{ "abstract": "Introduction\n\nLow-dose atropine eye drops slow childhood myopia progression, but randomized evidence in European children and for intermediate concentrations remains limited. This study evaluated 0.02% and 0.04% atropine for 12-month myopia control in Czech children.Methods\n\nThe MARS study was an investigator-initiated, phase IIIb, multicenter, randomized, double-masked, placebo-controlled trial. Children aged 6-11 years with documented accelerated prerandomization axial length (AL) elongation and cycloplegic spherical equivalent refraction (SER) from -0.50 to -4.75 D were randomized 2:1:1 to nightly 0.02% atropine, 0.04% atropine, or placebo. The primary endpoint was the between-group difference in AL change at Month 12 for 0.02% atropine versus placebo. Linear mixed-effects models accounted for inter-eye correlation. Repeated-measures and multiple-imputation sensitivity analyses assessed the effect of missing data.Results\n\nA total of 191 participants (351 eyes) were included in the primary analysis. Compared with placebo, adjusted mean between-group differences in AL change were -0.144 mm for 0.02% atropine (95% confidence interval [CI] -0.201 to -0.087; P < 0.0001) and -0.157 mm for 0.04% atropine (95% CI -0.222 to -0.092; P < 0.0001). Corresponding differences in SER progression were 0.352 D (95% CI 0.199 to 0.505; P < 0.0001) and 0.389 D (95% CI 0.214 to 0.564; P < 0.0001). No statistically significant difference was detected between 0.02 and 0.04% atropine for AL (0.013 mm; 95% CI -0.043 to 0.069; P = 0.8935) or SER (-0.037 D; 95% CI -0.189 to 0.115; P = 0.8802). Sensitivity analyses yielded consistent AL estimates.Conclusions\n\nNightly 0.02% and 0.04% atropine reduced axial elongation and myopia progression over 12 months compared with placebo. The trial was not designed or powered to establish equivalence between the active doses; within this sample, no statistically significant difference was detected between them.Trial registration\n\nEuropean Clinical Trials Database (EudraCT no. 2020-002046-16), Clinical Trials Information System (CTIS), EU Clinical Trial (EU CT) no. 2024-515888-54-00.", "abstract_shown": true, "affiliations": [ "Department of Ophthalmology for Children and Adults, Second Faculty of Medicine, Charles University and University Hospital Motol and Homolka, V Úvalu 84, 15006, Prague 5, Czech Republic. martin.hlozanek@fnmotol.cz.", "Center of Pediatric Ophthalmology, BINOCULAR S.R.O., Litomyšl, Czech Republic.", "Department of Optometry and Orthoptics, Faculty of Medicine, Masaryk University, Brno, Czech Republic.", "Department of Pediatric Ophthalmology, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czech Republic.", "Center of Excellence CREATIC, Faculty of Medicine, Masaryk University, Brno, Czech Republic.", "Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.", "Department of Ophthalmology, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic.", "Department of Ophthalmology for Children and Adults, Second Faculty of Medicine, Charles University and University Hospital Motol and Homolka, V Úvalu 84, 15006, Prague 5, Czech Republic." ], "article_type": "research article", "arxiv": null, "author_total": 14, "authors": [ { "affs": [ 0 ], "name": "Martin Hložánek", "orcid": "0000-0002-7962-7783" }, { "affs": [ 1, 2 ], "name": "Miroslav Dostálek", "orcid": "0000-0002-4335-4998" }, { "affs": [ 3 ], "name": "Rudolf Autrata", "orcid": "0000-0002-2689-882X" }, { "affs": [ 4 ], "name": "Radka Štěpánová" }, { "affs": [ 4 ], "name": "Jana Unar Vinklerová" }, { "affs": [ 5 ], "name": "Jarmila Heissigerová", "orcid": "0000-0002-2614-4681" }, { "affs": [ 6 ], "name": "Pavel Studený", "orcid": "0000-0003-1279-4074" }, { "affs": [ 1, 2 ], "name": "Barbora Čáslavská" }, { "affs": [ 1, 2 ], "name": "Lucie Jeřábková" }, { "affs": [ 7 ], "name": "Nina Zelenayová", "orcid": "0000-0002-4445-6072" }, { "affs": [ 3 ], "name": "Inka Krejčířová", "orcid": "0000-0002-3975-3830" }, { "affs": [ 6 ], "name": "Renáta Brunnerová" }, { "affs": [ 5 ], "name": "Marta Korbasová", "orcid": "0000-0001-5742-9463" }, { "affs": [ 3 ], "name": "Martin Komínek", "orcid": "0000-0001-8322-5165" } ], "bibtex": "https://research.draconitic.com/paper/0g53w279b4gzx.bib", "cited_by": 0, "doi": "10.1007/s40123-026-01506-x", "fulltext_url": "https://europepmc.org/articles/PMC13694685", "id": "0g53w279b4gzx", "issns": [ "2193-8245", "2193-6528" ], "landing_url": "https://europepmc.org/article/MED/42832165", "language": "eng", "licence": "CC-BY-NC", "licence_label": "CC BY-NC", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/", "metadata_licence": null, "native_subjects": [ [ "lcc", "RE1-994" ], [ "openalex", "2713|Ophthalmology and Visual Impairment Studies" ] ], "openalex": "W7220452832", "pdf_url": "https://europepmc.org/articles/PMC13694685?pdf=render", "pmcid": "PMC13694685", "pmid": "42832165", "published": "2026-10-05", "publisher": "Adis, Springer Healthcare", "ris": "https://research.draconitic.com/paper/0g53w279b4gzx.ris", "sources": [ { "first_seen": "2026-10-30T12:18:10Z", "native_id": "MED:42832165", "source": "europepmc", "url": "https://europepmc.org/article/MED/42832165" }, { "first_seen": "2026-10-30T13:45:42Z", "native_id": "294b79b5ed7e4147b68909eaaedca879", "source": "doaj", "url": "https://doi.org/10.1007/s40123-026-01506-x" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2713|Ophthalmology and Visual Impairment Studies", "subfield": "epidemiology-public-health" } ], "title": "Effectiveness of 0.02% and 0.04% Atropine Therapy for Myopia Control in Czech Children: The MARS Trial.", "title_text": "Effectiveness of 0.02% and 0.04% Atropine Therapy for Myopia Control in Czech Children: The MARS Trial.", "type": "peer-reviewed", "updated_at": "2026-10-30T13:45:42Z", "url": "https://research.draconitic.com/paper/0g53w279b4gzx", "venue": "Ophthalmology and therapy", "versions": [] }