Why This Article Matters
Most evidence for low-dose atropine has come from East Asian populations, with less certainty about its effectiveness in European children. CHAMP-UK was a multicentre, double-masked, placebo-controlled RCT conducted at five UK centres, enrolling 289 children aged 6–12 years. Participants received preserved 0.01% atropine or placebo for two years.
Summary
The prespecified primary endpoint was 24-month spherical-equivalent refractive error. At 24 months, myopia progression was 0.33 D less with atropine than placebo (95% CI 0.17–0.49; P<0.001). Axial elongation was also 0.14 mm lower (95% CI 0.07–0.21; P<0.001). Adherence was excellent, at 80%.
Commentary
How robust are these findings?
The trial has important strengths: appropriate randomisation and allocation concealment, masking of participants and investigators, standardised cycloplegic refraction and axial-length measurement, and objective electronic monitoring of adherence.
Some limitations deserve attention.
First, 20% of participants did not have primary-outcome data (spherical equivalent refraction) at 24 months. Size of the treatment effect is sensitive to how missing data are handled.
Second, the effect was statistically significant but modest: approximately 0.33 dioptre and 0.14 mm over two years. Whether this represents a clinically meaningful benefit for an individual child depends on factors such as age and ethnicity.
Third, generalisability is good for UK children similar to those included in the study, but may be less certain in other settings. Seventy-two percent of participants were White, subgroup analyses were not powered to detect differences between groups, and electronic adherence monitoring may have improved adherence compared with routine clinical practice. The study also excluded children with ≥2 D astigmatism and those already using myopia-control treatments, limiting applicability to some real-world patients.
What can we learn?
CHAMP-UK provides evidence that 0.01% atropine has a small but measurable effect on myopia progression in UK children of diverse ethnic backgrounds and is well tolerated. In clinical practice, where other treatment options are also available, treatment decisions need to be individualised rather than using a one-size-fits-all approach.
Atropine 0.01% can be a useful treatment option in our myopia-management toolbox.
