Atropine eye drops reduce gamma zone enlargement over 3 years

Low-concentration atropine reduced parapapillary gamma zone enlargement in a concentration-dependent manner over 3 years. Continuous treatment with 0.05 percent atropine demonstrated efficacy in controlling gamma zone development, according to latest findings from the LAMP Gamma zone study presented by study author Dr Jason Yam of the Chinese University of Hong Kong at APAO 2026.

The global prevalence of myopia is increasing rapidly. By 2050, 49.8 percent of the world’s population is estimated to have myopia. [Ophthalmology 2016;123:1036-1042]

“Myopia is not just about wearing glasses. Elongation of eyeballs may lead to complications, such as myopic macular degeneration, retinal detachment, or even blindness,” stressed Yam.

Following the success of the LAMP1 and LAMP2 studies for prevention of myopia and axial elongation, the recently published LAMP Gamma zone study evaluated the effects of low-concentration atropine eye drops on the parapapillary gamma zone among 238 children with myopia over 3 years. [Ophthalmology 2019;126:113-124; JAMA 2023;329:472-481; Ophthalmol Sci 2026;6:101085]

“To our knowledge, this is the first clinical study to report the longitudinal effect of low-concentration atropine eye drops on parapapillary structure changes,” pointed out Yam. “If low-concentration atropine proves effective in curbing the enlargement of the gamma zone, it may indicate a reduced risk of future myopia-related complications and enhanced visual outcomes for myopic children later in their life.”

In the LAMP Gamma zone study, enrolled children were randomized to receive 0.05, 0.025 or 0.01 percent atropine, or placebo eye drops.  In year 2, placebo participants switched to 0.05 percent atropine (switch-over subgroup). In year 3, each group was rerandomized to continue or cease treatment (washout subgroups). [Ophthalmol Sci 2026;6:101085]

Eighty percent of children completed the 3-year follow-up. The cumulative gamma zone area changes differed significantly between the initial 0.05, 0.025 and 0.01 percent atropine groups (mean, 0.09, 0.19 and 0.22 mm², respectively) over 3 years. Concentration-dependent effects were observed among continued treatment groups (overall p<0.001). Of note, continuous treatment with 0.05 percent atropine demonstrated strong efficacy in controlling gamma zone development over 3 years of treatment.

“Atropine may exert a direct impact on the sclera by reducing both DNA synthesis and glycosaminoglycan production, ultimately mitigating scleral elongation and remodelling,” explained Yam.

Several associated factors for changes in the parapapillary gamma zone during atropine treatment were identified, including 0.05 percent atropine (β, -0.07; p=0.005), female gender (β, 0.05; p=0.006), larger baseline gamma zone area (β, 0.23; p<0.001), and axial length elongation (β, 0.14; p<0.001).

Notably, the cumulative gamma zone enlargement in the switch-over subgroup was greater than that observed in the 0.05 percent washout subgroup, even though both groups received 0.05 percent atropine for 2 years and placebo eye drops or a washout period of 1 year. These results suggest that early treatment with 0.05 percent atropine may provide greater protection against parapapillary gamma zone expansion.

In summary, the LAMP Gamma zone study showed that continued treatment with 0.05 percent atropine may effectively mitigate parapapillary structural alterations.