{
  "abstract": "Background/aims Although 0.01% atropine is widely used for myopia control, its efficacy is debated and its effectiveness across different ethnicities is unknown. We aim to evaluate its efficacy in different ethnic backgrounds.Methods The randomised clinical trials (RCTs) that compared 0.01% atropine against a placebo in myopic children from five databases through August 2025 were included. The primary outcomes included (1) the ratio of the means (RoM), defined as the RoM of annual changes in spherical equivalent refraction (SER) or ocular axial length (AL) in 0.01% atropine to the placebo groups, for accounting in the natural progression; and (2) the mean differences (MDs) in SER progression and AL elongation.Results A meta-analysis of 25 RCTs (4374 children aged 4–18) showed that 0.01% atropine reduced the SER progression by 37% annually (RoM: 0.63; 95% CI 0.54 to 0.74), with efficacy being much greater in South Asian populations (66% reduction; RoM: 0.34, 95% CI 0.27 to 0.42), than East Asian populations (35% reduction; RoM: 0.65, 95% CI 0.54 to 0.78) and white populations (28% reduction; RoM: 0.72, 95% CI 0.59 to 0.86) (p<0.0001). Regarding the MD, 0.01% atropine was effective in slowing an overall myopia progression of 0.21D per year (95% CI 0.15D to 0.27D) compared with placebo group. A similar pattern was observed in AL elongation.Conclusion 0.01% atropine effectively slows myopia progression across ethnicities, with the greatest efficacy observed in South Asian populations. Clinical practice should consider this ethnic difference to optimise the treatment effects.PROSPERO registration number CRD42025632545.",
  "authors": [
    {
      "affiliations": [
        "Department of Ophthalmology, The University of Hong Kong, Hong Kong, Hong Kong",
        "Queen Mary Hospital, Hong Kong, Hong Kong",
        "The Hong Kong University-Shenzhen Hospital, Shenzhen, China"
      ],
      "name": "Xiu Juan Zhang"
    },
    {
      "affiliations": [
        "Department of Ophthalmology, The University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Mingming Liu"
    },
    {
      "affiliations": [
        "Department of Ophthalmology, The University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Edison Chak Fung Ho"
    },
    {
      "affiliations": [
        "Singapore Eye Research Institute, Singapore National Eye Centre, Singapore",
        "Eye-ACP, Duke-NUS Medical School, Singapore"
      ],
      "name": "Marco Yu"
    },
    {
      "affiliations": [
        "Department of Ophthalmology, The University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Ryan Tak Chun Wong"
    },
    {
      "affiliations": [
        "Department of Ophthalmology, The University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Weijia Chen"
    },
    {
      "affiliations": [
        "Department of Ophthalmology, The University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Ebenezer Zaabaar"
    },
    {
      "affiliations": [
        "Department of Ophthalmology, The University of Hong Kong, Hong Kong, Hong Kong",
        "The Hong Kong University-Shenzhen Hospital, Shenzhen, China"
      ],
      "name": "Philip Yawen Guo"
    },
    {
      "affiliations": [
        "School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China"
      ],
      "name": "Chen-wei Pan"
    },
    {
      "affiliations": [
        "Singapore Eye Research Institute, Singapore National Eye Centre, Singapore",
        "Eye-ACP, Duke-NUS Medical School, Singapore",
        "Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore",
        "Centre for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore"
      ],
      "name": "Ching-Yu Cheng"
    },
    {
      "affiliations": [
        "Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Jason C Yam"
    },
    {
      "affiliations": [
        "The Primasia International Eye Research Institute (PIERI), School of Medicine, The Chinese University of Hong Kong (Shenzhen), Shenzhen, China",
        "C-MER Dennis Lam Eye Center, C-MER International Eye Care Group Limited, Hong Kong, Hong Kong"
      ],
      "name": "Dennis Shun-chiu Lam"
    },
    {
      "affiliations": [
        "Department of Ophthalmology, The University of Hong Kong, Hong Kong, Hong Kong",
        "Queen Mary Hospital, Hong Kong, Hong Kong"
      ],
      "name": "Kendrick Shih"
    },
    {
      "affiliations": [
        "Department of Ophthalmology, The University of Hong Kong, Hong Kong, Hong Kong",
        "Queen Mary Hospital, Hong Kong, Hong Kong",
        "The Hong Kong University-Shenzhen Hospital, Shenzhen, China"
      ],
      "name": "Christopher Kai Shun Leung"
    }
  ],
  "title": "Efficacy of 0.01% atropine eye drops for myopia control in children of different ethnicities: a systematic review and meta-analysis",
  "uid": "f59d9399-af22-5534-b484-0ad618c612bb"
}