Ocular Surface Outcomes with Different 0.05% Atropine Dosing Frequencies in Children with Myopia: A Secondary Analysis of a Randomized Trial

INTRODUCTION: This study aimed to compare the effects of three dosing frequencies of 0.05% atropine on the ocular surface in children with myopia. METHODS: In this sub-analysis of a randomized controlled trial, children with myopia (aged 6-14 years) were randomized to 0.05% atropine once daily (Qd), twice weekly (Biw), or once weekly (Qw). Objective parameters, including noninvasive tear breakup time (NIBUT), tear meniscus height (TMH), lipid layer thickness (LLT), incomplete blink rate (IBR), and bulbar conjunctival hyperemia index (BCHI), were assessed at baseline, 2 weeks, and 12 months. Subjective symptoms were evaluated using the Ocular Surface Disease Index (OSDI). RESULTS: Among 130 children (260 eyes) completing objective assessments (Qd: n = 43; Biw: n = 49; Qw: n = 38), a representative subset of 78 completed the OSDI questionnaire. Dosing frequency had no differential effect on any outcome (time-by-group interaction: all P > 0.05). Across all groups, first and average NIBUT increased significantly from baseline through 12 months (P < 0.001), with a shift toward less severe dry eye grades (P < 0.001). IBR decreased, indicating improved blink quality (P < 0.001) and BCHI decreased by 12 months (P = 0.001). LLT increased transiently at 2 weeks (P = 0.003), while TMH remained stable (P = 0.712). OSDI scores remained stable, with no significant differences among regimens (P = 0.193). CONCLUSIONS: During the 12-month follow-up period, ocular surface parameters and subjective symptoms remained comparable among the three 0.05% atropine dosing regimens, with no evidence of clinically significant deterioration. TRIAL REGISTRATION: ChiCTR2100043506.