Science
Combination Treatment With Orthokeratology And Atropine
In this article:
This study investigated the efficacy of combination therapy with orthokeratology and 0.01% atropine in a group of school aged children. During the 2 year follow-up period, the combination was more effective in slowing axial elongation than orthokeratology alone, especially in the first year and in those with low initial myopia.
Paper title: Efficacy of combined orthokeratology and 0.01% atropine solution for slowing axial elongation in children with myopia: a 2-year randomised control trial
Authors: Kinoshita, Nozomi (1), Konno, Yasuhiro (2), Hamada, Naoki (3), Kanda, Yoshinobu (4), Shimmura-Tomita, Machiko (5), Kaburaki, Toshikatsu (5), Kakehashi, Akihiro (5)
- Department of Ophthalmology, Saitama Medical Centre, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan.
- Konno Eye Clinic, Saitama, Japan.
- Omiya Hamada Eye Clinic, Saitama, Japan.
- Department of Hematology, Saitama Medical Centre, Jichi Medical University, Saitama, Japan.
- Department of Ophthalmology, Saitama Medical Centre, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan
Date: July 2020
Reference: Kinoshita N, Konno Y, Hamada N, Kanda Y, Shimmura-Tomita M, Kaburaki T, Kakehashi A. Efficacy of combined orthokeratology and 0.01% atropine solution for slowing axial elongation in children with myopia: a 2-year randomised trial. Sci Rep. 2020 Jul 29;10(1):12750
Summary
This study investigated the treatment effect gained from combination myopia therapy with orthokeratology (OK) and 0.01% atropine, in comparison to monotherapy with OK alone. 80 Japanese children aged 8-12 years were followed during a 2 year period. The combination of OK and 0.01% atropine was more effective than OK monotherapy in slowing axial elongation (axial length increase in combination group 0.29±0.20mm vs monotherapy group 0.40±0.23mm). This corresponds to a 28% increased efficacy. Importantly, the treatment effect was greatest in the first twelve months, with no significant difference between groups from 12-24 months.
Additionally, the increased myopia control efficacy was found to be significant in children with low levels of baseline myopia of 1-3D, but not in children with 3-6D of myopia. There was no relationship found between age and efficacy.
This study appears to point to best efficacy of combination treatment with orthokeratology and 0.01% atropine in 1-3D myopes in the first 12 months of treatment. The evidence for the use of combination therapy in moderate initial myopia is lacking at this time. Additional long-term research is required to examine the best targets for combination treatment and if these findings are replicated in large size randomised control trials.
What does this mean for my practice?
Clinically, this indicates that combination therapy with orthokeratology and 0.01% atropine could be an option in low myopes (-1 to -3D); however, the treatment effect decreases after the first year.
What do we still need to learn?
Long term studies are required to investigate this further and to determine the targets for combination treatment
Abstract
Title: Efficacy of combined orthokeratology and 0.01% atropine solution for slowing axial elongation in children with myopia: a 2-year randomised trial
Authors: Nozomi Kinoshita, Yasuhiro Konno, Naoki Hamada, Yoshinubo Kanda, Machiko Shimmura-Tomita, Toshikatsu Kaburaki, Akihiro Kakehash
Methods: Eighty Japanese children, aged 8-12 years, with a spherical equivalent refraction (SER) of - 1.00 to - 6.00 dioptres (D) were randomly allocated into two groups to receive either a combination of orthokeratology (OK) and 0.01% atropine solution (combination group) or monotherapy with OK (monotherapy group). Seventy-three subjects completed the 2-year study. Over the 2 years, axial length increased by 0.29 ± 0.20 mm (n = 38) and 0.40 ± 0.23 mm (n = 35) in the combination and monotherapy groups, respectively (P = 0.03).
Results: Interactions between combination treatment and age or SER did not reach significance level (age, P = 0.18; SER, P = 0.06). In the subgroup of subjects with an initial SER of - 1.00 to - 3.00 D, axial length increased by 0.30 ± 0.22 mm (n = 27) and 0.48 ± 0.22 mm (n = 23) in the combination and monotherapy groups, respectively (P = 0.005). In the - 3.01 to - 6.00 D subgroup, axial length increased by 0.27 ± 0.15 mm (n = 11) and 0.25 ± 0.17 mm (n = 12) in the combination and monotherapy groups, respectively (P = 0.74).
Conclusions: The combination therapy may be effective for slowing axial elongation, especially in children with low initial myopia.
Meet the Authors:
About Ailsa Lane
Ailsa Lane is a contact lens optician based in Kent, England. She is currently completing her Advanced Diploma In Contact Lens Practice with Honours, which has ignited her interest and skills in understanding scientific research and finding its translations to clinical practice.
Read Ailsa's work in the SCIENCE domain of MyopiaProfile.com.
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