The three-year findings of the MOSAIC (Myopia Outcome Study of Atropine in Children) trial, published in JAMA Ophthalmology on January 9, 2025, shed light on the efficacy and safety of different atropine eye drop regimens in controlling myopia progression in European children.
This secondary analysis, referred to as MOSAIC2, evaluated 199 children aged six to 16 years from the original 24-month MOSAIC trial. Conducted at the Centre for Eye Research Ireland in Dublin, the study explored nightly atropine concentrations of 0.05% and 0.01%, as well as placebo regimens.
One of the key findings came from children who switched from placebo to 0.05% atropine in the third year of the study. These children experienced a significant reduction in axial elongation and refractive error progression at 12 months, compared to those who tapered or ceased 0.01% atropine treatment.1
Interestingly, children who stopped or reduced 0.01% atropine treatment did not experience rebound myopia progression. This is reassuring for clinicians concerned about the risks of ceasing or tapering low-dose atropine therapy.1
Overall, the study reported high compliance, with more than 80% of children consistently using their prescribed treatments. The similar rates of adherence across different groups show that atropine eye drops are generally easy to use, even at higher concentrations.1
While the 0.05% atropine group reported more side effects—blurred near vision and photophobia—these issues were transient and did not discourage treatment adherence, with no children discontinuing due to adverse reactions.1
Clinical implications
The study’s findings highlight a critical balance between efficacy and tolerability in selecting the appropriate atropine concentration for individual patients. While 0.05% atropine offers superior efficacy, the mild side effects associated with its use may not be acceptable to all patients.
Conversely, 0.01% atropine provides a well-tolerated alternative, particularly for younger children or those with milder myopia progression, though its efficacy may diminish if the regimen is tapered or ceased prematurely.
The MOSAIC study adds to a growing body of evidence supporting the use of atropine eye drops for managing childhood myopia. However, questions remain regarding the optimal duration of treatment, long-term safety and the potential for rebound effects with higher concentrations.
Future research is essential to address these gaps, particularly in diverse populations with varying genetic, environmental and lifestyle factors that influence myopia progression. The findings from MOSAIC2 set the stage for larger, multi-center studies exploring these variables.
References
- Loughman J, Lingham G, Nkansah EK, Kobia-Acquah E, Flitcroft DI. Efficacy and Safety of Different Atropine Regimens for the Treatment of Myopia in Children: Three-Year Results of the MOSAIC Randomized Clinical Trial. JAMA Ophthalmol. 2025 Jan 9 [Epub ahead of print].
