Progressive Additional Lenses Can Assist Atropine Treatments in Children

Progressive addition lens wear can supplement atropine myopia control therapy in patients with low contact lens tolerance.

Progressive addition lenses (PALs) can supplement atropine myopia control treatments in children, according to research published in Ophthalmic and Physiological Optics. This option can provide an alternative for patients resistant to contact lens wear seeking a medical option to improve visual acuity and horizontal fusional reserve.

Researchers recruited 40 children (23 boys; mean age, 10.00 years) with myopia who were treated with atropine drops of various concentrations (0.05%, n=2; 0.125%, n=25; 0.25%, n=1; 0.3%, n=11; 0.5%, n=1) for myopia control. The patients attended a total of 6 visits in1-year and underwent assessments of accommodative lag, heterophoria, near point of convergence, and stereopsis. All study participants completed a questionnaire detailing visual complaints and underwent treatment with progressive lenses. Clinicians determined the participants’ distance visual acuity through a subjective refraction and near visual acuity estimated with the monocular estimate method retinoscopy obtained at the Harmon distance.

The researchers note significant improvements in patients’ distance visual acuity in high-contrast conditions while they wore the PALs compared with not wearing any correction (0.06 vs 0.41 logarithm of the minimum angle of resolution [logMAR]; P <.0001). The study also shows improvements in patients near visual acuities in both high and low contrast conditions, with the PAL correction (0.08 and 0.23 logMAR, respectively) compared with not wearing the correction (0.23 and 0.29, respectively; P ≤.001 for both conditions). 

Wearing PALs also resulted in a significantly longer mean near point of convergence break (12.68 vs 10.98 cm) and recovery (17.97 vs 16.13 cm; P =.05) and a difference in near heterophoria (-1.20 vs -3.90; P <.0001) compared with not wearing the correction. The participants’ daily visual complaint entries revealed fewer complaints and higher satisfaction with the PALs. 

Improvements in daily visual quality will reduce visual complaints and may decrease the dropout rate of atropine therapy.

“[S]ometimes the parents choose not to have their children wear glasses, especially at the beginning of myopia progression, and prefer to use topical atropine instead. Therefore, it was recommended to use PAL for children undergoing atropine treatment to minimize distance blur and thus avoid a rapid increase in myopic refractive errors,” the researchers note. “Improvements in daily visual quality will reduce visual complaints and may decrease the dropout rate of atropine therapy.”

Study limitations include reliance on self-reporting to determine PAL compliance.


Sun H-Y, Tsai J-D, Nien Y-S, Peng C-C, Ke C-H, Kuo H-Y. The use of progressive addition lenses to improve the daily visual function of children receiving topical atropine treatment. Ophthalmic Physiol Opt. Published online December 1, 2022. doi:10.1111/opo.13077