Combination of Atropine and Ortho-k wins an edge over monotherapy for myopia in young kids

The combination of Atropine with Ortho-k was found to be beneficial in controlling myopia in young kids aged 8-12 years as per a recent study that was published in the British Journal of Ophthalmology.  

Myopia is caused due to various factors like genetics, environment, etc. Multiple drugs aid in the management like atropine. Researchers have conducted an age-stratified randomized controlled trial to investigate the 2-year efficacy of the combination of atropine and orthokeratology vs monotherapy and explore the factors influencing their efficacy. 

164 children aged 8–12 years with spherical equivalent refraction of −1.00 to −6.00 D were stratified into two age subgroups and randomly assigned to receive placebo drops+spectacles (control), 0.01% atropine+spectacles (atropine), ortho-k+placebo (ortho-k) or combined treatment. Axial length was measured at baseline and visits at 6, 12, 18, and 24 months. The primary analysis was done following the criteria of intention to treat, which included all randomized subjects. 

Results:

• Axial elongations were significantly reduced by all interventions at all visits (all p<0.05).
• Combined treatment significantly reduced the 2-year axial elongation than monotherapies (all p<0.05).
• After age stratification, there was no difference between combined treatment and ortho-k in the subgroup aged 8 to 10 (p=0.106), and there was no difference between combined treatment and atropine in the subgroup aged 10 to 12 (p=0.121). 
• The ortho-k group had a significant age-dependent effect on the control group (p for interaction=0.013), and also on the atropine group (p for interaction=0.035), indicating that ortho-k can be more effective in younger children. 

Thus, the study shows that ortho-k treatment benefitted young children and combination therapy with atropine and ortho-k improved the efficacy of myopia in children aged 8-12 when compared to monotherapy. 

Further reading: http://dx.doi.org/10.1136/bjo-2022-321272 

Xu S, Li Z, Zhao W, et alEffect of atropine, orthokeratology and combined treatments for myopia control: a 2-year stratified randomized clinical trial British Journal of Ophthalmology Published Online First: 13 October 2022.