The University of Houston is co-leading a national study, the first of its kind in the United States, exploring whether atropine eyedrops can delay the onset of nearsightedness in young children and lessen its progression over a lifetime, a project with potential to shape future standards in vision care.
Scientists at UH and The Ohio State University have received two grants from the National Eye Institute, National Institutes of Health, totaling $25 million to test daily drops of low concentration atropine as a nearsightedness preventive therapy in children age 6-11 years old.
The study's name already has the sweet sound of success: Delaying the Onset of Nearsightedness Until Treatment - or the DONUT - Study
The more nearsighted, or myopic, someone becomes, the greater their risk of sight-threatening complications later on as an adult including myopic degeneration, retinal detachment, glaucoma. Our goal is to ultimately decrease how myopic someone becomes to hopefully reduce their risk of complications later in life."
David Berntsen, co-principal investigator on the grants and Golden-Golden Professor of Optometry at UH
Berntsen is co-leading the study with Jeffrey Walline, professor at Ohio State's College of Optometry and Lisa Jordan, research professor and director of the Data Coordination and Analysis Center at Ohio State.
The case for atropine
Previous studies in the United States and Asia have suggested atropine can slow the progression of nearsightedness after its onset. A study in Asia reported that atropine drops can delay the onset of nearsightedness, but there has been no such study conducted in the U.S. This new study aims to administer the drug before diagnosis in children deemed at highest risk for developing myopia.
People are generally born farsighted, and previous research has shown that children whose farsightedness has decreased to a specific measure by third grade are at the highest risk – with almost 90% accuracy – for developing nearsightedness by eighth grade. Those children will be recruited to join the study.
The clinical trial will be conducted at the University of Houston, Ohio State and 12 additional centers across the U.S. Researchers plan to enroll over 600 children who will be randomly assigned to receive nightly drops of either 0.05% low-concentration atropine or a placebo for two years.
The timing of the onset of nearsightedness in children receiving the drug will be compared to those who receive the placebo. Any children in the placebo arm of the trial who are diagnosed with myopia during the study will begin receiving the atropine drops. All children who become nearsighted will also receive an annual voucher for corrective lenses, Berntsen said.
The eye grows fastest just before the onset of myopia, which tends to begin between the ages of 8 and 10 and progresses up to about age 16. After that, the eye might continue to grow but it does not become more myopic in most people.
The researchers predict that the atropine drops will reduce the proportion of children who become nearsighted from 20% in the placebo group to 10% in the treatment group, and that atropine will slow pre-myopic eye growth by 30% over the course of the study.
The growing problem
Myopia affects at least one-third of adults in the United States, and is becoming more prevalent – because, the scientific community believes, children are spending less time outdoors now than in the past.
In decades past, myopia was considered more as a nuisance than a disease. But over the last 10 years, vision research has advanced beyond alleviating symptoms to better understanding and addressing the mechanisms of nearsightedness with an eye toward lowering the risk for vision loss in adulthood.
Berntsen, Walline, and Jordan previously co-led studies showing that multifocal contact lenses can effectively slow the progression of nearsightedness. In a 2020 clinical trial and follow-up study, they reported that multifocal contact lenses with a high add power significantly slowed the progression of myopia in nearsighted kids as young as seven years old, and in 2025, they reported that those benefits lasted after the treatment ended.
"Our previous work has shown that young children are very successful with treatments to slow the progression of myopia. This new study will now look to see if we can delay when a child first becomes myopic," Berntsen said.
In addition to the health ramifications of myopia, correcting the condition is expensive, costing an estimated $4 billion to $7 billion annually in the United States. And high myopia not only threatens vision, but limits the options for refractive surgery, contact lenses and glasses – all factors that point to the importance of getting ahead of the diagnosis, Walline said.
"The number of myopic individuals in the world is projected to increase to 50% by the year 2050, and over one third of the U.S. populations is myopic. Anything that we can do to delay the onset of myopia in children has the potential to have a significant impact on this growing problem," Berntsen said.
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