Changes in Axial Length and Refraction After Gradual Versus Prompt Cessation of Atropine 0.01% Treatment for Myopia Management

Abstract

Purpose: Recent studies have demonstrated the effects of low-concentration atropine eye drops in slowing myopia progression. However, some studies have shown a rebound effect after treatment cessation. This study compares the rate of myopic progression following a rapid washout versus tapered cessation of 0.01% atropine. Methods: This retrospective study included children treated with atropine 0.01% between 2015 and 2022. After 24 months of treatment, the gradual cessation (GC) group stopped atropine by reducing usage by one day per week each month until complete discontinuation. The prompt cessation (PC) group stopped treatment immediately. Subjective refraction was measured after cycloplegia, and axial length was assessed before drop instillation to compare myopia progression between the GC and PC groups during the 12 months following treatment cessation. Results: Each group included 25 patients matched for age and spherical equivalent (SE) refractive error. The GC group had a mean age of 10.55 ± 1.19 years and the PG group 10.10 ± 1.7 years. The baseline SE refractive error averaged −4.33 ± 1.62D in GC and −4.50 ± 1.87D in PG. Mean follow-up was 12.4 ± 3.2 months (GC) and 12.2 ± 2.04 months (PG At follow up, the GC group had a mean SE refractive error progression of 0.21 ± 0.24 D and axial elongation of 0.15 ± 0.1 mm, while the PC group showed 0.43 ± 0.26 D and 0.25 ± 0.18 mm, respectively. However, linear mixed model (LMM) analysis revealed no statistically significant differences between the groups for axial length (p = 0.682) or SE (p = 0.541) change after treatment cessation. Conclusions: The findings indicate that neither gradual nor prompt discontinuation of 0.01% atropine resulted in statistically significant differences in myopia progression. These results suggest no significant differences in myopia progression after treatment cessation between the two methods and provide no evidence of a rebound effect.