Adjunctive effects of orthokeratology and atropine 0.01% eye drops on slowing the progression of myopia

Clin Exp Optom. 2022 Jul;105(5):520-526. doi: 10.1080/08164622.2021.1943318. Epub 2021 Jul 6.


Clinical relevance: All eye health care practitioners should know how to control myopia.

Background: Investigating the adjunctive effects of orthokeratology and 0.01% atropine eye drops on controlling the progression of myopia in Chinese children.

Methods: The prospective study included Chinese children aged 8 to 13 years having a spherical equivalent refractive error ranging from -2.00 to -5.00 D. Participants were categorised into two groups: combination group (orthokeratology and 0.01% atropine) or atropine group (0.01% atropine). The axial length and spherical equivalent refraction were measured at baseline and every three months post-treatment and compared over two years.

Results: The combinaion and atropine groups comprised 20 and 22 participants. Following two years of treatment, the average spherical equivalent refraction change was 0.88 ± 0.31 D and 1.14 ± 0.63 D in the combination group and atropine group, respectively (P = 0.026), with an average increment in axial length of 0.50 ± 0.17 mm and 0.61 ± 0.21 mm, respectively (P = 0.091). In the atropine group, increased axial length was positively correlated with baseline spherical equivalent refraction (P = 0.018) and negatively correlated with baseline age (P = 0.003). However, these correlations were not observed in the combination group. In the subgroup of subjects aged 8-10 years and another subgroup of subjects with shorter initial axial length (22.00 to 24.50 mm), the changes in axial length over two years were significantly smaller in the combination group than the atropine group.

Conclusion: Orthokeratology and 0.01% atropine eye drops combination therapy were found to be more effective in reducing progression of myopia, as measured through spherical equivalent refraction changes, than atropine monotherapy in children over two years. Combinatorial therapy was more effective in controlling the elongation of axial length in children with younger baseline age or shorter baseline axial length.

Keywords: Atropine; Axial length; myopia; orthokeratology.

MeSH terms

  • Adolescent
  • Atropine* / therapeutic use
  • Axial Length, Eye
  • Child
  • China
  • Humans
  • Myopia* / drug therapy
  • Ophthalmic Solutions / therapeutic use
  • Orthokeratologic Procedures*
  • Prospective Studies
  • Refraction, Ocular


  • Ophthalmic Solutions
  • Atropine