From the Research
The most effective approach for controlling myopia progression in children and adolescents is the combination of orthokeratology and atropine, as it has been shown to have a synergistic effect in slowing axial elongation and myopic progression. Orthokeratology involves wearing specially designed rigid gas-permeable contact lenses overnight that temporarily reshape the cornea, providing clear vision during the day without glasses while simultaneously slowing myopia progression by creating peripheral myopic defocus on the retina 1. Atropine, an anticholinergic medication, is used in low concentrations (typically 0.01% to 0.05%) as eye drops applied once daily, usually at bedtime, and works by binding to muscarinic receptors in the eye, influencing biochemical pathways that regulate eye growth 2.
The choice between treatments depends on the child's age, myopia progression rate, lifestyle factors, and family preferences, with some practitioners recommending combination therapy for rapidly progressing myopia. According to a systematic review and network meta-analysis, the combination of 0.01% atropine with orthokeratology has been shown to be effective in slowing down myopia progression, with a synergistic effect that is comparable to high-dose atropine 2. Another study found that the axial elongation was lower in the combination group of atropine and orthokeratology than that of the orthokeratology group, indicating a superior effect of the combination therapy 3.
Key considerations for the treatment include:
- Starting treatment early, typically between ages 6-12, for maximum effectiveness
- Continuing treatment throughout the period of potential eye growth, often until late adolescence
- Regular follow-up appointments every 3-6 months to monitor effectiveness and adjust treatment as needed
- Patient compliance with recommended lens cleaning and disinfection for orthokeratology
- Potential side effects of atropine, such as pupil dilation, light sensitivity, and blurred near vision, particularly at higher concentrations.
Overall, the combination of orthokeratology and atropine is a safe and effective method for controlling myopia progression in children and adolescents, and should be considered as a first-line treatment option for rapidly progressing myopia 2, 1.