Key Takeaways

  • Daily 0.01% atropine significantly slowed myopia progression by 0.33 diopters and reduced axial elongation by 0.14 mm over 2 years compared with placebo
  • The multicenter UK trial demonstrated consistent efficacy across age, sex, ethnicity, and baseline myopia severity
  • Low-dose atropine was well tolerated, with no increase in adverse events or treatment-related serious safety concerns

Daily treatment with low-concentration atropine eye drops significantly slowed myopia progression in children and was well tolerated over two years, according to results from the CHAMP-UK randomized clinical trial published in The BMJ. The findings provide some of the strongest evidence to date that 0.01% atropine is an effective myopia-control therapy in a predominantly European pediatric population.

The multicenter, double-masked, placebo-controlled trial enrolled 289 children aged 6 to 12 years with myopia ranging from -0.50 to -10.00 diopters at five National Health Service and academic centers across the United Kingdom. Participants were randomized in a 2:1 ratio to receive either one drop of preserved atropine 0.01% or placebo in each eye every evening for 2 years.

At the end of the study, children treated with atropine experienced significantly less myopia progression than those receiving placebo. The adjusted mean difference in spherical equivalent refractive error was 0.33 D in favor of atropine (95% CI, 0.17-0.49; P<0.001). Investigators also reported significantly less axial elongation, with a mean treatment difference of 0.14 mm (95% CI, 0.07-0.21; P<0.001).

The researchers found the treatment effect was consistent regardless of age, sex, ethnicity, or baseline myopia severity. While the overall reduction in progression was described as modest, atropine-treated children were more likely to have stable myopia and substantially less likely to experience rapid progression of at least 1.0 diopter over the 2-year study period.

Safety outcomes were favorable. Investigators reported no increase in adverse events compared with placebo, and no treatment-related serious adverse events occurred during the trial. Although atropine produced a small increase in pupil diameter, it did not result in clinically meaningful differences in visual acuity, reading speed, quality of life, or symptoms such as photophobia or near blur.

The findings are particularly notable because much of the previous evidence supporting low-dose atropine has come from East Asian populations, where myopia prevalence is substantially higher. CHAMP-UK demonstrates that 0.01% atropine can also provide benefit in a UK population, where childhood myopia has increased markedly over recent decades.

The investigators concluded that while higher concentrations of atropine may produce greater efficacy, 0.01% atropine offers a favorable balance between efficacy and tolerability. They noted that treatment adherence remained high throughout the study, aided by electronic monitoring, and suggested the therapy could become an important option for slowing childhood myopia progression in routine clinical practice.

Reference

1. Azuara-Blanco A, Logan NS, McConnell E, et al. Low concentration atropine eye drops and progression of myopia in children: multicentre placebo controlled, double masked, randomised trial in the UK (CHAMP-UK). BMJ. 2026;393:e086698. doi:10.1136/bmj-2025-086698.