Comparing the Efficacy of Low-Dose Atropine Eye Drops, Orthokeratology, and Combined Treatment for Myopia Progression Control

Abstract Myopia is a common eye condition affecting approximately one-third of the global population. Its prevalence is increasing at an alarming rate in children and adolescents, raising concerns about long-term consequences. Several interventions have been proposed to slow down myopia progression. This study aimed to compare the effectiveness of 0.01% atropine eye drops, orthokeratology, and combined atropine eye drops with orthokeratology in controlling myopia progression. This retrospective cohort study involved three international ophthalmic centers in China. Chinese and Caucasian children aged 8–18 years with cycloplegic spherical equivalent between − 1.00 to -6.00 diopters and astigmatism of ≤ 1.50 D in both eyes were included. Patients were divided into four groups: control group (only wear glasses), orthokeratology, 0.01% atropine eye drops, and combined orthokeratology with 0.01% atropine eye drops. Comprehensive ophthalmic examinations were performed at every visit, and the refractive error and axial length were measured at baseline, 6 months, and 12 months. A total of 736 eyes of 736 myopic children were included in the study, with 265 in the control group, 155 in the orthokeratology group, 181 in the atropine group, and 135 in the combined group. After 12 months of treatment, the combination of orthokeratology and atropine showed the greatest effect (mean − 0.25D) in slowing myopia progression followed by the atropine group (mean − 0.57D) and the orthokeratology group (mean − 0.42D), with a statistically significant difference compared to the control group (p < 0.001). The results of this study suggest that combined orthokeratology with 0.01% atropine eye drops is more effective in controlling myopia progression compared to orthokeratology or atropine eye drops alone. Therefore, this combined approach could be considered as a potential treatment option for myopia control in children and adolescents.