Atropine 0.01% and 0.125% similarly boost DIMS efficacy

Paper title: The effect of defocus incorporated multiple segment spectacles' lenses combined with different concentrations atropine for myopia control

Authors: Lee C-Y (1,2,3), Yang S-F (1,4), Chang Y-L (5), Huang J-Y (4), Lian I-B (6), Chang C-K (7,8)

1. Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
2. Nobel Eye Institute, No. 13-5, Gongyuan Rd., Zhongzheng Dist., Taipei, Taiwan
3. Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung, Taiwan
4. Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
5. Department of Medical Education, Cathay General Hospital, Taipei, Taiwan
6. Institute of Statistical and Information Science, National Changhua University of Education, Changhua, Taiwan
7. Nobel Eye Institute, No. 13-5, Gongyuan Rd., Zhongzheng Dist., Taipei, Taiwan
8. Department of Optometry, Da-Yeh University, Changhua, Taiwan

Date: Published online April 10, 2025

Reference: Lee CY, Yang SF, Chang YL, Huang JY, Lian IB, Chang CK. The effect of defocus incorporated multiple segment spectacles' lenses combined with different concentrations atropine for myopia control. Sci Rep. 2025 Apr 10;15(1):12356

[Link to open access paper]

Previous research has shown that combining DIMS lenses with low-concentration atropine can improve myopia control compared to DIMS alone, suggesting an additive treatment effect. However, few studies have evaluated the effect of combining these therapies at different atropine doses. This study aimed to determine whether low-dose (0.01%) or high-dose (0.125%) atropine offered additional benefit over DIMS lenses alone, and whether dose-dependent differences existed when used in combination.

Key points were as follows:

• Children aged 6–15 years were retrospectively assigned to three groups: DIMS only, DIMS + 0.01% atropine, and DIMS + 0.125% atropine, each followed for one year.
• Mean cycloplegic SER progression was −0.30 D in the DIMS-only group, −0.17 D in the DIMS + 0.01% group, and −0.16 D in the DIMS + 0.125% group.
• Axial elongation was 0.13 mm (DIMS), 0.06 mm (DIMS + 0.01%), and 0.06 mm (DIMS + 0.125%).
• Both atropine groups showed better myopia control than DIMS alone, but there was no additional benefit from the higher atropine dose.
• Younger age was associated with faster SER progression in all groups, and with greater axial elongation in the DIMS and low-dose atropine groups.

These findings align with prior studies suggesting additive effects when combining pharmacological and optical therapies, but this is the first to compare two concentrations of atropine in combination with myopia control spectacles.

Surprisingly, there was no difference in treatment effect between the low- and high-dose atropine groups. Low-dose atropine is often more readily accepted for myopia control in children, due to fewer side effects and minimal impact on accommodation. However, this study found that lower dose 0.01% atropine appears to provide the same additional benefit as the higher 0.125% concentration when used with DIMS lenses.

Additionally, younger children in this study experienced greater axial elongation and SER progression across all treatment groups. This was a correlation across the 6-15year old participants – a specific age which increased risk was not stated. This underlines the importance of early intervention and suggests that combination treatment may be especially beneficial in younger patients. Practitioners should continue to tailor myopia management plans based on both risk profile and patient age.

This study used a retrospective design which limits control over confounding factors such as prior treatment history, compliance, and follow-up consistency. The follow-up duration was limited to one year, which may not be sufficient to determine whether the similar outcomes between atropine concentrations persist over longer periods. Cycloplegic refraction was only measured at baseline and after 12 months, which limits data on how myopia progressed over the one-year treatment period.

Although no adverse effects were reported, pupil size, near vision and accommodation were not assessed in this study. These measures could provide valuable insight into the functional impact of different atropine concentrations and may help guide treatment choice based on tolerability. The participants were requested to instil atropine nightly and wear the spectacles for 8 hours daily. However, atropine and spectacle use was not objectively verified for compliance, which could influence treatment response.

Future research could explore whether differences between atropine concentrations, when combined with myopia control spectacles or other optical treatments, emerge over longer timeframes.

Purpose: We aim to evaluate the myopia control effect of defocus incorporated multiple segments’ (DIMS) spectacle lens in combination with different concentrations of atropine (ATR).

Methods: A retrospective cohort study was conducted and DIMS users were categorized according to ATR concentration: 55 DIMS alone, 55 DIMS-Low ATR (0.01%) and 50 DIMS-High ATR (0.125%) groups. All three myopia control methods were applied for one year. Primary outcomes measures were changes in spherical equivalent refraction (SER) and axial length (AXL). One-way ANOVA was utilized to compare the outcome differences among the three groups, and multiple linear regression was utilized to analyze the effects of age, sex, baseline SER and baseline AXL on myopia progression among the three groups.

Results: The cycloplegic SER progression was −0.30 ± 0.25 D, −0.17 ± 0.49 D and −0.16 ± 0.14 D in DIMS, DIMS-Low ATR and DIMS-High ATR groups respectively. The DIMS group showed a significant higher cycloplegia SER progression (P = 0.003). The AXL elongation was 0.13 ± 0.08 mm, 0.06 ± 0.20 mm and 0.06 ± 0.14 mm in DIMS, DIMS-Low ATR and DIMS-High ATR groups respectively and AXL elongation was significantly higher in DIMS group (P = 0.011). The young age demonstrated positive correlation to the higher cycloplegia SER progression in all groups (all P < 0.05). The young age is also correlated to higher AXL elongation in the DIMS and DIMS-Low ATR groups (both P < 0.05).

Conclusion: The myopia control effects of low- and high-concentration ATRs in DIMS users show no significant difference, while the addition of atropine in combination with DIMS spectacles had a greater effect on myopia control than DIMS spectacles alone.

[Link to open access paper]