LAMP Eight-Year Data On Tapering Low-Concentration Atropine

Key Takeaways

• Tapering before discontinuation was associated with less spherical-equivalent progression and less axial elongation over 3 years than stopping outright.
• The taper strategy used step-down dosing during year 6 before all participants stopped treatment and were observed for two additional years.
• A good response to discontinuation was more common with tapering, while younger age and more myopic or longer eyes at prediscontinuation were linked to faster progression.

Children in the LAMP follow-up had less myopia progression after tapering low-concentration atropine before stopping than after stopping outright.

In this JAMA Ophthalmology randomized clinical trial follow-up, children originally enrolled at ages 4 to 12 years with myopia entered discontinuation testing after completing year 5 on atropine. The follow-up included children who remained in study care long enough to enter this phase. They were randomized 1:1, with the taper group receiving 0.05% atropine for 6 months followed by 0.025% for 6 months during year 6. The stop group received 0.05% atropine for the full prediscontinuation year, and all participants then stopped treatment and were monitored for 2 years during years 7 and 8. Main outcomes were 3-year myopia progression, the proportion with a good discontinuation response, and factors linked to faster progression within the broader follow-up.

Over the 3-year discontinuation comparison, spherical-equivalent progression was faster after stopping, reaching −0.78 D versus −0.54 D with tapering. The between-group difference was −0.24 D, with a 95% CI from −0.46 to −0.03 D and P = .02. Axial length also increased more in the stop group, at 0.44 mm versus 0.33 mm over 3 years. The axial-length difference was 0.11 mm, with a 95% CI of 0.03 to 0.19 mm and P = .01. These findings reflected slower refractive and axial change in the taper group during follow-up.

A good response to discontinuation was defined by a spherical-equivalent progression threshold of −0.5 D in both eyes during the discontinuation period. That outcome occurred in 65.1% of the taper group and 42.6% of the stop group, with P = .003. Younger age and more myopic spherical equivalent or longer axial length at prediscontinuation were associated with faster progression over 3 years. Larger estimated group differences were also reported among younger children and those with more severe myopia at prediscontinuation. Among 246 children who completed year 5, 180 completed 8 years of follow-up, and investigators said the roughly 0.25-D difference still had uncertain clinical relevance.