Low-Dose Atropine for Pediatric Myopia: First-Year Progression as a Risk-Stratification and Management Signal

Purpose: To determine whether first-year refractive progression predicts longer-term on-treatment myopia control and whether early progression guides escalation decisions and subsequent trajectories. Design: Retrospective cohort, single practice. Participants: Five hundred fifty-five children (1107 eyes) treated with 0.01% (93.5%) or 0.02% (6.5%) atropine for ≥12 months. Methods: Spherical equivalent refraction (SER) progression was annualized (diopters [D]/year; positive = worse). At 12 months, eyes met or did not meet the ≤0.25 D/year threshold; children were categorized as responsive (both eyes), partially responsive (one eye), or unresponsive (neither eye). Progression was also modeled continuously (per 0.25 D/year). Escalation was defined as increasing the atropine concentration and/or adding optical therapy. Primary analyses associated 12-month response with on-treatment outcomes and progression before and after escalation. Eye-level models accounted for intereye correlation and baseline covariates. One-eye-per-subject sensitivity analyses were also performed. Main Outcome Measures: Successful control (≤0.25 D/year over on-treatment course) and change in SER progression around escalation. Results: = 0.892). With atropine monotherapy, early response modestly predicted post-12-month success (OR: 1.57; 95% CI: 1.02-2.41). Conclusions: Twelve-month response strongly stratifies overall on-treatment control as an early management signal, not a fixed treatment end point. Response-guided escalation slowed initial failures and attenuated post-12-month differences. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.