Retrospective comparison of myopia progression between low-concentration atropine combined with spectacles and spectacles alone in myopic children aged 6 to 10 years

This study aimed to evaluate the efficacy and safety of low-concentration atropine combined with spectacles in controlling myopia progression among school-aged children and to assess treatment differences across age and refractive subgroups. This retrospective controlled study included 80 myopic children (160 eyes) who visited our center between January 2022 and January 2024. Among them, 40 patients (80 eyes) received low-concentration atropine combined with spectacles (combination group), and 40 patients (80 eyes) used spectacles alone (control group). All participants completed baseline, 6-, 12-, and 18-month follow-ups. Changes in spherical equivalent (SE), axial length, visual function (including best-corrected visual acuity and amplitude of accommodation) and adverse events were compared between groups. Subgroup analyses were conducted according to age and baseline refractive error. Statistical analyses included t tests, chi-square tests, and repeated-measures analysis of variance. Baseline demographic and refractive parameters did not differ significantly between the 2 groups (P > .05). After 18 months, myopia progression was significantly slower in the combination group compared with the control group (-0.45 ± 0.33 D vs -1.00 ± 0.39 D, P < .001), with an annual progression rate of approximately -0.30 D/year. Axial elongation was also significantly reduced (0.19 ± 0.14 mm vs 0.36 ± 0.17 mm, P < .001), and SE change was positively correlated with axial growth (R = 0.70, P < .001). Best-corrected visual acuity remained stable in both groups, while amplitude of accommodation increased significantly in the combination group (P = .03). Mild and reversible adverse reactions occurred in 10.0% of the combination group, primarily transient photophobia and near blur, with no serious events reported. Subgroup analysis revealed greater efficacy in younger children aged 6 to 8 years and those with baseline SE ≤ -2.00 D (P < .05). Low-concentration atropine combined with spectacles effectively slows myopia progression and axial elongation in children aged 6 to 10 years while maintaining stable visual function and demonstrating good safety and tolerability. The combined intervention provides superior control compared to optical correction alone, particularly benefiting younger and early-onset myopic children. These findings offer new clinical evidence supporting the combined application of low-concentration atropine in pediatric myopia management.