A combination of low-dose atropine and orthokeratology (OK) treatment may slow myopia progression more effectively than OK treatment alone, according to a meta-analysis published in Ophthalmic and Physiological Optics. Increased pupil diameter was noted, with no significant ocular surface or refractive parameter changes observed in individuals receiving both treatments.
Two independent reviewers performed a systematic database search of randomized controlled trials, nonrandomized controlled trials, and retrospective cohort studies (REs) comparing OK treatment with combined low-dose atropine and OK therapies. Overall, 15 studies including 969 children (combined treatment: n=479; OK treatment: n=490) were included in the meta-analysis.
Compared with OK treatment alone, the report states that the combination of low-concentration atropine with OK lenses significantly slowed axial growth (weighted mean difference [WMD]= −0.12 mm; 95% CI, −0.13 to −0.11; P < .001) and reduced the spherical equivalent refraction rate of change (WMD=0.15 diopters [D]; 95% CI, 0.06-0.24; P <.001).
A slight increase in pupil diameter occurred among patients receiving combined treatment (WMD=0.62mm; 95% CI, 0.42-0.81; P <.001). No significant differences were reported in the amplitude of accommodation, intraocular pressure, tear film break-up time or corneal endothelial cell density between the OK and combined therapy groups.
Researchers highlight the benefit of using both forms of treatment to combat myopia progression stating, “a combination therapy of low-concentration atropine and orthokeratology lenses has a greater effect in slowing myopia progression during a 6-to-12-month treatment duration and is still effective during 24-month treatment duration.”
Study limitations include a small number of investigations, differences in design among the studies, potential geographical bias, and the use of self-prepared, as opposed to commercially-available, low-dose atropine in a majority of the studies.
Zheng NN, Tan KW. The synergistic efficacy and safety of combined low-concentration atropine and orthokeratology for slowing the progression of myopia: a meta-analysis. Ophthalmic Physiol Opt. Published online August 2, 2022. doi:10.1111/opo.13029