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Aim To evaluate the effectiveness of atropine 0.01% in young premyopic and low-myopic children.Methods Children (5–9 years old) with premyopia (spherical equivalent refraction, SER+1.00 to −0.49D, n 156) or low myopia (SER −0.50 to −1.50D, n 52), with at least 1 parent with myopia <−3.00D, were randomised to receive placebo or atropine 0.01% eye-drops in a 1:1 ratio. Cycloplegic autorefraction and axial length were measured every 6 months over 2 years.Results Mean baseline SER was +0.5+/−0.04D in premyopia and −1.00±0.06D in the low-myopia eyes. Progression over 2 years in premyopic eyes was −0.96±0.10D vs −0.82±0.10D (p=0.328), or 0.72±0.03 mm vs 0.63±0.04 mm (p=0.161) in the placebo and atropine groups, respectively. Progression in eyes remaining emmetropic was −0.43±0.37D vs −0.29±0.37D (p=0.007) or 0.49±0.22 mm vs 0.41±0.38 mm (p=0.209) in the placebo versus atropine-treated eyes, respectively; while eyes which became myopic progressed by −1.78±0.82D vs −1.63±0.82D (p=0.121) or 1.08±0.34 mm vs 0.96±0.14 mm (p=0.010). Incident myopia at 2 years was 42.6% in placebo and 44.8% in atropine 0.01% treated eyes (p=0.896). In the low-myopia group, placebo versus atropine treated eyes progressed by −1.65±0.15D vs −1.23±0.15D (p=0.066) or 0.86±0.07 mm vs 0.68±0.05 mm (p=0.062) at 2 years. There was no difference in near acuity, glare (2.7%) or allergy (6.0%) between treatment groups.Conclusions Although there were no significant differences in myopia progression between atropine and placebo treated eyes, there were trends towards less myopic shift in atropine-treated eyes in premyopic eyes which remained emmetropic and in eyes with low myopia.