become a major global public health concern. Its prevalence has increased markedly in recent 

decades, especially in Asian countries, including India. The global burden of myopia is expected 

to reach epidemic levels, with projections estimating that half of the world’s population will be 

myopic by 2050. Early-onset myopia often progresses during childhood and increases the risk of 

high myopia in adulthood. High myopia is associated with complications such as retinal 

detachment, glaucoma, and myopic maculopathy d/t excessive axial length elongation, which 

can cause permanent visual impairment. 

Atropine eye drops are widely recognized as an effective intervention for slowing myopia 

progression. Mainly Low-dose atropine is now widely used to slow myopia progression, but its 

optimal concentration varies. Earlier, high concentrations such as 1% atropine were shown to be 

highly effective in reducing myopia progression, but they caused significant side effects 

including photophobia and near blur, as demonstrated in the ATOM1 ( Atropine for the 

Treatment of Childhood Myopia) study. To address these concerns, the ATOM2 study 

compared 0.5%, 0.1% and 0.01% atropine, and found that while all concentrations were 

effective, 0.01% had the least side effects, although it was less effective in controlling axial 

elongation. More recently, the LAMP (Low-Concentration Atropine for Myopia Progression) 

study reported that 0.05% atropine provided better control of myopia progression and axial 

length growth compared to 0.01%, while still maintaining acceptable tolerability. These 

findings suggest that 0.05% and 0.01% represent two clinically useful concentrations, and 

comparing their effectiveness in different populations, such as Indian children, is necessary to 

select the most suitable dosage for routine clinical use.

Although low-dose atropine therapy is used for myopia management, region-specific evidence in 

North Indian pediatric populations is limited. Environmental and lifestyle factors such as 

outdoor activity, near-work duration, and screen exposure vary across different regions and may 

influence treatment outcomes.

Hence by comparing 0.05% and 0.01% atropine, this study aims to assess which concentration 

provides better control of myopia progression (refractive and axial length changes) with acceptable tolerance in the local population. The findings may help develop region-appropriate 

myopia management recommendations for Indian children.