Can using atropine enhance myopia control with ortho-k?

Paper title: The Efficacy of Atropine Combined With Orthokeratology in Slowing Axial Elongation of Myopia Children: A Meta-Analysis

Authors: Canran Gao, Shuling Wan, Yuting Zhang, Jing Han

Date: 2021

Reference: Gao C, Wan S, Zhang Y, Han J. The Efficacy of Atropine Combined With Orthokeratology in Slowing Axial Elongation of Myopia Children: A Meta-Analysis. Eye Contact Lens. 2021 Feb 1;47(2):98-103. [link]

This meta-analysis of 5 studies involving 341 children analysed the effect of combining atropine with orthokeratology on axial length growth, compared to orthokeratology alone. The five studies were one month to two years in duration. The mean difference in axial elongation was found to be 0.09mm over one year in children using atropine plus orthokeratology, compared to those using orthokeratology alone.

The greatest effect was noted in the first six months of combined treatment and a variety of atropine concentrations were used: 0.01%, 0.025% and even 0.125%. Interestingly, the 0.125% dataset showed the least efficacy, although the meta-analysis was unable to isolate which concentration could be most effective, and did not provide any data on impact of age or baseline refraction on the combined efficacy. This indicates that more research is needed to establish an optimum treatment concentration and time period when using atropine in a combination therapy.

All the children who participated in the studies were wearing orthokeratology lenses and it could be assumed the extra treatment effect seen with the combination was due to the addition of atropine. This provides compelling data for eyecare practitioners who are able to consider using atropine as a combined approach and provide further axial length reduction for their patients.

The extra benefit of using atropine was seen within 6 months, suggesting that this follow-up period could be an optimum time frame to assess the impact of combination treatment on axial length.

The mechanism by which atropine has provided this increased effect is unknown at present, as are the ideal candidate and optimum concentration of atropine to utilize in combination with orthokeratology. Further analysis of the timescale of combination benefit is also required - short-term or long-term - to best support development of treatment plans.

The two newest, prospective clinical trials on combining orthokeratology with atropine are utilizing 0.01% - these were not published at the time of this meta-analysis. Read more in our article Combination atropine treatments: when more is more.

Title: The Efficacy of Atropine Combined With Orthokeratology in Slowing Axial Elongation of Myopia Children: A Meta-Analysis

Authors: Canran Gao, Shuling Wan, Yuting Zhang, Jing Han

Purpose: Previous studies have found that atropine can slow axial elongation and control the progression of myopia. Some ongoing trials have applied atropine combined with orthokeratology for myopia control, but few studies explored the effect of the strategy on axial elongation. This meta-analysis made a preliminary evaluation of the effect of atropine combined with orthokeratology on axial elongation to provide a reference for further researches.

Methods: We performed a specific search on PubMed, EMBASE, Cochrane library, Web of Science, Ovid and Chinese electronic databases of VIP and Wanfang for randomized controlled trials, cohort studies and case-control studies conducted up to December 2019. The weighted mean difference (WMD) of mean change in axial elongation between the combination group of atropine and orthokeratology and the orthokeratology group was used for evaluation. Publication bias was detected using the Funnel plots test.

Results: A total of five studies involving 341 participants younger than 18 years old met our inclusion criteria. The axial elongation was lower in the combination group of atropine and orthokeratology than that of the orthokeratology group (0.25 vs. 0.35; WMD=−0.09 mm, [95% confidence intervals, −0.15 to −0.04], Z=3.39,=0.0007).

Conclusions: This meta-analysis demonstrates atropine combined with orthokeratology is effective in slowing axial elongation in myopia children. This effect may be superior to that of the orthokeratology alone.