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Randomized trialGraefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2026

Association between pupil size and response to atropine therapy in the Atropine Treatment of Myopia study (ATOM2).

Daniel Peh, Bryan Sim, Hla Myint Htoon … Audrey Chia

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OphthalmologyRandomized trial

Change in pupil size during atropine treatment was only a weak predictor of treatment response.

Association between pupil size and response to atropine therapy in the Atropine Treatment of Myopia study (ATOM2).

Daniel Peh … Audrey Chia

Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2026

Purpose

To determine if pupil size at baseline, on treatment, or change in pupil size while on atropine was associated with myopia progression.

Methods

This study utilized data from the ATOM2 study, a prospective, randomized, double-masked trial.

n = 400 children

0.53-0.69

Results

0.53-0.69

test correctly predicted treatment response only slightly better than chance

n = 400 children

More results

At baseline, the mean photopic and mesopic pupil size was 3.96+/-0.63 mm and 4.48+/-0.66 mm, respectively.

Pupils on higher doses were more dilated, with eyes with smaller pupil size at baseline having smaller pupil size on treatment.

More results

So while a larger change in pupil size (e.g. ≥2.5 mm in 6.0-8.9year old children, or ≥2 mm in older children) was more likely to be associated with a better result; having a smaller pupil size change did not necessarily suggest a poor result.

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Conclusion

A larger change in pupil size on treatment was associated with a better treatment response.

Post

Association between pupil size and response to atropine therapy in the Atropine Treatment of Myopia study (ATOM2).

Change in pupil size during atropine treatment was only a weak predictor of treatment response.

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