Higher superior to low atropine dose, orthokeratology for paediatric myopia

Treatment with 0.04% atropine appears to improve myopia control in children and teens compared with 0.01% atropine or orthokeratology, despite a higher incidence of photophobia, according to a study.

The study included 209 children aged 8 to 15 years (mean age 10.5 years, 49.8 percent female) with refractive errors between −1.0 and −4.0 dioptre. They were randomly assigned to receive atropine 0.01% (n=69) or 0.04% (n=68), administered daily, or overnight orthokeratology (n=72). Treatment lasted 2 years.

The 2-year axial length (AL) growth was the primary outcome.

In total, 69.6 percent of the 0.01% atropine group, 70.6 percent of the 0.04% atropine group, and 73.6 percent of the orthokeratology group completed the 2-year follow-up.

The 2-year AL growth was significantly reduced in children receiving 0.04% atropine than in those receiving 0.01% atropine (difference, 0.18 mm, 95 percent confidence interval [CI], 0.11–0.26; p<0.001). A nonsignificant but clinically meaningful difference was observed between the 0.01% atropine group and the orthokeratology group, in favour of the former (difference, 0.08 mm, 95 percent CI, 0.003–0.15; p=0.04).

In regression analyses, older age predicted less AL growth across all treatment groups. On the other hand, a more myopic spherical equivalent at baseline was associated with slower axial elongation for the orthokeratology group.

As for safety, photophobia occurred more frequently in the 0.04% atropine group than in the 0.01% atropine group (22.9 percent vs 2.1 percent; difference, 20.8 percent, 95 percent CI, 8.3–33.4; p=0.002). In the orthokeratology group, 26.4 percent of the participants had a slight corneal fluorescein staining.