On 29 July 2026, the National Institute for Health and Care Excellence—NICE—published draft guidance on the use of low-dose atropine eye drops for children with progressive myopia.
The draft recommendation does not currently support the routine use of Ryjunea®, a licensed low-dose atropine eye drop, on the NHS. This is disappointing news for families and eye-care professionals who had hoped that children with worsening short-sightedness would soon have equitable access to another evidence-based treatment option.
It is important, however, to emphasise that this is draft guidance rather than NICE’s final decision. Consultation is open until 19 August 2026, with final guidance currently expected on 2 December 2026.
What has NICE decided?
NICE assesses both the clinical effectiveness of a treatment and whether it represents an appropriate use of limited NHS resources.
Its draft guidance does not recommend low-dose atropine for routine NHS use at present. This does not mean that atropine has been found to be unsafe, nor does it mean that the medicine has lost its UK licence.
There is an important distinction between:
- MHRA approval, which confirms that a medicine can be licensed for a particular use in the UK; and
- NICE guidance, which considers whether that medicine should be routinely funded by the NHS.
Ryjunea has already received UK regulatory approval as the first licensed low-dose atropine treatment intended to slow childhood myopia progression. The present NICE decision is therefore about routine NHS funding and cost-effectiveness rather than regulatory approval.
What is childhood myopia?
Myopia, commonly called short-sightedness, occurs when the eye grows too long or focuses light in front of the retina rather than directly on it. Children with myopia usually see nearby objects more clearly than things in the distance.
Myopia often progresses while a child is growing. Their glasses prescription may become stronger from year to year as the eye continues to lengthen.
Corrective glasses or contact lenses allow a child to see clearly, but ordinary lenses do not necessarily slow the underlying growth of the eye.
The higher the eventual level of myopia, the greater the lifetime risk of several eye conditions, including retinal problems, glaucoma and myopic changes affecting the macula. This is why modern myopia management aims not only to provide clear vision, but also to reduce the rate at which myopia progresses.
What is low-dose atropine?
Atropine has been used in ophthalmology for many years. In a much lower concentration, atropine eye drops can be prescribed to try to slow the progression of myopia in children.
Ryjunea contains low-dose atropine at a concentration of 0.1 mg/ml. Its UK licence allows treatment to be initiated in children aged between 3 and 14 years whose myopia:
- is between −0.50 and −6.00 dioptres; and
- has been progressing by at least 0.50 dioptres per year.
The drops are administered once daily, usually at bedtime.
The licensing decision was supported by the Phase III STAR study. The manufacturer reported that treatment reduced the annual progression of myopia by approximately 30% over two years compared with placebo, with an acceptable safety and tolerability profile.
Atropine does not cure myopia, remove the need for glasses or guarantee that a child will avoid eye disease later in life. Its purpose is to slow progression so that the child may finish growing with a lower level of myopia than they otherwise would have developed.
Why is the draft NICE decision disappointing?
Myopia management is already available privately using specially designed glasses, contact lenses and, where clinically appropriate, atropine.
However, the cost of private treatment means that access is not equal. Some families can afford several years of treatment and monitoring, while others cannot.
A licensed atropine product could be particularly valuable for children who:
- develop myopia at a young age;
- have rapidly progressing myopia;
- have difficulty using contact lenses;
- have a strong family history of high myopia; or
- need an additional option alongside optical myopia-control treatment.
The draft decision risks continuing a two-tier system in which access to myopia management depends partly on a family’s ability to pay.
As a paediatric ophthalmologist, I find this disappointing. Although no treatment is perfect, slowing the progression of myopia during childhood may reduce the final prescription a child reaches. Families should be able to discuss the full range of appropriate options without cost being the principal barrier.
Does the draft decision mean atropine cannot be prescribed?
No.
Ryjunea remains a licensed prescription-only medicine in the UK. The draft NICE recommendation concerns whether it should be routinely funded by the NHS in England.
It may still be possible to prescribe low-dose atropine privately when it is clinically appropriate. Treatment should be supervised by an ophthalmologist or appropriately qualified independent prescriber with experience in assessing and managing childhood myopia.
Low-dose atropine is generally well tolerated, but possible adverse effects include:
- increased sensitivity to bright light;
- glare;
- some difficulty focusing at near;
- irritation or an allergic reaction; and
- dilation of the pupils.
The potential benefits, limitations and side effects should be discussed with parents before treatment is started.
What other myopia-control options are available?
Atropine is only one possible part of myopia management.
Depending on a child’s age, prescription, rate of progression and ability to manage different treatments, options may include:
- specially designed myopia-control spectacle lenses;
- soft myopia-control contact lenses;
- orthokeratology contact lenses;
- low-dose atropine; or
- a combination of treatments in selected cases.
Children should also be encouraged to spend regular time outdoors and to take sensible breaks from prolonged close work. These measures cannot reverse established myopia, but may help reduce the risk of myopia developing or progressing.
What happens next?
The NICE recommendation remains open for consultation until 19 August 2026.
NICE can reconsider evidence, modelling, consultation responses and any revised commercial arrangements before issuing its final recommendation. The current expected publication date for final guidance is 2 December 2026.
I hope that the consultation process will lead to a solution that recognises both the long-term implications of progressive childhood myopia and the importance of fair access to treatment.
Until final guidance is published, parents should not stop or alter any existing myopia-control treatment without speaking to the clinician responsible for their child’s care.
This article provides general information and is not a substitute for an individual eye examination or personalised medical advice.
