What is the relationship between pupil size and myopia management? As the pupil controls the light input to the retina, does pupil size influence myopia risk or the response to myopia treatments? This review covers atropine’s influence on pupil size, the relationship with treatment zone size in orthokeratology, combination treatments and advice on normal outcomes.
Atropine 0.01% combined with orthokeratology slows axial elongation to less than 0.1mm/year over two years in Chinese children aged 6-11 years. This is the equal-longest study on this topic and first to measure potential mechanisms of pupil size and choroidal thickness. The largest effect of the combination occurred in the first 6 months.
This meta-analysis of 5 studies of 1, 6 and 12 months duration found that slower axial growth is evident when using orthokeratology in conjunction with atropine as a combined therapy compared to orthokeratology alone. A slowing effect of 0.09mm was seen with the combined approach for up to a 12 month follow-up period. Longer data was not available for the meta-analysis.
Contact lens options are ideal for higher myopes. What about when they have moderate astigmatism as well? This case discusses the evidence base for myopia control options which correct for astigmatism, along with patient-specific considerations and whether a combination treatment with atropine is needed.
Myopia control is vital for children with fast myopia progression. What are the key risk factors for faster myopia progression? What clinical findings indicate a more proactive myopia management strategy may be required? This case describes risk factors and evidence-based treatment options for fast myopia progressors.
When atropine isn’t working as a monotherapy, is it valuable to combine it with a myopia controlling contact lens? Could switching from atropine to a contact lens be the better option? In this post on the Facebook discussion group, a colleague sought opinions on combining atropine and MiSight contact lenses.