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Corneal biometry changes with 0.01% atropine for myopia control: a randomised controlled trial and case of incidental keratoconus

Year: 2026

Type: article

Abstract: Changes in corneal curvature have been reported with low-concentration atropine eyedrops for myopia treatment and have been suggested to play a role in the refractive changes observed during atropine therapy. A case of keratoconus was identified from the WA-ATOM cohort. We tested the null hypothesis that 0.01% atropine eyedrops produce no change in corneal parameters or ectasia risk compared to placebo. Children with progressive myopia (6–16 years; n = 153) were randomly assigned to receive 0.01% atropine eyedrops or a placebo (2:1 ratio) for 2 years, followed by a 1-year washout. Scheimpflug imaging was performed at baseline, 24-months, and 36-months. Changes in corneal parameters were compared between the treatment and placebo groups using linear mixed models. One child allocated to the treatment group developed keratoconus during the treatment phase. At 24 and 36 months, the atropine group had significantly lower (i.e., improved) BAD-D values compared to the placebo group, with between-group differences of -0.119 ± 0.054 and − 0.144 ± 0.051, respectively ( p = 0.029 and 0.005). At 36 months, the atropine group showed significantly greater steepening of K max relative to the placebo group (-0.173 ± 0.084D, p = 0.039). All other corneal parameters and cylindrical power remained similar between the groups. There was no evidence of increased ectasia risk with the use of 0.01% atropine eyedrops when used to manage paediatric myopia. The case of incidental keratoconus in the treatment group (1 out of 153 children) is consistent with population prevalence rates.

Source: Scientific Reports

DOI: 10.1038/s41598-026-74892-8

Authors: Alvid Soh, Gareth Lingham, Elsie Chan, Antony Clark, David A. Mackey, Samantha Sze-Yee Lee