Which Works Best: 0.02% Atropine Or Orthokeratology?

Paper title: Comparison of Administration of 0.02% Atropine and Orthokeratology for Myopia Control

Authors: Yong Lyu,¹ Na Ji, Ai-Cun Fu,¹ Wei-Qun Wang,¹ Li Wei, Jian Qin,¹ Bing-Xin Zhao¹

1. Ophthalmology, The First Affiliated Hospital of Zhengzhou University (Y.L., A.-C.F., W.-Q.W., L.W., B.-X.Z.), Zhengzhou, China; Ophthalmology, The Affiliated Eye Hospital of Suzhou Vocational Health College (N.J.), Suzhou, China; and Ophthalmology, Provincial People's Hospital (J.Q.), Henan Eye Hospital, Zhengzhou, China.

Date: Feb 2021

Reference: Lyu Y, Ji N, Fu AC, et al. Comparison of Administration of 0.02% Atropine and Orthokeratology for Myopia Control. Eye Contact Lens. 2021 Feb 1;47(2):81-85

[Link to abstract]

This paper compared the efficacy of 0.02% atropine eye drops and orthokeratology (OK) in controlling axial length (AL) elongation in a group of 203 Chinese children aged 7-14. The 0.02% atropine drops were diluted from 1% and these children wore single vision spectacles, whilst the orthokeratology group was historical. Following 2 years of treatment, the atropine group demonstrated significantly faster axial length elongation (0.58±0.35mm) compared to the OK group (0.36±0.30mm).

 In both groups, younger age and shorter baseline axial length were associated with faster axial length elongation, as expected. Whilst the ages of the two groups matched, the OK group had a longer baseline AL, so this could account to some degree for the slower overall progression observed. Every 1mm shorter baseline axial length resulted in 0.11mm faster AL elongation in the OK group and 0.17mm in the 0.02% atropine group over two years. With overlapping 95% confidence intervals, the overall effect between the two groups could be similar; although when AL was controlled for, a stronger myopia control effect was found in higher myopes wearing OK, but not in the 0.02% atropine group.

 Clinically, this study indicates that OK may be more effective in controlling AL elongation in comparison to 0.02% atropine, particularly in children with higher baseline myopia, but further research is required as the two groups weren’t completely matched.

Clinically, this research advocates for the use of orthokeratology in preference to 0.02% atropine for myopia control, especially in children with higher baseline myopia.

As the two groups in this study weren’t completely matched, further randomised controlled trials are required to investigate this further.

Title: Comparison of Administration of 0.02% Atropine and Orthokeratology for Myopia Control

Authors: Yong Lyu, Na Ji, Ai-Cun Fu, Wei-Qun Wang, Li Wei, Jian Qin, Bing-Xin Zhao

Methods: In this historical control study, 247 children with myopia whose administration of 0.02% atropine (n=142) or underwent orthokeratology from an earlier study (n=105, control group) were enrolled. Data on AL and other baseline parameters were recorded at baseline and after 1 and 2 years of treatment.

Results: The mean changes in AL in the first and second years of treatment were 0.30±0.21 and 0.28±0.20 mm, respectively, in the 0.02% atropine group and 0.16±0.20 and 0.20±0.16 mm, respectively, in the orthokeratology group. Axial length elongations after 2 years of treatment were 0.58±0.35 and 0.36±0.30 mm (P=0.007) in the 0.02% atropine and orthokeratology groups, respectively. Multivariate regression analyses showed that the AL elongation was significantly faster in the 0.02% atropine group than in the orthokeratology group (β=0.18, P=0.009). In multivariate regression analyses, younger age and shorter baseline AL were associated with a rapid AL elongation in the 0.02% atropine group (βage=-0.04, P=0.01; βAL=-0.17, P=0.03), while younger age, lower baseline spherical equivalent refractive error (SER), and shorter baseline AL were associated with a greater increase in AL in the orthokeratology group (βage=-0.03, P=0.04; βSER=0.06, P=0.03; βAL=-0.11, P=0.009). Faster AL elongation was found in the 0.02% atropine group compared with the orthokeratology group at higher baseline SER (P=0.04, interaction test).

Conclusions: Within the limits of this study design, orthokeratology seems to be a better method for controlling AL elongation compared with administration of 0.02% atropine in children with higher myopia over a treatment period of 2 years.

[Link to abstract]