Science Snippets: Combination Treatments

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Can using atropine enhance the effect of orthokeratology? 

This meta-analysis of 5 studies involving 341 children analysed the effect of combining atropine with orthokeratology on axial length growth, compared to orthokeratology alone. The five studies were one month to two years in duration. The mean difference in axial elongation was found to be 0.09mm over one year in children using atropine plus orthokeratology, compared to those using orthokeratology alone. The greatest effect was noted in the first six months of combined treatment and a variety of atropine concentrations were used: 0.01%, 0.025% and even 0.125%. Interestingly, the 0.125% dataset showed the least efficacy, although the meta-analysis was unable to isolate which concentration could be most effective, and did not provide any data on impact of age or baseline refraction on the combined efficacy. This indicates that more research is needed to establish an optimum treatment concentration and time period when using atropine in a combination therapy.

Gao C, Wan S, Zhang Y, Han J. The Efficacy of Atropine Combined With Orthokeratology in Slowing Axial Elongation of Myopia Children: A Meta-Analysis. Eye Contact Lens. 2021 Feb 1;47(2):98-103. [Link]

Efficacy of combination therapy with orthokeratology and low dose atropine for myopia control

This study investigated the treatment effect gained from combination myopia therapy with orthokeratology (OK) and 0.01% atropine, in comparison to monotherapy with orthokeratology alone. 80 Japanese children aged 8-12 years were followed during a 2 year period. The combination of OK and 0.01% atropine was more effective than OK monotherapy in slowing axial elongation (axial length increase in combination group 0.29±0.20mm vs monotherapy group 0.40±0.23mm, or 28% increased efficacy). Importantly, the treatment effect was greatest in the first twelve months, with no significant difference between groups from 12-24 months. Also, the increased myopia control efficacy was found to be significant in children with low levels of baseline myopia of 1-3D, but not in children with 3-6D of myopia. There was no relationship found between age and efficacy. Additional long-term research is required to examine the best targets for combination treatment - this study appears to point to best efficacy in 1-3D myopes in the first 12 months of treatment.  

Kinoshita N, Konno Y, Hamada N. et al. Efficacy of combined orthokeratology and 0.01% atropine solution for slowing axial elongation in children with myopia: a 2-year randomised trial. Sci Rep. 2020;10:12750. [Link]

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About Kate

Dr Kate Gifford is a clinical optometrist, researcher, peer educator and professional leader from Brisbane, Australia, and a co-founder of Myopia Profile.

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About Ailsa

Ailsa Lane is a contact lens optician based in Kent, England. She is currently completing her Advanced Diploma In Contact Lens Practice with Honours, which has ignited her interest and skills in understanding scientific research and finding its translations to clinical practice.

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About Clare

Clare Maher is a clinical optometrist in Sydney, Australia, and a second year Doctor of Medicine student, with a keen interest in research analysis and scientific writing.