Comparative efficacy of optical correction methods combined with 0.01% atropine in myopia control

Abstract

Purpose: To evaluate axial length changes in myopic children treated with different optical correction methods combined with 0.01% atropine eye drops. Methods: This retrospective study included 366 myopic children (366 eyes) from the Eye Hospital of Wenzhou Medical University (January 2021-December 2024). Participants were stratified into six groups: orthokeratology (OK, n = 52), OK + atropine (OKA, n = 50), highly aspherical lenslets (HAL, n = 83), HAL + atropine (HALA, n = 69), single-vision spectacles (SP, n = 65), and SP + atropine (SPA, n = 47). Axial length (AL) elongation after one year was compared using one-way analysis of variance. Results: After one year, AL elongation differed significantly across groups (F = 25.345, P < 0.001). The OK (0.25 ± 0.13 mm), OKA (0.18 ± 0.14 mm), HAL (0.16 ± 0.16 mm), HALA (0.08 ± 0.19 mm), and SPA (0.23 ± 0.18 mm) groups all showed significantly less AL elongation than the SP group (0.39 ± 0.20 mm; all P < 0.001). The HALA group demonstrated the strongest effect (P < 0.01 vs. others), and both OKA and HALA outperformed OK (P = 0.036) and HAL (P = 0.004). Adjunctive 0.01% atropine therapy significantly attenuated AL elongation in older children with myopia, with the most pronounced reduction observed in the OKA group (0.03 ± 0.14 mm). Among subjects with higher baseline refractive error, both OKA (0.12 ± 0.13 mm) and SPA (0.16 ± 0.19 mm) groups demonstrated significantly slower AL progression, whereas the HALA (0.12 ± 0.21 mm) cohort exhibited comparatively less effective control of AL growth. Conclusion: The combination therapy of OK, HAL, or SP with 0.01% atropine significantly slowed myopia progression. Subgroup analysis revealed a differential efficacy: OKA and SPA demonstrated superior control in older children with higher myopia, whereas HALA was more effective in older children with low myopia.