{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T06:09:50Z","timestamp":1792735790207,"version":"4.5.0"},"reference-count":24,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Purpose: To evaluate the real-world effectiveness of low-dose atropine in slowing myopia progression in European children and to contextualize axial elongation using an age- and race-adjusted epidemiological model. Methods: This retrospective, longitudinal cohort study included 76 children (mean age 8.7 \u00b1 1.5 years) with myopia treated with atropine 0.01%, 0.025%, or 0.05% at a tertiary hospital in Madrid. Cycloplegic spherical equivalent (SE) and axial length (AL) were recorded at baseline and 12 months. Expected untreated AL elongation was estimated using a published meta-regression model. Observed and expected AL changes were compared using paired t-tests. Predictors of SE and AL progression were assessed using multiple linear regression including age, sex, baseline SE or AL, atropine concentration, adherence, ethnicity, and family history. Results: Mean SE progression was \u22120.08 \u00b1 0.11 D per year, and mean AL elongation was 0.08 \u00b1 0.23 mm per year. Expected untreated elongation was 0.36 \u00b1 0.09 mm per year and significantly exceeded the observed elongation (p &lt; 0.001), representing a 78% relative reduction (effect size Cohen\u2019s d = \u22121.18). Older age (\u22659 years) and more negative baseline SE were associated with greater SE progression (p &lt; 0.05). Adverse effects and treatment tolerability were not systematically evaluated in this retrospective cohort. No significant differences were found across atropine concentrations, adherence levels, sex, ethnicity, or family history. The regression model for AL progression was not statistically significant. Conclusions: Low-dose atropine demonstrated real-world effectiveness in reducing myopia progression in European children. Axial elongation was markedly lower than epidemiological expectations, supporting low-dose atropine as a first-line therapy in routine clinical practice. Age and baseline refractive error were significant predictors of treatment response.<\/jats:p>","DOI":"10.3390\/jcm15114393","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T17:18:16Z","timestamp":1780679896000},"page":"4393","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effectiveness of Low-Dose Atropine for Myopia Control in European Children: A Real-World Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1097-4581","authenticated-orcid":false,"given":"Cristina","family":"Alvarez-Peregrina","sequence":"first","affiliation":[{"name":"Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, 28037 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola Marcela","family":"Pinz\u00f3n Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, 28037 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Navarro Villanueva","sequence":"additional","affiliation":[{"name":"Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, 28037 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4319-2797","authenticated-orcid":false,"given":"Pablo","family":"De Gracia","sequence":"additional","affiliation":[{"name":"School of Optometry, University of Detroit Mercy, Novi, MI 48377, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7008-4700","authenticated-orcid":false,"given":"Manuel","family":"Moriche-Carretero","sequence":"additional","affiliation":[{"name":"Hospital Universitario Infanta Sof\u00eda, 28702 Madrid, Spain"},{"name":"Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Teresa","family":"Cedazo-Anton","sequence":"additional","affiliation":[{"name":"Hospital Universitario Infanta Sof\u00eda, 28702 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raquel","family":"Coca-Serrano","sequence":"additional","affiliation":[{"name":"Hospital Universitario Infanta Sof\u00eda, 28702 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2583-1789","authenticated-orcid":false,"given":"Miguel \u00c1ngel","family":"S\u00e1nchez-Tena","sequence":"additional","affiliation":[{"name":"Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, 28037 Madrid, Spain"},{"name":"ISEC LISBOA\u2014Instituto Superior de Educa\u00e7\u00e3o e Ci\u00eancias, 1750-179 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"M20","DOI":"10.1167\/iovs.18-25957","article-title":"IMI\u2014Defining and classifying myopia: A proposed set of standards for clinical and epidemiologic studies","volume":"60","author":"Flitcroft","year":"2019","journal-title":"Investig. 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