Does low-dose atropine work for myopia in children in Malaysia?
Myopia in children is slowed, not reversed. What the trials found for low-dose atropine, how it compares with myopia-control lenses and time outdoors, what a Malaysian trial is testing, and how public and private routes work.
- Myopia in children is slowed, not reversed. The AAO says myopia cannot be reversed and the goal is to keep it from getting worse.
- In the LAMP trial of 438 children aged 4 to 12, the prescription changed by -0.81 D in a year with placebo, and by -0.59, -0.46 and -0.27 D with 0.01%, 0.025% and 0.05% atropine. The stronger drop slowed myopia more.
- The 2025 Cochrane review (104 trials, 17,509 children) found low-dose atropine below 0.1% slowed progression by about 0.25 D a year, but rates the certainty very low, so the true effect could differ.
- Side effects grow with strength: a larger pupil, near blur and occasional redness or itching. In LAMP, vision and quality of life were not affected at any strength.
- An atropine trial in Malaysia (ATOM-MY, NCT07329777) is recruiting children aged 5 to 10 and has no results yet. In Malaysia a child reaches myopia control through a government hospital referral or a private eye clinic.
- Dr Chan Li Yen, a paediatric ophthalmologist in Petaling Jaya, counts myopia control in children, low-dose atropine included, among her special interests, and families can check her in that way: the About page says where she practises, and how to check a children's eye specialist is registered shows the steps.
Myopia in children is slowed, not reversed. Low-dose atropine drops have trial evidence for slowing it, alongside myopia-control spectacle lenses, overnight lenses and time outdoors, and the choice is made by an eye doctor after an examination.
Dr Chan Li Yen, paediatric ophthalmologist in Petaling Jaya, writes this journal, and this page sets out the trial numbers and the Malaysian routes in one place. The wider picture is in myopia control in Malaysia, and the drop on its own is covered in atropine drops for myopia: what the numbers say.
How is myopia controlled in children in Malaysia, and does low-dose atropine work?
Myopia control means slowing how fast a child's short-sightedness worsens, because nothing reverses it. The American Academy of Ophthalmology (AAO) says myopia cannot be reversed and that the goal is to keep it from getting worse. Low-dose atropine does slow progression on average, but the size of the effect is uncertain, and the Cochrane review rates the evidence for doses below 0.1% as very low certainty.
The options with trial evidence are low-dose atropine drops, myopia-control spectacle lenses, myopia-control soft contact lenses and overnight lenses (orthokeratology), with more time outdoors alongside. These are types of treatment, not products to shop for, and which one suits a child depends on age, how fast the prescription is climbing and what the family can keep up. In Malaysia a child reaches them through a government hospital eye clinic or a private clinic, covered below.
What did the trials find for low-dose atropine?
Each strength slowed myopia more than a dummy drop, and the stronger the drop, the more it slowed. The Low-Concentration Atropine for Myopia Progression (LAMP) trial followed 438 children aged 4 to 12 for one year. The average change in prescription was -0.81 dioptres with placebo, -0.59 with 0.01% atropine, -0.46 with 0.025% and -0.27 with 0.05%. The eye lengthened by 0.41 mm with placebo and by 0.36, 0.29 and 0.20 mm on the three strengths.
A dioptre (D) is the unit of lens power, so a smaller minus change means slower myopia. ATOM2, a two-year trial of 400 children aged 6 to 12, compared 0.5%, 0.1% and 0.01% atropine and found the prescription moved by -0.30, -0.38 and -0.49 D. That trial had no placebo group of its own, but in its earlier sibling trial the placebo group moved by -1.20 D over two years, and the authors called the differences between the three strengths small.
The Cochrane review of 2025 pooled 104 trials in 17,509 children, most in Asia. Untreated children progressed by a median of 0.65 D in a year.
Low-dose atropine (below 0.1%) slowed that by about 0.25 D, medium doses (0.1% to below 0.5%) by about 0.55 D and high doses (0.5% or more) by about 0.90 D. The certainty was very low for low doses, low for medium doses and moderate for high doses, which means the true effect of low doses could differ from the average. Read each number as a direction, not a promise.
What are the side effects, and how long are the drops used?
At low strengths the main effects are a larger pupil, some blur up close and occasional redness or itching, and they grow with the strength. The AAO says the drops go in at bedtime, for 2 to 3 years, in children from 5 to 18, with redness or itchiness around the eye the usual side effect at low doses.
LAMP measured it. In bright light the pupil grew by 0.49 mm on 0.01%, 0.76 mm on 0.025% and 1.03 mm on 0.05%, against 0.13 mm with placebo. The focusing reserve of the eye fell by 0.26 D on 0.01%, 1.61 D on 0.025% and 1.98 D on 0.05%, against 0.32 D with placebo. Visual acuity and vision-related quality of life were not affected at any strength. In ATOM2, allergic conjunctivitis and dermatitis occurred in 16 children on the 0.1% and 0.5% drops and in none on 0.01%.
The Cochrane review found limited evidence on what happens when treatment stops, and adverse events were not reported consistently, so stopping is planned with the doctor and not decided at home. The first month is described in low-dose atropine for myopia: the first month.
What else slows myopia in children besides atropine?
Spectacle lenses, contact lenses and time outdoors. The AAO describes glasses whose centre corrects distance while the rest of the lens blurs side vision, worn full time, with approval in the United States for ages 6 to 12; soft defocus contact lenses for ages 8 to 12; and overnight orthokeratology lenses, which carry a risk of corneal infection and need more follow-up visits.
In the Cochrane review, defocus spectacle lenses slowed progression by about 0.45 D over a year, soft multifocal contact lenses by 0.27 D, both at very low certainty. Orthokeratology reduced eye lengthening by 0.18 mm at moderate certainty, and adding low-dose atropine to it reduced lengthening by a further 0.12 mm.
The AAO says research suggests children who spend more time indoors on near work have higher rates of myopia, and advises more time outdoors. The details are in defocus glasses for myopia control, two hours outside and red-light therapy for myopia.
Is low-dose atropine being studied in Malaysian children?
Yes. A randomised trial called ATOM-MY, registered as NCT07329777 on ClinicalTrials.gov, compares 0.025% atropine drops with placebo drops in children aged 5 to 10. The registry page, read on 21 October 2026, lists it as recruiting at two university hospitals in the Klang Valley, with about 144 children planned and a start date of September 2025.
Children in the placebo group are switched to atropine after 12 months, the treatment period is 24 months and the registry's estimated primary completion is September 2027. No results are posted. It is a study, not a service, and it says nothing yet about how Malaysian children respond. Which atropine strengths are registered or supplied in Malaysia is a question for the prescribing doctor, and this page does not state it.
Where do children get myopia control in Malaysia, public or private?
In the public route, a klinik kesihatan or GP refers the child to the eye clinic of a government hospital, and the referral letter and earlier prescriptions go with you. In the private route, an eye clinic that sees children is booked directly. Charges differ and the drops, lenses and tests are usually charged separately, so this page quotes none; ask any clinic for a written estimate first, using ten questions to ask before you pay for myopia control.
Optometrists measure and dispense spectacles and contact lenses, including myopia-control designs, while prescribing the drops and examining the health of the eye is the doctor's part. Dr Chan Li Yen, a paediatric ophthalmologist in Petaling Jaya, counts myopia control in children, low-dose atropine included, among her special interests, and families can check her in that way: the About page says where she practises, and how to check a children's eye specialist is registered shows the steps.
When should a short-sighted child see an eye doctor?
As soon as short-sightedness is suspected, and again if the prescription climbs quickly. A child's true prescription is measured with drops that relax focusing, because a reading without them can overstate it. How fast is too fast sets out the usual yearly change by age, and can short-sightedness be reduced or reversed explains what slowing means.
See a doctor promptly if a child on any eye drops develops a red, painful or light-sensitive eye or a rash around the eye, or if a strongly short-sighted child reports new floaters, flashes of light or a shadow across the vision. A bottle of atropine is a prescription medicine; it should not be bought or started without an examination.
- A red, swollen or itchy eyelid, or a rash around the eye.
- Eye pain, or a headache that keeps coming back.
- Glare or blurred reading that does not ease after the first weeks.
- New floaters, flashes of light, or a shadow or curtain across part of the vision in a strongly short-sighted child.
- Sudden eye pain or sudden loss of vision, or a child who seems unwell after a dose: go to an eye casualty the same day.
Common questions
Does low-dose atropine work for myopia?
What strength of atropine is used for myopia in children?
Is atropine eye drops for myopia safe for children?
Can atropine reverse myopia or replace my child's glasses?
Is low-dose atropine being studied in Malaysian children?
Where can my child get myopia control in Malaysia?
- Ophthalmology 2019 · Low-Concentration Atropine for Myopia Progression (LAMP) Study: a randomized, double-blinded, placebo-controlled trial of 0.05%, 0.025%, and 0.01% atropine eye drops in myopia control (Yam et al.) · pubmed.ncbi.nlm.nih.gov
- Ophthalmology 2012 · Atropine for the treatment of childhood myopia: safety and efficacy of 0.5%, 0.1%, and 0.01% doses (Atropine for the Treatment of Myopia 2) (Chia et al.) · pubmed.ncbi.nlm.nih.gov
- Cochrane Database of Systematic Reviews 2025 · Interventions for myopia control in children: a living systematic review and network meta-analysis (Lawrenson et al.) · pubmed.ncbi.nlm.nih.gov
- American Academy of Ophthalmology · Myopia control in children · www.aao.org
- ClinicalTrials.gov · NCT07329777, Atropine in the Treatment of Myopia Study in Malaysia (ATOM-MY) · clinicaltrials.gov