Efficacy of myopia control by combination of orthokeratology and instillation of low-concentration atropine

Majority of reports regarding methods of myopia control are devoted to the use of orthokeratology lenses (OKL) or atropine. The purpose of the study was to estimate the efficacy and safety of using OKL in combination with instillation of 0.01% atropine drops for myopia control in children.

Material and methods. Prospective cohort study included 34 patients (68 eyes) aged 8 to 14 years old with acquired myopia. Groups with low (17 patients, 34 eyes), moderate (12 patients, 24 eyes) and high (5 patients, 10 eyes) myopia were identified and examined prior to and 6, 12 and 18 months after adding 0.01% atropine instillations to OKL wearing. To assess the degree of progression of myopia in dynamics the following parameters were evaluated: refraction (by Huvitz MRK 3100P, axial length (AL) by IOL-Master, “Carl Zeiss”, (Germany), amplitude of accommodation (AA) by Grand Seiko WRK-5100K, positive-relative accommodation (PRA), pseudoaccommodation (PA) and annual gradient of progression (AGP).

Results. The most noticeable effect was observed in patients with low myopia. In patients with low myopia, the rate of annual progression gradient decreased by 3.4 times by 18th month of atropine use; therefore a condition close to stabilization of myopia progression occurred. The data is statistically significant.

In patients with moderate myopia, despite the decrease of the AGP within 6-month period of atropine use by 3.7 times, the increase of APG was observed by 12th month of atropine use, which continued until 18th month of observation. In spite of this, in comparison with baseline indices, the decrease in the rate of myopia progression was obtained. The data is statistically significant.

In patients with high myopia, change in the AGP was not observed within the 6-month period of atropine use; afterwards, a gradual decrease in the rate of myopia progression was noted: AGP decreased by 1.2 times by 12th month. By 18th month of atropine use, AGP decreased by 1.5 times compared to its initial level. The data is statistically significant.

Evidently, the inhibitory effect of OKL, which is determined by optical factors such as peripheral myopic defocus, even in combination with atropine, is not sufficient to halt the progression of high myopia, because of structural and biomechanical changes of the sclera.

Conclusion. Based on the preliminary results obtained, 100% efficacy of a long-term instillation of low-concentration atropine cannot be claimed, how-ever, the positive effect does exist and therefore the study continues.

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