Atropine slows axial elongation over two years in MAD trial

A 2-year interim analysis of the Myopia Atropine Dose (MAD) randomized clinical trial found modest axial elongation in children treated with atropine. The findings were presented in a poster at the ARVO 2026 Annual Meeting.

The ongoing double-masked, multicenter trial includes Dutch children aged 6–11 years with progressive myopia and compares atropine 0.05% with 0.5%.

This intention-to-treat analysis evaluated 132 participants who completed the 24-month visit, assessing axial length (AL) and cycloplegic spherical equivalent refraction (SER) changes. Linear regression models examined whether baseline characteristics predicted progression.

Over 2 years, mean axial length increased from 24.32 mm to 24.63 mm, a mean elongation of 0.30 mm (SD 0.24). Sixteen children (12.1%) discontinued treatment within 24 months, most often due to mild tolerability issues.

In multivariable analysis, younger age at baseline was the only independent predictor of axial elongation (β = -0.05 mm/year; P = 0.001). Baseline axial length, baseline SER, and sex were not significantly associated with axial progression. Similarly, none of the evaluated baseline factors predicted changes in refractive error over the study period.

Reference

Roelof Polling J, et al. Age Predicts Axial Elongation in Atropine-Treated Children: Two-Year Interim Results from the MAD Trial. Poster presented at: ARVO 2026 Annual Meeting; May 3-7, 2026; Denver, CO.