The combination of dual-focus soft CLs (namely, MiSight) and atropine 0.05% was more effective in slowing myopic progression and axial elongation than atropine monotherapy, even among those with a poor response to the atropine.  Photo: Coopervision. Click image to enlarge.

There are now many treatments aimed at slowing myopia progression, but not all patients respond and some may experience low efficacy to an initial approach. Combination therapy can mitigate subpar results but studies of its efficacy have yielded mixed results. In a recent study, Korean researchers evaluated the combined effect of dual-focus soft contact lenses (CLs) and 0.05% atropine in the control of myopia and found that this combination is an effective treatment strategy in children with rapidly progressing myopia. The team’s paper on the work was recently published in Eye & Contact Lens.

A total of 142 myopic children between the ages of seven and 13 were included. Atropine was administered at bedtime and prescribed if the rate of myopia progression exceeded -1.00D. After one year of treatment, patients who exhibited myopia progression of more than 0.75D or an increase in axial length of more than 0.25mm were additionally treated with dual-focus soft CLs (MiSight) alongside atropine (combination group, n=71). By contrast, patients who showed myopia progression of less than 0.50D and axial elongation of less than 0.20mm continued treatment with atropine only (monotherapy group, n=71). Those in the combination group were further divided into high myopia and low/moderate myopia subgroups, using a cutoff of 26D.

The addition of MiSight to an atropine regimen significantly reduced the rate of myopic progression and axial growth in children who exhibited a low therapeutic response to the eye drops alone. This contrasts with the increased rates of myopic progression and axial elongation observed in children of the same age who were treated with atropine eye drops alone over the same period. The effect was particularly significant in non–high myopia compared with high myopia, the authors noted.

Overall, myopic progression and axial elongation were significantly suppressed by 0.38D and 0.19mm over one year in the combination treatment group compared with the atropine monotherapy group. “The one-year outcomes of previous studies are consistent with our findings, demonstrating that axial elongation was significantly reduced by 0.09mm in subjects receiving combination therapy with ortho-K lenses and atropine eye drops, compared with those using ortho-K lenses alone,” the authors wrote in their paper.

When the combination treatment group was divided into high myopia and low/moderate myopia subgroups, the rate of myopic progression and axial elongation was significantly reduced in the low/moderate myopia group compared with the high myopia group after lens application. This is consistent with a previous study that reported the combination of 0.025% atropine eye drops with ortho-K lenses was more effective in slowing axial growth in children with low myopia than ortho-L lenses alone, but this effect was not observed in children with high myopia.

“Other studies on the combined treatment effect of 0.01% atropine and ortho-K lenses have also reported that the inhibition of axial elongation is more effective in low myopia compared with high myopia,” the authors wrote. “Therefore, in children with rapid myopia progression and/or those who do not respond to 0.05% atropine, it may be worth considering combination treatment before myopia progresses further.”