Atropine, Ortho-K Combo Enhances Myopia Control Outcomes

In subjects undergoing a combined ortho-K and atropine regimen, values for conjunctival hyperemia trended towards a significant increase, which aligned with the mild iritis response of ortho-K users (particularly those receiving dual therapy). Photo: Robert Ensley, OD; Getty Images. Click image to enlarge. As with any medical intervention, myopia control efforts come with a set of risks. While they’re widely considered quite safe, researchers behind one recent study wanted to evaluate safety and efficacy when dealing with combined orthokeratology (ortho-K) lens and atropine drop use.The prospective randomized study included 100 pediatric patients aged eight to 18; kids were then assigned to a combination therapy group, which received ortho-K and 0.01% atropine treatment, or a monotherapy group, which received ortho-K treatment only. Participants were followed for 12 months, with check-ups at one, three six and 12 months.The researchers found, as one might expect, that the combo group experienced superior myopia control with significant reduction in axial elongation as well as better improvement in best-corrected visual acuity. These subjects did, however, also experience decreased tear film stability, as evidenced by greater reduction in tear break-up time, while also having more pronounced corneal epithelial thinning. No significant difference was seen between the groups for Schirmer’s test, endothelial cell density or intraocular pressure. Interestingly, the combination therapy subjects also had slightly better adherence to treatment than the monotherapy group (93% vs. 91%); both groups reported high satisfaction.In the discussion section of their paper, the authors explain that “the synergistic effect likely arises from the complementary mechanisms of both treatments; ortho-K lenses reshape the cornea to alter peripheral defocus and reduce myopic progression, while atropine eye drops modulate biochemical pathways involved in axial elongation via muscarinic receptor inhibition.” When combining both mechanisms, this may work better than one alone to effectively stunt eye growth.The authors are not ignorant of the negative effects seen, though, acknowledging that the dual therapy also suggested exacerbated tear film instability and corneal structural alterations. Along with the atropine, while the drops are generally safe, they do note that “its anticholinergic properties may subtly influence lacrimal secretion or meibomian gland function, potentially contributing to ocular surface changes when it is used in conjunction with overnight lens wear.” What’s more, ortho-K’s mechanical impact on the corneal epithelium may compound with effects from atropine on epithelial homeostasis, leading to the epithelial thinning that was seen.The investigators further stress that these findings demonstrate a clinical trade-off for potential myopia control patients which requires careful consideration. They argue that enhanced myopia management will be beneficial for patients, but that this should not come at the cost of compromising long-term ocular surface health in a pediatric population with still developing ocular physiology. When applying these results to real-world scenarios, the researchers suggest that “the slight but measurable decline in the tear break-up time and epithelial integrity highlights the need for routine ocular surface monitoring and early intervention strategies—such as lubricating eye drops or tailored lens fitting protocols—for children undergoing dual treatment.” Click here for the journal source. Li F, Mai X, Li Q, Mai X. Longitudinal safety and efficacy of dual treatment with orthokeratology lenses and 0.01% atropine eye drops: a focus on epithelial changes and tear film stability. BMC Ophthalmol. 2025;25:320.