{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T01:46:36Z","timestamp":1792201596060,"version":"4.4.0"},"reference-count":36,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2025,10,21]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background\/aim<\/jats:title>\n                    <jats:p>Clinical uncertainty remains regarding optimal atropine concentration, treatment duration and potential differences in efficacy for myopia control between Asian and non-Asian children. This systematic review and meta-analysis evaluated the efficacy of different concentrations of atropine for myopia control, comparing outcomes among East Asian, South Asian and white European children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Five databases were searched for randomised controlled trials (RCTs) including children \u226416 years with myopia who received atropine treatment. Thirty-four RCTs with \u226512 months of follow-up were included. Weighted mean differences (WMD) in spherical equivalent refraction (SER) progression and axial length (AL) elongation were pooled by atropine concentration and ethnicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared with controls, atropine significantly reduced myopia progression across all concentrations: &lt;0.1% (WMD in SER: 0.44 (95% CI 0.35 to 0.52) dioptres (D)\/year; AL: \u22120.20 (95% CI \u22120.24 to \u22120.16)\u2009mm\/year), 0.1% to &lt;0.5% (0.81 (95% CI 0.50 to 1.13) D\/year) and \u22650.5% (1.06 (95% CI 0.88 to 1.24) D\/year; \u22120.36 (95% CI \u22120.40 to \u20130.33)\u2009mm\/year). The pooled effect on SER and AL progression across all concentrations was greater in East Asians (0.63 (95% CI 0.50 to 0.76) D\/year; \u22120.26 (95% CI \u22120.31 to \u22120.20)\u2009mm\/year) than in South Asians (0.40 (95% CI 0.11 to 0.70) D\/year; \u22120.13 (95% CI \u22120.21 to \u22120.05)\u2009mm\/year) or white Europeans (0.18 (95% CI 0.11 to 0.25) D\/year; \u22120.11 (95% CI \u22120.16 to \u22120.05)\u2009mm\/year).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Atropine slows myopia progression in a dose-dependent manner in studies with 1\u20135 years of follow-up. Efficacy appears greater in Asian children, particularly East Asians, who also exhibit greater photopic pupil dilation. These findings support the role of atropine in myopia control and highlight the importance of ethnicity-specific considerations when prescribing and tailoring treatment strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42023454104.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bjo-2025-328518","type":"journal-article","created":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T17:20:15Z","timestamp":1761844815000},"page":"483-491","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Ethnic and dose-dependent differences in atropine efficacy for myopia control: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"110","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6011-0365","authenticated-orcid":false,"given":"Sayantan","family":"Biswas","sequence":"first","affiliation":[{"name":"School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9918-787X","authenticated-orcid":false,"given":"Carla","family":"Lanca","sequence":"additional","affiliation":[{"name":"New York University Abu Dhabi, Division of Science, Abu Dhabi, UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisy","family":"Kynman-Sprinks","sequence":"additional","affiliation":[{"name":"School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3724-2391","authenticated-orcid":false,"given":"Andrzej","family":"Grzybowski","sequence":"additional","affiliation":[{"name":"Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland"},{"name":"Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,10,30]]},"reference":[{"key":"2026042202150741000_110.5.483.1","doi-asserted-by":"crossref","unstructured":"Matsumura S , Ching-Yu C , Saw S-M . Global epidemiology of myopia. In: Ang M , Wong TY , eds. Updates on Myopia: A clinical perspective. Singapore: Springer Singapore, 2020: 27\u201351.","DOI":"10.1007\/978-981-13-8491-2_2"},{"key":"2026042202150741000_110.5.483.2","doi-asserted-by":"crossref","DOI":"10.1186\/s12886-019-1220-0","article-title":"A review on the epidemiology of myopia in school children worldwide","volume":"20","author":"Grzybowski","year":"2020","journal-title":"BMC Ophthalmol"},{"key":"2026042202150741000_110.5.483.3","doi-asserted-by":"crossref","DOI":"10.1186\/s40101-024-00354-7","article-title":"The influence of the environment and lifestyle on myopia","volume":"43","author":"Biswas","year":"2024","journal-title":"J Physiol Anthropol"},{"key":"2026042202150741000_110.5.483.4","doi-asserted-by":"crossref","DOI":"10.1167\/iovs.62.5.2","article-title":"IMI Impact of Myopia","volume":"62","author":"Sankaridurg","year":"2021","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"2026042202150741000_110.5.483.5","doi-asserted-by":"publisher","DOI":"10.1097\/ICL.0000000000000677"},{"key":"2026042202150741000_110.5.483.6","doi-asserted-by":"crossref","DOI":"10.1186\/s12886-020-01746-w","article-title":"Efficacy and safety of atropine to control myopia progression: a systematic review and meta-analysis","volume":"20","author":"Zhao","year":"2020","journal-title":"BMC Ophthalmol"},{"key":"2026042202150741000_110.5.483.7","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.18240\/ijo.2023.08.20","article-title":"Efficacy and safety of atropine at different concentrations in prevention of myopia progression in Asian children: a systematic review and Meta-analysis of randomized clinical trials","volume":"16","author":"Wei","year":"2023","journal-title":"Int J Ophthalmol"},{"key":"2026042202150741000_110.5.483.8","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1097\/ICL.0000000000000189","article-title":"Use of Atropine for Prevention of Childhood Myopia Progression in Clinical Practice","volume":"42","author":"Shih","year":"2016","journal-title":"Eye Contact Lens"},{"key":"2026042202150741000_110.5.483.9","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1097\/OPX.0000000000000178","article-title":"Atropine slows myopia progression more in Asian than white children by meta-analysis","volume":"91","author":"Li","year":"2014","journal-title":"Optom Vis Sci"},{"key":"2026042202150741000_110.5.483.10","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1001\/jamaophthalmol.2017.1091","article-title":"Efficacy and Adverse Effects of Atropine in Childhood Myopia: A Meta-analysis","volume":"135","author":"Gong","year":"2017","journal-title":"JAMA Ophthalmol"},{"key":"2026042202150741000_110.5.483.11","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1001\/jamaophthalmol.2023.2855","article-title":"Low-Dose 0.01% Atropine Eye Drops vs Placebo for Myopia Control: A Randomized Clinical Trial","volume":"141","author":"Repka","year":"2023","journal-title":"JAMA Ophthalmol"},{"key":"2026042202150741000_110.5.483.12","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1001\/jamaophthalmol.2023.2097","article-title":"Efficacy and Safety of 0.01% and 0.02% Atropine for the Treatment of Pediatric Myopia Progression Over 3 Years: A Randomized Clinical Trial","volume":"141","author":"Zadnik","year":"2023","journal-title":"JAMA Ophthalmol"},{"key":"2026042202150741000_110.5.483.13","doi-asserted-by":"publisher","DOI":"10.1111\/aos.15761"},{"key":"2026042202150741000_110.5.483.14","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1111\/ceo.14368","article-title":"Myopia progression following 0.01% atropine cessation in Australian children: Findings from the Western Australia \u2013 Atropine for the Treatment of Myopia (WA\u2010ATOM) study","volume":"52","author":"Lee","year":"2024","journal-title":"Clinical Exper Ophthalmology"},{"key":"2026042202150741000_110.5.483.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2021.10.002"},{"key":"2026042202150741000_110.5.483.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2019.12.011"},{"key":"2026042202150741000_110.5.483.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2018.05.029"},{"key":"2026042202150741000_110.5.483.18","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2026042202150741000_110.5.483.19","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1089\/jop.2011.0017","article-title":"Atropine in ameliorating the progression of myopia in children with mild to moderate myopia: a meta-analysis of controlled clinical trials","volume":"Online First","author":"Song","year":"2011","journal-title":"J Ocul Pharmacol Ther"},{"key":"2026042202150741000_110.5.483.20","doi-asserted-by":"crossref","unstructured":"Chen C , Yao J . Efficacy and Adverse Effects of Atropine for Myopia Control in Children: A Meta-Analysis of Randomised Controlled Trials. J Ophthalmol 2021;4274572. doi:10.1155\/2021\/4274572","DOI":"10.1155\/2021\/4274572"},{"key":"2026042202150741000_110.5.483.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2015.11.010"},{"key":"2026042202150741000_110.5.483.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2021.10.016"},{"key":"2026042202150741000_110.5.483.23","doi-asserted-by":"publisher","DOI":"10.1097\/OPX.0000000000002176"},{"key":"2026042202150741000_110.5.483.24","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1111\/opo.13401","article-title":"Regional\/ethnic differences in ocular axial elongation and refractive error progression in myopic and non\u2010myopic children","volume":"45","author":"Naduvilath","year":"2025","journal-title":"Ophthalmic Physiologic Optic"},{"key":"2026042202150741000_110.5.483.25","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1002\/jcph.2320","article-title":"Incidence of Adverse Events Induced by Atropine in Myopic Children: A Meta\u2010Analysis","volume":"63","author":"Sun","year":"2023","journal-title":"The Journal of Clinical Pharma"},{"key":"2026042202150741000_110.5.483.26","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1007\/s40123-019-0194-6","article-title":"A Pilot Study on the Efficacy and Safety of 0.01% Atropine in German Schoolchildren with Progressive Myopia","volume":"8","author":"Joachimsen","year":"2019","journal-title":"Ophthalmol Ther"},{"key":"2026042202150741000_110.5.483.27","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1111\/ceo.14148","article-title":"Low\u2010concentration atropine eyedrops for myopia control in a multi\u2010racial cohort of Australian children: A randomised clinical trial","volume":"50","author":"Lee","year":"2022","journal-title":"Clinical Exper Ophthalmology"},{"key":"2026042202150741000_110.5.483.28","doi-asserted-by":"crossref","first-page":"1636","DOI":"10.1097\/OPX.0b013e31826c1831","article-title":"Impact of pupil diameter on axial growth in orthokeratology","volume":"89","author":"Chen","year":"2012","journal-title":"Optom Vis Sci"},{"key":"2026042202150741000_110.5.483.29","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2019-315440"},{"key":"2026042202150741000_110.5.483.30","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1097\/OPX.0000000000000627","article-title":"Is Pupil Diameter Influenced by Refractive Error? Optometry and vision science: official publication of the American","volume":"92","author":"Orr","year":"2015","journal-title":"Academy of Optometry"},{"key":"2026042202150741000_110.5.483.31","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-1313.2008.00611.x"},{"key":"2026042202150741000_110.5.483.32","doi-asserted-by":"crossref","first-page":"2009","DOI":"10.1007\/s40123-024-00972-5","article-title":"Association Between Myopia and Pupil Diameter in Preschoolers: Evidence from a Machine Learning Approach Based on a Real-World Large-Scale Dataset","volume":"13","author":"Xu","year":"2024","journal-title":"Ophthalmol Ther"},{"key":"2026042202150741000_110.5.483.33","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1001\/jamaophthalmol.2023.5467","article-title":"Topical Atropine for Childhood Myopia Control: The Atropine Treatment Long-Term Assessment Study","volume":"142","author":"Li","year":"2024","journal-title":"JAMA Ophthalmol"},{"key":"2026042202150741000_110.5.483.34","doi-asserted-by":"crossref","unstructured":"Zhang XJ , Zhang Y , Yip BHK , et al . Five-Year Clinical Trial of the Low-Concentration Atropine for Myopia Progression (LAMP) Study: Phase 4 Report. Ophthalmology 2024. doi:10.1016\/j.ophtha.2024.03.013","DOI":"10.1016\/j.ophtha.2024.03.013"},{"key":"2026042202150741000_110.5.483.35","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1111\/opo.13403","article-title":"Efficacy in myopia control\u2014The impact of rebound","volume":"45","author":"Bullimore","year":"2025","journal-title":"Ophthalmic Physiologic Optic"},{"key":"2026042202150741000_110.5.483.36","doi-asserted-by":"publisher","DOI":"10.1002\/pst.1589"}],"container-title":["British Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bjo-2025-328518","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T09:15:51Z","timestamp":1776849351000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjo.bmj.com\/lookup\/doi\/10.1136\/bjo-2025-328518"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,30]]},"references-count":36,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,4,22]]},"published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1136\/bjo-2025-328518"],"URL":"https:\/\/doi.org\/10.1136\/bjo-2025-328518","relation":{},"ISSN":["0007-1161","1468-2079"],"issn-type":[{"value":"0007-1161","type":"print"},{"value":"1468-2079","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,30]]}}}