Low-dose atropine eye drops are a prescription option that eye doctors use to try to slow the progression of myopia, or short-sightedness, in children. The concentrations used for this purpose are roughly 0.01% to 0.05%, far below the 1% solution sold commercially, and no manufacturer makes an FDA-approved product at those strengths in the United States. That is why the drops are compounded, and why the decision to use them belongs entirely to the child's eye doctor.
Myopia usually begins in childhood and tends to progress as the eye continues to grow. Slowing that progression matters beyond the strength of the glasses, because higher myopia is associated with a greater lifetime risk of retinal detachment, glaucoma and myopic maculopathy. Compounded atropine ophthalmic drops are one of several approaches an eye doctor may consider, and they are used off-label at these concentrations.
What is low-dose atropine for myopia?
Atropine is an old drug in eye care. At the 1% concentration that has been used for decades, it dilates the pupil and relaxes the focusing muscle, which is useful for eye examinations and for certain treatments but leaves a child light-sensitive and blurry up close for days.
Low-dose atropine is the same drug at a small fraction of that strength. The intent is not to dilate the pupil at all. It is to slow the axial elongation of the eye, meaning the front-to-back growth that drives myopia progression, while keeping the dose low enough that daily vision is largely unaffected.
How is atropine thought to slow myopia progression?
The mechanism is not fully established. The leading hypotheses involve receptors in the retina and sclera rather than the focusing muscle, which is consistent with low doses having an effect on progression without the pupil and focusing side effects that higher doses cause.
That distinction matters for a parent reading about this. Researchers are describing a plausible biological pathway, not a settled one, and the treatment reached routine clinical use before the mechanism was pinned down.
Which concentrations are used for myopia control?
Prescribers commonly order 0.01%, 0.02% or 0.05%. All three are far below the commercial product, and all three are off-label for myopia control. The table below shows how the concentrations differ in what a child is likely to notice.
| Concentration | Typical purpose | Status | Pupil, near effects |
|---|---|---|---|
| 1% solution | Dilation, cycloplegia | FDA-approved | Marked, lasting days |
| 0.05% | Myopia control | Off-label, compounded | Mild to moderate |
| 0.02% | Myopia control | Off-label, compounded | Usually mild |
| 0.01% | Myopia control | Off-label, compounded | Usually minimal |
Higher concentrations within the low-dose range have generally produced a larger measured effect on progression in trials, and also more pupil dilation and more difficulty focusing up close. Which side of that trade-off suits a particular child is a clinical judgement, and the concentration is the prescriber's decision, not a parent's and not a pharmacy's.
What do the trials actually show?
This is an active research area rather than a settled one, and it is worth being clear about that.
Trials in East Asian populations, particularly the ATOM series in Singapore and the LAMP studies in Hong Kong, reported that low-dose atropine slowed myopia progression compared with placebo, with 0.05% generally outperforming 0.01% in the LAMP work. Those results drove much of the current clinical interest.
More recent trials in North American populations have been less consistent. Some, including the MTS1 and CHAMP trials, did not reproduce a significant benefit for 0.01% against placebo on their primary endpoints. Researchers continue to debate why, with candidate explanations including differences in concentration, formulation and preservatives, population, and study design.
The summary is that low-dose atropine is a reasonable option that many eye doctors use and that has real supporting evidence, that the optimal concentration is not settled, and that the results have not been uniform across populations. It is not a certain outcome for any individual child, and anyone presenting it as one is going beyond the data.
This is also why you will see a range of numbers quoted online for how much progression is slowed. Those figures come from different trials, different concentrations, different age groups and different measures, and they are not interchangeable. A prescriber who knows your child's refraction history and axial length measurements is in a far better position than any article to say what to expect.
What happens when a child stops using the drops?
Rebound is the term used for faster-than-expected progression after the drops are stopped, and it has been reported in the atropine literature. It appears more pronounced after higher concentrations, which is part of the reason the very low concentrations attracted interest in the first place.
Because of this, eye doctors often plan how treatment will end rather than simply stopping, and may taper the concentration or continue until the eye has largely stopped growing. Do not stop the drops on your own without telling the prescriber.
What side effects do children have with low-dose atropine?
The two effects parents ask about most are light sensitivity and blurred near vision. Both come from the same pharmacology that makes 1% atropine unusable for daily wear, and both are much less pronounced at 0.01% to 0.05%.
Dosing at bedtime is usual partly because any light sensitivity or blurring at near is then slept through. At these low concentrations most children tolerate the drops well. Reported effects include mild light sensitivity, slight difficulty focusing up close, local stinging and irritation, and occasionally allergic eyelid reactions. Report anything more than that to the prescribing eye doctor.
Some children who already need reading correction, or who are borderline, may notice near work becoming harder at the higher end of the range. That is one of the things follow-up visits are for.
Why is low-dose atropine compounded?
Commercial atropine ophthalmic solution is manufactured at 1%, which is roughly twenty to a hundred times the concentration used for myopia control. There is no FDA-approved atropine product at 0.01% to 0.05% on the United States market, so a pharmacy has to prepare it to the prescriber's order. Compounded preparations are not FDA-approved, and that is a statement about regulatory status rather than about quality.
Diluting a commercial 1% bottle at home is not a substitute. These are sterile preparations for the eye, and concentration accuracy, sterility and beyond-use dating are the reasons this belongs in a sterile compounding lab. The same logic explains how a compounding pharmacy differs from a retail pharmacy, which stocks manufactured products rather than preparing them.
Children are a common reason prescribers turn to compounding at all, because a manufactured product may exist only in a strength or dose form a child cannot use. That is the same reason prescribers order custom oral suspensions for children who cannot swallow tablets.
It is also what pharmacies fall back on when a manufactured product is unavailable, though shortage compounding and strength-specific compounding are different situations with different rules.
Who prescribes low-dose atropine and what does follow-up look like?
This is prescribed by an eye doctor, an optometrist or ophthalmologist, who is examining the child and tracking progression. Dose, concentration, schedule and duration are all their decisions. Bayview Pharmacy does not provide consultations and does not determine whether a medication is appropriate for anyone.
Follow-up usually means periodic measurement of refraction and, where available, axial length, so the prescriber can see whether progression is slowing and decide whether to continue, change concentration or stop. Myopia control is often combined with other measures the eye doctor will discuss, and time spent outdoors is consistently associated with slower progression in the literature.
Prescribers who want to send an order or ask about strengths and vehicles can reach us through the for providers page.
Our ophthalmology compounding page covers the sterile eye preparations we make and what a prescriber needs to specify on the order.
What does low-dose atropine cost?
Compounded atropine ophthalmic drops start at $60, and the final price depends on the concentration, the bottle size and how the prescriber wants it prepared. Compounded preparations are generally not billed through insurance, so this is usually an out-of-pocket cost, and a course of myopia control runs over years rather than weeks.
Questions about payment, refills, shipping and the states where Bayview is licensed are answered on our frequently asked questions page.
What Bayview prepares for myopia control
On a prescriber's order, we prepare atropine ophthalmic drops at low concentrations for a named patient, compounded in our USP 797 sterile lab. The prescriber specifies the concentration, the volume and whether a preservative-free presentation is wanted.
Other sterile eye preparations we make on prescription sit alongside it in the eye and vision category.
Those include fortified gentamicin eye drops, prepared at concentrations above the commercial product because a prescriber has asked for them in serious corneal infection.
The same is true of fortified tobramycin drops, which are made to order rather than stocked.
A different example is acetylcysteine ophthalmic solution, which prescribers order for certain corneal surface conditions and which has no FDA-approved ophthalmic equivalent in the United States.
If you are comparing options, the searchable catalog of compounded medications lists what we prepare by category.
Our guide to choosing a compounding pharmacy covers what to ask before a prescription is sent anywhere.
Talk to your child's eye doctor
If your child's prescription has been changing year after year, myopia control is worth raising at the next eye examination. Ask what the measured rate of progression has been, what options the practice uses, and how progress would be tracked.
Whether low-dose atropine is appropriate for a particular child is a decision for their eye doctor, who is examining and monitoring them. If they decide to prescribe it, they can send the order to us directly and we will prepare it to their specification.
Frequently asked questions
What is low-dose atropine used for?
The American Academy of Ophthalmology and about two decades of research support that low-dose atropine can slow myopia progression in many children. The size of the effect varies, and your eye doctor decides whether it is appropriate and which concentration to use.
Is low-dose atropine FDA-approved?
No. Only 1% atropine is commercially available in the US; the low concentrations used for myopia (about 0.01% to 0.05%) have no FDA-approved product, so they are compounded and prescribed off-label, and are not FDA-approved.
How is it used?
Usually one drop in each eye once daily at bedtime, exactly as your eye doctor directs. Wash hands first, don't touch the dropper tip to the eye, and for a child an adult should give the drops.
What are the side effects?
The most common are mild, light sensitivity, blurred near vision, or eye redness or itching, and are less common at the lowest concentrations. Using the drop at bedtime helps limit daytime symptoms.
Which strength is best: 0.01%, 0.02%, or 0.05%?
Your eye doctor chooses. In the LAMP study, 0.05% had the greatest effect among the low doses, while 0.01% had the fewest side effects and the least rebound. The right concentration depends on the individual child.
Can I give a compounded medication to my child?
Only if it was prescribed for that child by name. Never split an adult’s prescription or give a child a preparation dispensed for a sibling, even at what seems like a smaller dose.
Compounding is often used specifically for children, and for good reasons: a strength that is not made commercially, a liquid instead of a tablet a child cannot swallow, a flavor that makes a course of treatment finishable, or a formulation without a dye or preservative a child reacts to. If your child has been prescribed something compounded, that is usually why.
Use the oral syringe supplied with the prescription and measure carefully. Pediatric doses are often calculated by weight, which means the margin between doses is narrower than it is for an adult and a measuring error matters more.
Call us at 401-284-4505 with any question about how to give it, how to store it, or what to do if your child spits out a dose. Our pharmacists would far rather answer that call than have you guess.
Do I need a prescription?
Yes. All of our medications require a valid prescription from a licensed provider. We're a dispensing and compounding pharmacy, so we don't provide consultations or write prescriptions. If you don't have one yet, you'll need to find and see a provider first.
Can you fill a prescription from my own provider?
Yes. Your provider can send your prescription to Bayview Pharmacy by e-prescribe, fax, or phone, or you can transfer an existing prescription from another pharmacy.
Do you perform sterile compounding?
Yes.
Our sterile laboratory operates under USP 797. Preparations made there include fortified gentamicin, tobramycin and vancomycin eye drops, low-dose atropine drops, and preservative-free hydromorphone infusions for hospice and palliative care.
How much do compounded medications cost?
Pricing varies depending on ingredients and formulation complexity.
Do you accept insurance?
Most compounded medications are not covered by insurance. We can always try and run your insurance prior to compounding your prescription if you wish.
Do sterile medications cost more?
Sterile preparations often cost more due to specialized requirements, such as third-party testing, environmental monitoring, and regulations.
How does shipping work?
Once your prescription is verified, we prepare your medication and ship it discreetly in plain packaging either via UPS or USPS. A pharmacy technician confirms the details with you before it goes out, and we're available if you have any questions.
What states do you ship to?
Bayview fills and ships prescriptions for patients in Rhode Island, Massachusetts, Connecticut, New Jersey, New Hampshire, Florida, Maine, and Pennsylvania.
New York: Bayview currently serves eligible New York patients on a limited basis under New York's isolated-transaction criteria. Full nonresident pharmacy registration is pending. We do not ship controlled substances to New York addresses.
If you are not sure whether your prescription is affected, call us at (401) 284-4505 and we will check before anything is prepared.
What Bayview compounds for this
Important: Compounded medications are prepared to a prescriber's order for an individual patient. They are not FDA-approved, and the FDA has not evaluated them for safety, effectiveness, or manufacturing quality. This article is educational and is not a substitute for advice from your prescriber or pharmacist.
This preparation contains a controlled substance. Controlled-substance prescriptions carry refill limits, must be e-prescribed, and can only be shipped to states where Bayview holds the required licensure.
Uses discussed here may be off-label, meaning they are not part of any FDA-approved labeling. Off-label use is a decision for you and your prescriber, based on the available evidence.
Veterinary preparations are compounded to a veterinarian's order for a specific animal and are not FDA-approved animal drugs. Never give a compounded human medication to an animal without veterinary direction.
Compounded prescriptions are paid for directly rather than billed through insurance. Most are HSA/FSA-eligible, and many patients submit the receipt to their plan for possible reimbursement. Pricing depends on the strength, dose form and quantity your prescriber orders. Read more about cost and insurance.
Compounded atropine ophthalmic drops start at $60, with the final price depending on the concentration, the bottle size and whether a preservative-free presentation is ordered. Compounded preparations are generally not billed through insurance, so this is usually an out-of-pocket cost, and myopia control is measured in years rather than weeks. Questions about payment and shipping are answered on our FAQ page.
Bayview Pharmacy is a compounding pharmacy in Warwick, Rhode Island, licensed to fill and ship compounded prescriptions for patients in Rhode Island, Massachusetts, Connecticut, New Jersey, New Hampshire, Florida, Maine and Pennsylvania. Prescriptions for New York patients are filled on a limited basis, and controlled substances are not shipped to New York addresses. See every state we ship to.
Related reading
