Tapered atropine discontinuation reduces myopia rebound in children

A tapered discontinuation strategy for low-concentration atropine was associated with less myopia rebound compared with abrupt cessation in children treated for high myopia, according to findings from an 8-year follow-up of the LAMP randomized clinical trial.¹

Investigators reported that children who gradually reduced atropine before stopping experienced significantly less spherical equivalent progression and axial length elongation over 3 years following treatment modification. The findings address a persistent clinical gap in pediatric myopia management: how best to discontinue atropine therapy after prolonged use.²

“There is a lack of evidence on whether tapered discontinuation is better than abrupt discontinuation,” wrote investigators.¹

Tapering strategy reduced myopia progression after discontinuation

The multicenter, randomized clinical trial enrolled 246 children who had completed 5 years of atropine therapy within the LAMP study. Participants had a mean age of 13.47 years and a mean baseline spherical equivalent of approximately −6.3 diopters (D). Children were randomly assigned to either a taper group or a stop group and followed for an additional 3 years. The taper group received 0.05% atropine for 6 months followed by 0.025% for 6 months before discontinuation, while the stop group continued 0.05% atropine for 12 months before stopping. Both groups remained untreated thereafter for 2 years.

At 3 years after randomization, myopia progression was significantly lower in the taper group compared with the stop group. Mean spherical equivalent change was −0.54 D in the taper group vs −0.78 D in the stop group (difference, 0.24 D; 95% CI, 0.03–0.46; P = .02). Axial length elongation followed a similar pattern, measuring 0.33 mm vs 0.44 mm, respectively (difference, −0.11 mm; 95% CI, −0.19 to −0.03; P = .01).

Differences were most pronounced during the postdiscontinuation period. Between years 7 and 8, spherical equivalent progression was −0.31 D in the taper group compared with −0.57 D in the stop group (difference, 0.28 D; 95% CI, 0.14–0.42; P < .001), while axial elongation was 0.21 mm vs 0.32 mm, respectively (difference, −0.10 mm; 95% CI, −0.15 to −0.04; P < .001).

A “good response” to discontinuation, defined as spherical equivalent progression of −0.5 D or less in both eyes after stopping treatment, was observed in 65.1% of the taper group compared with 42.6% of the stop group (P = .003).

Age and baseline myopia influenced rebound risk

Investigators identified age and baseline refractive error as additional predictors of post-treatment progression. Older age and less severe baseline myopia were associated with reduced spherical equivalent progression and axial elongation over 3 years. Younger children and those with higher degrees of myopia demonstrated larger differences between taper and stop strategies, although no significant interaction effects were observed.¹

Longer overall exposure to 0.05% atropine was also associated with a protective effect over 8 years, with each additional year of treatment linked to less refractive progression and axial elongation.¹

Safety and clinical outcomes remained stable

Safety outcomes were generally comparable between groups. No photophobia was reported at year 8, and adverse events were uncommon and not attributed to atropine therapy. Vision-related quality-of-life measures did not differ significantly between groups.

The LAMP trial provides randomized evidence supporting a gradual taper rather than abrupt discontinuation of low-dose atropine to reduce rebound myopia progression. These findings align with prior observational reports and smaller trials suggesting dose-dependent rebound effects after atropine cessation. However, optimal tapering schedules remain uncertain, and whether similar benefits extend to other atropine concentrations or shorter treatment durations is unclear.

Clinically, the results may inform discontinuation strategies for pediatric patients nearing the end of atropine therapy, particularly those with high baseline myopia or younger age at cessation. Given the chronic nature of myopia progression and variability in treatment response, individualized discontinuation planning may be warranted.

“This study found that tapering atropine concentration before treatment discontinuation is better than stopping without taper,” wrote investigators.

References

1. Zhang Y, Zhang XJ, Zaabaar E, et al. Discontinuation approach and follow-up of low-concentration atropine for myopia progression: eight-year results of the LAMP randomized clinical trial. JAMA Ophthalmol. Published online March 26, 2026. doi:10.1001/jamaophthalmol.2026.0436
2. Zaabaar E, Zhang Y, Kam KW, et al. Low-concentration atropine for controlling myopia onset and progression in East Asia. Asia Pac J Ophthalmol (Phila). 2024;13(6):100122. doi:10.1016/j.apjo.2024.100122