentration affects accommodative and binocular visual function in children receiving treatment for myopia control. The analysis found that atropine's effects on accommodation are dose-dependent, with low-dose regimens demonstrating minimal functional impact while higher concentrations produce clinically meaningful reductions in accommodative amplitude.

The study, led by Clara Martínez-Pérez, OD, PhD, and colleagues, evaluated 13 randomized controlled trials comparing atropine concentrations ranging from 0.01% to 1.0% against placebo, single-vision correction, or no treatment. Researchers examined changes in accommodative amplitude, accommodative lag, stereoacuity, heterophoria, and fusional vergence in children and adolescents undergoing myopia treatment.

Among the key findings, atropine 0.01% was associated with a small but statistically significant reduction in accommodative amplitude. However, the magnitude of change was modest and did not consistently translate into clinically meaningful effects across follow-up periods. Investigators also found no significant impact on accommodative lag, stereoacuity, or most binocular vision parameters at this concentration.

The findings reinforce the growing perception among clinicians that ultra-low-dose atropine offers a favorable balance between myopia-control efficacy and visual tolerability, particularly for children with substantial near-work demands, researchers stated.

The analysis found greater variability with intermediate concentrations of 0.02% to 0.03%, while atropine 0.05% produced a more consistent reduction in accommodative amplitude and measurable changes in binocular visual function. Concentrations of 0.1% and higher were associated with pronounced cycloplegic effects and substantially greater accommodative impairment.

According to the authors, the findings suggest that clinicians should proactively assess accommodative and binocular vision status when prescribing higher-concentration atropine, particularly in children reporting near blur, asthenopia, or reading difficulties. In some cases, additional management strategies such as near additions or adjustments to treatment regimens may be appropriate.

The authors conclude that while low-dose atropine maintains a strong safety profile with minimal effects on accommodation, higher concentrations may require more comprehensive monitoring and patient counseling. The authors note that future research should further investigate the long-term clinical significance of atropine-induced accommodative changes and determine whether specific patient populations may be more susceptible to functional side effects. 

Reference

1. Martínez-Pérez C, Santodomingo-Rubido J, Villa-Collar C. Dose-Dependent Effects of Atropine on Accommodative and Binocular Visual Function for Myopia Control in Children: A Systematic Review and Meta-Analysis. Ophthalmic Physiol Opt. Published online May 18, 2026. doi:10.1007/s44402-026-00093-5.