Delaying the Onset of Nearsightedness Until Treatment (DONUT) Clinical Trial

Inclusion Criteria:

* Refractive Error (cycloplegic autorefraction, spherical equivalent, at least one eye, inclusive) 6 years: -0.74 D to +0.75 D 7 and 8 years: -0.74 D to +0.50 D 9 and 10 years: -0.74 D to +0.25 D 11 years: -0.74 D to plano
* Neither eye has -0.75 D or more myopia, spherical component
* Anisometropia: Less than 1.50 D difference between OD and OS, cycloplegic autorefraction, spherical equivalent
* Astigmatism: Less than 1.50 DC in both eyes by cycloplegic autorefraction
* Successfully complete run-in period: take at least 90% of unit dose artificial tears for 2 to 4 weeks (# of unit-dose vials used divided by # nights since baseline visit must equal 0.90 or greater)

Exclusion Criteria:

* If Visit 2 (randomization visit) is not completed within 4 weeks of the baseline, eligibility visit.
* Presence of strabismus (intermittent or constant) based on unilateral cover test at distance and near
* Known allergy to atropine
* Systemic issues that may affect accommodation or convergence (e.g., multiple sclerosis, myasthenia gravis, Graves ophthalmopathy, diabetes mellitus, Parkinson's disease, Down syndrome, etc.)
* Ocular disease (e.g., congenital glaucoma, retinal disease, nystagmus, amblyopia, etc.)
* Ocular surgery (e.g., cataracts, strabismus)
* Any previous myopia prevention/control therapy (e.g., atropine, soft contact lenses, orthokeratology, myopia control spectacles, etc.) for more than one month
* Pregnancy by self-report