Which pharmacological agent, used at a concentration of 0.01 percent nightly, has been shown in large randomised trials to slow myopia progression in children with minimal effect on pupillary size and accommodation?

• A Pirenzepine gel
• B Tropicamide 0.5 percent
• C Timolol maleate 0.25 percent
• D Low-dose atropine ✓

Explanation

The ATOM trials established that atropine 0.01 percent given nightly significantly slows axial elongation and refractive progression in children, with negligible pupillary dilation, minimal loss of accommodation and the lowest rebound effect on discontinuation compared with higher concentrations such as 0.1 and 0.5 percent. Tropicamide is too short acting, timolol has no evidence for myopia control, and pirenzepine was investigated earlier but did not enter routine practice.

Reference: AAO Basic and Clinical Science Course, Section 13: Refractive Errors, 2023-2024 ed.

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Written and medically reviewed by the StethoPrep medical team.