0.01% atropine reduces axial length by 0.04 mm/year in children with myopiaLow Dose Atropine Shows Mixed Results for Children with Myopia

Low-concentration atropine (0.01%) has been widely investigated as a safe intervention for myopia control in children, yet its true efficacy remains uncertain due to inconsistent trial findings and high heterogeneity. An artificial intelligence (AI)-assisted systematic review and Bayesian multivariate meta-analysis of randomised controlled trials (RCTs) was performed to evaluate 0.01% atropine in children. An AI pipeline was employed for literature screening, deduplication and structured data extraction. The primary outcomes were annualised changes in spherical equivalent refraction (SER, D/year) and axial length (AL, mm/year). Bayesian joint models synthesised SER and AL effects, explored heterogeneity with meta-regression and assessed the probability of clinically meaningful benefits. The 17 RCTs included demonstrated that 0.01% atropine significantly reduced AL (mean deviation [MD] = 0.04 mm/year; 95% credible interval [CrI]: −0.02–0.06), whereas the effect on SER was modest and heterogeneous (MD = 0.07 D/year; 95% CrI: −0.04 to 0.18). Meta-regression indicated attenuated efficacy in older children, in cohorts with longer baseline AL and in more recent or Western trials. The probability of achieving clinically meaningful thresholds (≥0.25 D/year SER; ≥0.10 mm/year AL) was 68 and 72%, respectively. Sensitivity analyses confirmed robustness of results, though small-study bias was likely. The results revealed that 0.01% atropine confers modest suppression of AL in paediatric myopia, with refractive benefits less consistent and context dependent. Although safe and well tolerated, its clinical impact is limited compared with higher concentrations, and its optimal use may be as part of combination strategies or in younger, fast-progressing children.