AIM: To investigate the efficacy and safety of orthokeratology combined with 0.01% atropine in controlling low to moderate myopia in adolescents.

METHODS: A prospective non-randomized controlled study was conducted among 120 eyes of 120 adolescents with low to moderate myopia. 60 eyes in the control group were treated with orthokeratology, and 60 eyes in the combined group were treated with orthokeratology combined with 0.01% atropine. The best corrected distant visual acuity(BCDVA), best corrected near visual acuity(BCNVA), refraction, axial length, accommodative amplitude, photopic pupil diameter, mesopic pupil diameter, lipid layer thickness(LLT), tear film break up time(BUT)and complications were determined before treatment and at 1a after treatment.

RESULTS: There were no significant differences in BCDVA and BCNVA within and between the two groups before and after treatment(P>0.05). After treatment, the spherical equivalents of both groups progressed significantly(P<0.01), and the average changes of spherical equivalent refractive error in the combined group and the control group were 0.21(0.03, 0.53)D and 0.40(0.15, 0.74)D respectively(P<0.01). The axial lengths of both groups were increased significantly(P<0.01), and the axial length elongations of the combined group and the control group were(0.13±0.19)mm and(0.22±0.21)mm respectively(P<0.01). There were no significant differences in the accommodative amplitude, photopic and mesopic pupil diameters of the control group before and after treatment(P>0.05). After treatment, the accommodative amplitude of the combined group decreased significantly, while the photopic and mesopic pupil diameters significantly increased, respectively(P<0.01). The accommodative amplitude of the combined group was smaller than that of the control group, while the photopic and mesopic pupil diameters were larger than those of the control group at 1a after treatment(P<0.01). The LLT and BUT in both groups were significantly reduced from baseline(P<0.01), but both showed no significant differences between the two groups at baseline and at 1a after treatment(P>0.05). During the treatment period, there was no difference in the incidence of total adverse reactions between the combined group and the control group(26.7% vs 15.0%, P>0.05).

CONCLUSION: Combined treatment with 0.01% atropine and orthokeratology would be a safe and more effective choice of treatment to control the development of myopia in adolescents.