Stopping atropine treatment for myopia control has long been a weak spot in otherwise well-established management strategies.
And while low-dose atropine is widely used to slow axial elongation, its effects don’t carry over once treatment ends. Many clinicians have observed a rebound effect, where myopia progression accelerates after discontinuation, particularly in younger patients or those treated with higher concentrations.
Until now, there hasn’t been strong long-term evidence guiding how to stop treatment—with some clinicians tapering doses, others stopping abruptly, and most making decisions based on experience rather than data.
With this in mind: New findings from the extended Low-Concentration Atropine for Myopia Progression (LAMP) randomized clinical trial address that gap, offering insight into whether tapering actually makes a difference.
Let’s start with the basics: Why is stopping atropine a tricky part of myopia care?
Atropine slows myopia progression by interfering with pathways that regulate axial eye growth.
However, this effect is not permanent: Once treatment is withdrawn, the eye can resume elongation, and in some cases, progression may temporarily accelerate beyond baseline rates.
This rebound phenomenon has been reported across multiple studies and appears to vary depending on dose, treatment duration, and patient age.
Sounds concerning …
Indeed. But despite this, there has been no standardized discontinuation protocol—with earlier studies focusing on treatment efficacy rather than what happens after stopping.
As a result, tapering strategies have been used inconsistently, and there’s been limited evidence to support them.
That uncertainty has made it difficult to plan long-term treatment, especially for younger children who may require several years of therapy.
So where does this new research come in?
This study builds on the long-running LAMP trial to evaluate whether tapering atropine before discontinuation leads to better long-term outcomes than stopping treatment abruptly.
The researchers specifically examined myopia progression and axial elongation over a 3-year period after treatment cessation.
Participants were randomized into two groups:
- Group 1: Those that gradually reduced atropine concentration before stopping
- Group 2: Those that discontinued treatment without tapering
The goal: To determine whether a step-down approach could reduce the rebound effect commonly seen after atropine withdrawal.
Who was included in the study?
The study included 246 children between the ages of 4 and 12 who had previously participated in the LAMP trial and were still receiving atropine treatment at year 5.
- All participants were randomized in a 1:1 ratio into taper and stop groups.
During the prediscontinuation phase, the taper group received 0.05% atropine for 6 months followed by 0.025% for another 6 months, while the stop group remained on 0.05% atropine for a full year.
After that, both groups discontinued treatment and were followed for an additional 2 years.
What were the main outcomes of tapering vs stopping?
Children in the taper group experienced less myopia progression over the three-year discontinuation period compared to those in the stop group.
- Spherical equivalent progression was −0.54 diopters (D) in the taper group versus −0.78 D in the stop group.
- Axial elongation followed a similar pattern, with increases of 0.33 mm in the taper group and 0.44 mm in the stop group.
In addition, a greater proportion of children in the taper group met the study’s criteria for a favorable response to discontinuation.
Which patients benefited most from tapering?
The advantage of tapering was more pronounced in younger children and those with higher baseline myopia. These groups tended to experience faster progression overall, but also showed a greater difference between tapering and abrupt discontinuation.
What this suggests: Tapering may be particularly useful in patients at higher risk of rapid progression, where even modest reductions in axial growth could have long-term implications.
Any limitations to consider?
- The overall difference between groups, while statistically significant, was relatively small in magnitude
- All participants were ethnically Chinese, which limited how broadly the findings apply to other populations
- Also of influence to the results:
- Variability in prior treatment exposure
- Loss to follow-up over the extended study period
So how should clinicians interpret these findings?
The data support the use of a tapering approach when discontinuing atropine therapy, particularly in younger patients or those with more advanced myopia.
While the reduction in progression is modest, it may still be clinically relevant over time in patients at higher risk.
Rather than relying on abrupt discontinuation, clinicians may consider incorporating a gradual dose reduction as part of a longer-term management strategy.
And finally: the take home.
Tapering low-concentration atropine before discontinuation appears to reduce rebound myopia progression compared to stopping treatment abruptly, particularly in younger children and those with more advanced disease.
While the overall effect size is modest, the findings support a more gradual, individualized approach to ending atropine therapy in pediatric patients.