Adjunctive effect of orthokeratology and low dose atropine on axial elongation in fast-progressing myopic children-A preliminary retrospective study

Purpose: To investigate the adjunctive effect of orthokeratology (ortho-k) and low-dose atropine eye drops on axial length elongation in fast-progressing myopic children. Methods: Axial elongation in 60 eyes of 60 subjects who completed two years of ortho-k treatment was retrospectively reviewed. They were aged between 5.6-11.6 (mean, 8.3 +/- 1.5) years old when they started ortho-k treatment. During their first year of ortho-k treatment (Phase One), they all demonstrated a faster than 0.25 mm/yr axial elongation rate. They were then treated with nightly 0.01% atropine in addition to ortho-k treatment for another year (Phase Two). Annual axial elongation rates before and after atropine treatment were compared. Results: Baseline spherical equivalent refractive error was -2.65 +/- 1.08 DS and axial length was 24.34 +/- 0.92 mm for the study cohort. The mean axial elongation rate was 0.46 +/- 0.16 mm/yr during Phase One, being significantly faster in younger children (t = -4.920, P < 0.001). When atropine was added, annual axial elongation rate significantly decreased to 0.14 +/- 0.14 mm/yr (t=-11.988, P < 0.001), and those who were fast progressors in Phase One had a greater reduction in the rate of axial elongation during Phase Two (t=-8.052, P < 0.001). Conclusions: Axial elongation rate is faster in younger children undergoing ortho-k treatment. For fast myopia progressors, low dose atropine may significantly slow axial elongation in addition to ortho-k's treatment effect. Those who have faster axial elongation after ortho-k treatment will benefit more from the addition of low dose atropine, regardless of their refractive error and age.