{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T09:05:08Z","timestamp":1784019908110,"version":"3.55.0"},"reference-count":43,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"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>Objective: Myopia has reached epidemic proportions globally, with approximately 50% of the world population projected to be affected by 2050. Low-concentration atropine eye drops (0.01%, 0.025%, 0.05%) have emerged as a primary intervention for myopia control. Several meta-analyses on this topic have been published; however, none have included the most recent trials nor separately analyzed premyopia prevention outcomes. This systematic review and meta-analysis evaluates the efficacy and safety of these concentrations for myopia progression control and premyopia prevention. Methods: We searched PubMed, Web of Science, Embase, and Cochrane CENTRAL from database inception through April 2026. Randomized controlled trials (RCTs) comparing 0.01%, 0.025%, or 0.05% atropine with placebo or no treatment in children were included. Studies were screened using PICOS criteria (Population, Intervention, Comparison, Outcomes, Study design). Meta-analysis was performed using DerSimonian\u2013Laird random-effects models. Subgroup analyses were conducted by concentration, follow-up duration, and population (myopia progression vs. premyopia prevention). Results: Of 18 full-text articles assessed, 8 RCTs (n = 1756) met all PICOS criteria and were included in the quantitative synthesis. For myopia progression, 0.01% atropine demonstrated significant efficacy at 1 year (pooled MD = +0.291 D, 95% CI: 0.199 to 0.384; p &lt; 0.0001; I2 = 29.1%) and at 2 years (pooled MD = +0.174 D, 95% CI: 0.056 to 0.291; p = 0.0038; I2 = 0%). The 0.05% concentration showed the largest effect (pooled MD = +0.520 D, 95% CI: 0.409 to 0.630; p &lt; 0.0001; I2 = 0%). Clinically, a 0.25 D difference over 1\u20132 years may translate to approximately 0.50 D cumulative benefit over a typical 5-year treatment course, potentially reducing the risk of high myopia. For premyopia prevention, a narrative synthesis was performed due to extreme heterogeneity between studies (I2 = 99.2%). All concentrations showed an excellent safety profile with no serious adverse events. Conclusions: Low-concentration atropine is effective for myopia progression control at all three concentrations, with a concentration-dependent gradient (0.05% &gt; 0.025% &gt; 0.01%). The 0.01% concentration offers a reasonable balance of efficacy and tolerability. Further independent validation of the 0.05% concentration is warranted. The premyopia prevention indication requires additional well-designed RCTs.<\/jats:p>","DOI":"10.3390\/jcm15145504","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T08:04:31Z","timestamp":1784016271000},"page":"5504","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Low-Concentration Atropine (0.01%, 0.025%, 0.05%) for Myopia Progression in Children: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"15","author":[{"given":"Qi","family":"Wan","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu 610044, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu 610044, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ran","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu 610044, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu 610044, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5193-428X","authenticated-orcid":false,"given":"Ke","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu 610044, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1016\/j.ophtha.2016.01.006","article-title":"Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050","volume":"123","author":"Holden","year":"2016","journal-title":"Ophthalmology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1016\/j.preteyeres.2012.06.004","article-title":"The complex interactions of retinal, optical and environmental factors in myopia aetiology","volume":"31","author":"Flitcroft","year":"2012","journal-title":"Prog. 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