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Background/aims Although 0.01% atropine is widely used for myopia control, its efficacy is debated and its effectiveness across different ethnicities is unknown. We aim to evaluate its efficacy in different ethnic backgrounds.Methods The randomised clinical trials (RCTs) that compared 0.01% atropine against a placebo in myopic children from five databases through August 2025 were included. The primary outcomes included (1) the ratio of the means (RoM), defined as the RoM of annual changes in spherical equivalent refraction (SER) or ocular axial length (AL) in 0.01% atropine to the placebo groups, for accounting in the natural progression; and (2) the mean differences (MDs) in SER progression and AL elongation.Results A meta-analysis of 25 RCTs (4374 children aged 4–18) showed that 0.01% atropine reduced the SER progression by 37% annually (RoM: 0.63; 95% CI 0.54 to 0.74), with efficacy being much greater in South Asian populations (66% reduction; RoM: 0.34, 95% CI 0.27 to 0.42), than East Asian populations (35% reduction; RoM: 0.65, 95% CI 0.54 to 0.78) and white populations (28% reduction; RoM: 0.72, 95% CI 0.59 to 0.86) (p<0.0001). Regarding the MD, 0.01% atropine was effective in slowing an overall myopia progression of 0.21D per year (95% CI 0.15D to 0.27D) compared with placebo group. A similar pattern was observed in AL elongation.Conclusion 0.01% atropine effectively slows myopia progression across ethnicities, with the greatest efficacy observed in South Asian populations. Clinical practice should consider this ethnic difference to optimise the treatment effects.PROSPERO registration number CRD42025632545.