Therapeutic Effect of Topical 0.125% Atropine in South Korean Myopic Children: A Real-World Experience

Purpose: To evaluate the effectiveness of 0.125% atropine eye drops in controlling myopia progression by analyzing 1-year follow-up data through a multicenter retrospective study in South Korea. Methods: A retrospective chart review was conducted across five centers, including 121 myopic children (aged 4–11 years) treated with 0.125% atropine between January 2021 and December 2023. An equal number of age-, sex-, axial length (AL)-, and spherical equivalent (SE)-matched untreated individuals (control group) were included. Baseline and follow-up data at 6 and 12 months included visual acuity, autorefraction, AL measurement (IOLMaster 700), and fundus examination. The primary outcome measures were changes in SE and AL compared to controls. Results: Age, SE, and AL in the treatment group at baseline were 7.5 ± 1.5 years (range, 4 to 11), –3.07 ± 1.65 diopters (D; range, –0.25 to –5.88 D), and 24.39 ± 0.85 mm (range, 22.19 to 26.94 mm), respectively, and these parameters showed no statistical differences compared to the matched controls. SE after 1-year treatment was less myopic in the treatment group (–3.42 ± 1.72 D vs. –3.94 ± 1.92 D, p = 0.019). Similarly, AL was significantly shorter in treatment group compared to the control group (24.65 ± 0.88 mm vs. 24.88 ± 0.80 mm, p = 0.031). The SE change from baseline was –0.33 ± 0.73 D in the treatment group versus –0.91 ± 1.01 D in the control group (p < 0.001). AL increased by 0.25 ± 0.32 mm in the treatment group, significantly less than 0.49 ± 0.24 mm increase in the control group (p < 0.001). Baseline AL and mean keratometry showed no correlation with AL progression (all p > 0.05). Conclusions: The use of 0.125% atropine eye drops significantly reduced myopia progression, with approximately 50% reduction in AL elongation compared to controls. Given its effectiveness and variable compliance, 0.125% atropine eye drops may serve as a viable alternative to low-dose atropine for myopia control.