Comparative Efficacy of Optical Correction Methods Combined with 0.01% Atropine in Myopia Control

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Methods : This retrospective study included 366 myopic children (366 eyes) from the Eye Hospital of Wenzhou Medical University (January 2021-December 2024). Participants were stratified into six groups: orthokeratology (OK, n=52), OK + atropine (OKA, n=50), highly aspherical lenslets (HAL, n=83), HAL + atropine (HALA, n=69), single-vision spectacles (SP, n=65), and SP + atropine (SPA, n=47). Axial length (AL) elongation after one year was compared using one-way ANOVA. Results : After one year, AL elongation differed significantly across groups (F=25.345 P<0.001). The OK (0.25±0.13 mm), OKA (0.18±0.14 mm), HAL (0.16±0.16 mm), HALA (0.08±0.19 mm), and SPA (0.23±0.18 mm) groups all showed significantly less AL elongation than the SP group (0.39±0.20 mm; all P<0.001). The HALA group demonstrated the strongest effect (P<0.01 vs. others), and both OKA and HALA outperformed OK (P=0.036) and HAL (P=0.004). Adjunctive 0.01% atropine therapy significantly attenuated AL elongation in older children with myopia, with the most pronounced reduction observed in the OKA group (0.03±0.14 mm). Among subjects with higher baseline refractive error, both OKA (0.12±0.13 mm) and SPA (0.16±0.19 mm) groups demonstrated significantly slower AL progression, whereas the HALA (0.12±0.21 mm) cohort exhibited comparatively less effective control of AL growth. Conclusion : Combining OK, HAL, or SP with 0.01% atropine demonstrated significant efficacy in retarding myopia progression. And OKA and SPA exhibited superior control efficacy in older children with higher myopia, while HALA achieved greater outcomes specifically in older myopic children across refractive strata. Myopia Orthokeratology Axial length Atropine Figures Figure 1 Figure 2 Introduction The global myopia epidemic has led to a dramatic increase in prevalence rates, earlier onset, and rising incidence of high myopia, creating significant public health challenges due to associated complications [1-2] . Effective interventions for children with established myopia are critically needed. Among various myopia control strategies, orthokeratology (OK) lenses, atropine eye drops, and specialized myopia-control spectacles have demonstrated efficacy in multiple clinical studies [3] . OK lenses can reduce axial length (AL) progression by approximately 36-56% [3-8] . Regarding myopia-control spectacles, Bao et al. reported that highly aspherical lenslets (HAL) limited AL elongation to 0.13±0.02 mm over one year (64% efficacy versus 0.36±0.02 mm in controls) [9-10] , while Lam et al. demonstrated that defocus-incorporated multiple segments (DIMS) lenses reduced elongation to 0.11±0.02 mm (66% efficacy versus 0.32±0.02 mm) [11] . Long-term studies have shown that sustained 0.01% atropine therapy effectively slows myopia progression with minimal rebound effects, demonstrating excellent durability [12] . Tsai's meta-analysis revealed superior efficacy when combining OK lenses with 0.01% atropine compared to monotherapy [13] , while Tang et al. reported similar enhancement for DIMS lenses combined with atropine [14] . Although existing evidence supports combination therapy for OK lenses and DIMS spectacles with atropine, the efficacy of HAL lenses combined with 0.01% atropine and the real-world effectiveness of optical-atropine combinations require further investigation. This retrospective study evaluates AL changes in children receiving various optical corrections combined with 0.01% atropine, providing clinical evidence for these combined interventions Methods 1 Study Participants This retrospective study included 366 myopic children (366 eyes) who met the inclusion criteria at the Eye Hospital of Wenzhou Medical University from January 2021 to December 2024. Inclusion criteria: (1) Age 8-13 years; (2) Spherical refraction -0.25 to -6.00 D, cylindrical refraction 0.00 to -2.00 D, spherical equivalent ≤-0.50 D, with best-corrected visual acuity ≥5.0 in both eyes; (3) No history of ocular trauma, systemic diseases, or ocular pathologies; (4) For atropine users: confirmed 0.01% atropine use during the 1-year observation period per medical records; for non-users: no atropine use before or during observation; (5) No strabismus, amblyopia, or binocular vision disorders that might affect AL measurements. This study was performed in accordance with the Declaration of Helsinki and was approved by the Wenzhou Medical University Eye Hospital’s Ethics Committee (2025-165-K-135). As this was a retrospective study, the ethics committee agreed that children were not required to provide written informed consent. 2 Equipment and Lenses Orthokeratology lenses (Euclid, USA) and highly aspherical lenslet (Stellest, Essilor) were used. AL was measured using the IOLMaster 500 (Carl Zeiss), with five measurements averaged per eye. Individual measurements required a signal-to-noise ratio (SNR) >2.0, and composite SNR >32. 3 Group Allocation and Follow-up Participants were divided into six groups: OK lens (n=52), OK lens combine with atropine (OKA, n=50), HAL ( n=83), HAL combine with atropine (HALA, n=69), single-vision spectacles (SP, n=65), and SP combine with atropine (SPA, n=47), as shown in Figure 1. OK lens wearers followed standard fitting protocols with follow-ups at 1 day, 1 week, 1 month, and then every 2-3 months. HAL wearers were instructed to use lenses ≥12 hours/day, and atropine was administered once nightly to both eyes. AL changes were compared between baseline and the final follow-up visit. 4 Statistical Analysis Data were analyzed using SPSS 24.0. Normality was assessed using the Shapiro-Wilk test, with normally distributed data presented as mean±SD. Paired t-tests compared baseline and 1-year AL within groups, while one-way ANOVA compared changes between groups. Statistical significance was set at P<0.05. Results 1 Baseline Characteristics Comparative analysis of baseline characteristics among 366 eyes from 366 myopic children across six refractive correction methods revealed no statistically significant differences in age, spherical equivalent, sphere power, cylinder power, or baseline AL between any two groups (all P>0.05, Table 1). 2 Comparison of the AL elongation of myopic children in different groups After one year of treatment, all six groups showed significantly increased AL compared to baseline: OK (24.83±0.68 mm, t=-13.972, P<0.001), OKA (25.00±0.70 mm, t=-9.391, P<0.001), HAL (24.71±1.24 mm, t=-9.004, P<0.001), HALA (26.67±0.83 mm, t=-3.226, P=0.002), SP (25.06±0.75 mm, t=-15.755, P<0.001), and SPA (24.85±0.87 mm, t=-8.483, P<0.001). Significant differences in AL elongation were observed among groups (F=25.345, P<0.001). The OK (0.25±0.13 mm), OKA (0.18±0.14 mm), HAL (0.16±0.16 mm), HALA (0.08±0.19 mm), and SPA (0.23±0.18 mm) groups demonstrated significantly less axial growth than the SP group (0.39±0.20 mm, all P<0.001). Pairwise comparisons are detailed in Table 2. Compared to SP, myopia control efficacy was 35.9% (OK), 53.8% (OKA), 60.0% (HAL), 79.5% (HALA), and 41.0% (SPA). The OKA and HALA combinations showed approximately 28% and 50% greater efficacy than OK and HAL monotherapies, respectively. Figure 1 displays the frequency distribution of axial growth among groups. 3 Comparison of the AL elongation of myopic children in different groups under different ages and SE. As presented in Table 3, adjunctive 0.01% atropine therapy significantly attenuated AL elongation in older children with myopia, with the most pronounced reduction observed in the OKA group (0.03±0.14 mm). Among subjects with higher baseline refractive error, both OKA (0.12±0.13 mm) and SPA (0.16±0.19 mm) groups demonstrated significantly slower AL progression, whereas the HALA (0.12±0.21 mm) cohort exhibited comparatively less effective control of AL growth. Discussion The increasing prevalence, younger onset age, and rising incidence of high myopia pose a growing global health burden [1-2] . Effective interventions for myopic children remain an urgent priority. Our retrospective analysis demonstrates that both orthokeratology (OK) lenses and highly aspherical lenslets (HAL) combined with 0.01% atropine effectively slow myopia progression, with combination therapies showing superior efficacy. Both orthokeratology (OK) lenses and myopia control spectacles utilize peripheral defocus principles to convert hyperopic defocus into myopic defocus on the peripheral retina, thereby achieving myopia progression control [3-11] . Bullimore's meta-analysis [15] reported AL changes ranging from 0.19±0.21 mm to 0.47±0.18 mm after one year of OK lens wear. Walline et al. [16] documented a change of 0.25±0.22 mm in myopic children, which aligns with our study's findings (0.25±0.13 mm) with OK lenses. Bao's research [12-13] showed AL changes of 0.13±0.02 mm with highly aspherical lenslets, while Lam's study reported 0.11±0.02 mm changes with differently designed DIMS lenses. These results are comparable to our HAL lens findings (0.16±0.16 mm). Clinically, both OK lenses and highly aspherical lenslets demonstrate effective AL elongation control, producing intervention outcomes consistent with cohort studies. The precise mechanism by which low-dose atropine slows myopia progression remains unclear, though it may involve M-receptor modulation in the retina and sclera, inhibiting scleral fibroblast proliferation and subsequent AL elongation [13-14] . With the treating of 0.01% atropine, Li et al. reported AL elongation of 0.36±0.29 mm after 1 year [17] , while Hao et al. observed 0.20±0.03 mm in children wearing single-vision lenses with atropine [18]. Xu et al. documented 0.25±0.20 mm changes [19] , and Sun's meta-analysis of four studies found a range of 0.31±0.21 to 0.37±0.22 mm [20] . These findings are consistent with our study's results (0.23±0.18 mm AL elongation) for children using single-vision lenses with 0.01% atropine. Among optical interventions combined with 0.01% atropine for myopia control, the most widely reported approach is the combination of orthokeratology (OK) lenses and low-dose atropine. Xu [19] observed an AL change of 0.20±0.23 mm in myopic children after one year of combined OK lens and 0.01% atropine therapy. Similarly, a meta-analysis by Wang [21] compiling 10 studies reported AL elongation ranging from 0.06±0.03 mm to 0.21±0.15 mm after one year of combined treatment, which aligns with our OKA group findings (0.18±0.14 mm). Fewer studies have explored myopia control spectacles combined with low-dose atropine. A recent study reported an AL change of 0.15±0.15 mm after one year of DIMS lenses combined with 0.01% atropine, which is comparable to our HALA group results (0.08±0.19 mm) [14] . In this study, compared to the SP group, the myopia control efficacy of the OK, OKA, HAL, HALA, and SPA groups was 35.9%, 53.8%, 60.0%, 79.5%, and 41.0%, respectively, OKA and HALA showed greater effect on myopia control than SPA. Furthermore, compared to OK and HAL alone, the OKA and HALA groups exhibited approximately 28% and 50% greater efficacy in slowing AL elongation, indicating that combining OK lenses or HAL with 0.01% atropine enhances myopia control. The synergistic effect of OK or HAL combined with 0.01% atropine on AL elongation control was predominantly observed in older children with moderate baseline myopia. The improved efficacy of combining OK lenses or myopia control spectacles with low-dose atropine is generally attributed to atropine-induced pupil dilation, which enhances peripheral defocus signals and thereby optimizes myopia intervention outcomes [14,19-21] . Age-stratified analysis revealed significantly slower axial elongation in the 11-13-year cohort across all interventions (OKA: 0.03±0.14 mm; HALA: -0.03±0.06 mm; SPA: 0.11±0.20 mm) compared to the 8-10-year group (OKA: 0.20±0.12 mm; HALA: 0.09±0.20 mm; SPA: 0.26±0.17 mm), with the most pronounced difference observed in the orthokeratology augmented with 0.01% atropine (OKA) group. This age-dependent efficacy pattern aligns with Xu et al.'s findings [19] , where 8-10-year-olds exhibited greater axial elongation (0.42±0.20 mm) than 10-12-year-olds (0.18±0.19 mm) after 2-year combined orthokeratology and low-dose atropine therapy. The superior myopia control efficacy in older children likely reflects the well-documented age-related decline in myopia progression rates [4-7] , consistent with evidence that older baseline age enhances orthokeratology outcomes. Refractive error stratification demonstrated enhanced intervention efficacy for higher myopia in both OKA and standalone 0.01% atropine (SPA) groups, whereas highly aspherical lenslets with atropine (HALA) showed no significant refractive dependence. The inverse correlation between baseline spherical equivalent error and progression rate – previously established for orthokeratology [4-7] – explains OKA's superior performance in high myopia. Conversely, HALA maintained consistent efficacy across low-to-moderate myopia potentially attributable to its fixed -6.00D peripheral defocus design, which optimally targets this refractive range [9-10] . As a retrospective study, this research has inherent limitations. We could not verify perfect adherence to nightly 0.01% atropine use, but ensured medication availability through prescription records during the 1-year follow-up period. Additionally, with growing awareness of myopia interventions, many parents only added atropine after observing suboptimal efficacy with OK lenses or HAL alone, resulting in asynchronous initiation of optical and pharmacological therapies. After rigorous data screening, the OK-atropine cohort showed relatively small sample size. The enrolled participants (mean age 9-10 years, spherical equivalent -2.00 to -3.00D) were younger with milder myopia, potentially explaining the slightly inferior efficacy of OK lenses compared to HAL, consistent with Liu's findings [22] . In summary, combined therapy utilizing OK, HAL, or SP with adjunctive 0.01% atropine demonstrated significant efficacy in retarding myopia progression. And OKA and SPA exhibited superior control efficacy in older children with higher myopia, while HALA achieved greater outcomes specifically in older myopic children across refractive strata. Declarations Ethics approval and consent to participate This study was performed in accordance with the Declaration of Helsinki and was approved by the Wenzhou Medical University Eye Hospital’s Ethics Committee (2025-165-K-135). As this was a retrospective study, the ethics committee agreed that children were not required to provide written informed consent. Consent for publication Not applicable. Availability of data and materials Data are available from the authors upon reasonable request and with permission of corresponding author. Competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Funding Not applicable. Authors' contributions M.C. wrote the main manuscript text and prepared figures. H.L. X.Y. and Z. D. helped collect data. J.Q. and X.M. guided the article, All authors read and approved the final manuscript. References Holden BA, Fricke TR, Wilson DA, et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology. 2016 May;123(5):1036-42. Santodomingo-Rubido J, Villa-Collar C, Gilmartin B, et al. Myopia control with orthokeratology contact lenses in Spain: refractive and biometric changes. Invest Ophthalmol vis Sci 2012;53(8):5060–5. Huang J, Wen D, Wang Q, et al. Efficacy Comparison of 16 Interventions for Myopia Control in Children: A Network Meta-analysis. Ophthalmology. 2016 Apr;123(4):697-708. Santodomingo-Rubido J, Villa-Collar C, Gilmartin B, et al. Factors preventing myopia progression with orthokeratology correction. Optom Vis Sci. 2013 Nov;90(11):1225-36. Na M, Yoo A. The effect of orthokeratology on axial length elongation in children with myopia: Contralateral comparison study. Jpn J Ophthalmol. 2018 May;62(3):327-334. Cho P, Cheung SW. Retardation of myopia in Orthokeratology (ROMIO) study: a 2-year randomized clinical trial. Invest Ophthalmol Vis Sci. 2012 Oct 11;53(11):7077-85. Li SM, Kang MT, Wu SS, et al. Efficacy, Safety and Acceptability of Orthokeratology on Slowing Axial Elongation in Myopic Children by Meta-Analysis. Curr Eye Res. 2016 May;41(5):600-8. Bullimore MA, Johnson LA. Overnight orthokeratology. Cont Lens Anterior Eye. 2020 Aug;43(4):322-332. Bao J, Yang A, Huang Y, et al. One-year myopia control efficacy of spectacle lenses with aspherical lenslets[J]. Br J Ophthalmol,2022,106(8):1171-1176. Bao J, Huang Y, Li X, et al. Spectacle Lenses With Aspherical Lenslets for Myopia Control vs Single-Vision Spectacle Lenses: A Randomized Clinical Trial[J]. JAMA Ophthalmol,2022,140(5):472-478. Lam CSY, Tang WC, Tse DY, et al. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol. 2020 Mar;104(3):363-368. Chia A, Lu QS, Tan D. Five-Year Clinical Trial on Atropine for the Treatment of Myopia 2: Myopia Control with Atropine 0.01% Eyedrops. Ophthalmology. 2016 Feb;123(2):391-399. Tsai HR, Wang JH, Huang HK, et al. Efficacy of atropine, orthokeratology, and combined atropine with orthokeratology for childhood myopia: A systematic review and network meta-analysis. J Formos Med Assoc. 2022 Dec;121(12):2490-2500. Tang T, Lu Y, Li X, et al. Comparison of the long-term effects of atropine in combination with Orthokeratology and defocus incorporated multiple segment lenses for myopia control in Chinese children and adolescents. Eye (Lond). 2024 Jun;38(9):1660-1667. Bullimore MA, Johnson LA. Overnight orthokeratology. Cont Lens Anterior Eye. 2020 Aug;43(4):322-332. Walline JJ, Jones LA, Sinnott LT. Corneal reshaping and myopia progression. Br J Ophthalmol. 2009 Sep;93(9):1181-5. Li FF, Yam JC. Low-Concentration Atropine Eye Drops for Myopia Progression. Asia Pac J Ophthalmol (Phila). 2019 Sep-Oct;8(5):360-365. Hao Q, Zhao Q. Changes in subfoveal choroidal thickness in myopic children with 0.01% atropine, orthokeratology, or their combination. Int Ophthalmol. 2021 Sep;41(9):2963-2971. Xu S, Li Z, Zhao W, et al. Effect of atropine, orthokeratology and combined treatments for myopia control: a 2-year stratified randomised clinical trial. Br J Ophthalmol. 2023 Nov 22;107(12):1812-1817. Sun W, Hasebe S. Efficacy of 0.01% Atropine Eye Drops in Controlling Myopia Progression and Axial Elongation in Children: A Meta-analysis Based on Randomized Controlled Trials. Acta Med Okayama. 2022 Aug;76(4):457-463. Wang Z, Wang P, Jiang B, et al. The efficacy and safety of 0.01% atropine alone or combined with orthokeratology for children with myopia: A meta-analysis. PLoS One. 2023 Jul 26;18(7):e0282286. Liu Q, Chen Y, Feng Y, et al. Comparison of two-year myopia control efficacy between spectacle lenses with highly aspherical lenslets and orthokeratology lenses. Cont Lens Anterior Eye. 2025 Jan 16:102376. Tables Table 1. Comparison of the baseline parameters of myopic children Groups n Age,year SE (D) S (D) C (D) Baseline AL (mm) OK 52 9.13±1.43 -2.52±1.32 -2.25±1.24 -0.55±0.56 24.58±0.71 OKA 50 9.12±1.44 -2.82±1.41 -2.62±1.30 -0.40±0.47 24.83±0.75 HAL 83 9.33±1.38 -2.66±1.41 -2.39±1.37 -0.54±0.43 24.55±1.21 HALA 69 9.16±1.15 -2.42±1.10 -2.21±1.01 -0.43±0.43 24.59±0.79 SP 65 9.58±1.74 -2.70±1.22 -2.48±1.17 -0.45±0.41 24.67±0.75 SPA 47 9.45±1.43 -2.52±1.40 -2.27±1.33 -0.51±0.41 24.62±0.93 F 1.047 0.719 0.894 1.148 0.675 P 0.390 0.609 0.485 0.335 0.643 n , the number of cases. SE, spherical equivalent refraction; S, spherical refraction; C, cylinder refraction; AL, axial length; SP, Single vision spectacles, HAL, highly aspherical lenslets, OK, Orthokeratology lenses, A, add atropine drop. Table 2. Comparison of the AL elongation of myopic children in different groups Groups AL elongation (mm) P OK 0.25±0.13 P OK VS OKA =0.036, P OK VS HAL =0.003, P OK VS HALA <0.001, P OK VS SP <0.001, P OK VS SPA = 0.562 P OKA VS HAL =0.520, P OKA VS HALA =0.002, P OKA VS SP <0.001, P OKA VS SPA = 0.141 P HAL VS HALA =0.004, P HAL VS SP <0.001, P HAL VS SPA = 0.024 P HALA VS SP <0.001, P HALA VS SPA <0.001 P SP VS SPA <0.001 OKA 0.18±0.14 HAL 0.16±0.16 HALA 0.08±0.19 SP 0.39±0.20 SPA 0.23±0.18 AL, axial length; SP, Single vision spectacles, HAL, highly aspherical lenslets, OK, Orthokeratology lenses, A, add atropine drop. Table 3. Comparison of the AL elongation of myopic children in different groups under different ages and SE. Groups AL elongation (mm) P Age: 8-10 years OK 0.25±0.12 P OK VS OKA =0.258, P OK VS HAL =0.014, P OK VS HALA <0.001, P OK VS SP <0.001, P OK VS SPA = 0.741 P OKA VS HAL =0.230, P OKA VS HALA =0.001, P OKA VS SP <0.001, P OKA VS SPA = 0.160 P HAL VS HALA =0.009, P HAL VS SP <0.001, P HAL VS SPA = 0.007 P HALA VS SP <0.001, P HALA VS SPA <0.001 P SP VS SPA <0.001 OKA 0.20±0.12 HAL 0.16±0.17 HALA 0.09±0.20 SP 0.43±0.20 SPA 0.26±0.17 Age: 11-13 years OK 0.25±0.16 P OK VS OKA =0.003 P OK VS HAL =0.037, P OK VS HALA <0.001, P OK VS SP =0.822, P OK VS SPA = 0.043 P OKA VS HAL =0.150, P OKA VS HALA =0.488, P OKA VS SP <0.001,, P OKA VS SPA = 0.214 P HAL VS HALA =0.033, P HAL VS SP =0.005, P HAL VS SPA = 0.915 P HALA VS SP <0.001, P HALA VS SPA =0.057 P SP VS SPA =0.009 OKA 0.03±0.14 HAL 0.12±0.11 HALA -0.03±0.06 SP 0.27±0.14 SPA 0.11±0.20 SE: -0.25~-3.00 D OK 0.27±0.12 P OK VS OKA =0.122, P OK VS HAL =0.001, P OK VS HALA <0.001, P OK VS SP <0.001, P OK VS SPA = 0.973 P OKA VS HAL =0.108, P OKA VS HALA <0.001, P OKA VS SP <0.001, P OKA VS SPA = 0.141 P HAL VS HALA =0.003, P HAL VS SP <0.001, P HAL VS SPA = 0.001 P HALA VS SP <0.001, P HALA VS SPA <0.001 P SP VS SPA <0.001 OKA 0.21±0.14 HAL 0.15±0.16 HALA 0.06±0.19 SP 0.46±0.19 SPA 0.27±0.17 SE: ≤ -3.125 D OK 0.19±0.14 P OK VS OKA =0.202, P OK VS HAL =0.704, P OK VS HALA =0.197, P OK VS SP =0.042, P OK VS SPA = 0.594 P OKA VS HAL =0.278, P OKA VS HALA =0.991, P OKA VS SP <0.001, P OKA VS SPA = 0.461 P HAL VS HALA =0.269, P HAL VS SP =0.004, P HAL VS SPA = 0.820 P HALA VS SP <0.001, P HALA VS SPA =0.458 P SP VS SPA =0.008 OKA 0.12±0.13 HAL 0.17±0.15 HALA 0.12±0.21 SP 0.30±0.18 SPA 0.16±0.19 AL, axial length; SE, spherical equivalent refraction; SP, Single vision spectacles, HAL, highly aspherical lenslets, OK, Orthokeratology lenses, A, add atropine drop. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 26 Nov, 2025 Read the published version in BMC Ophthalmology → Version 1 posted Reviews received at journal 04 Aug, 2025 Reviewers agreed at journal 30 Jul, 2025 Reviewers agreed at journal 29 Jul, 2025 Reviewers invited by journal 29 Jul, 2025 Editor assigned by journal 24 Jul, 2025 Editor invited by journal 22 Jul, 2025 Submission checks completed at journal 18 Jul, 2025 First submitted to journal 18 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7126632","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":493064289,"identity":"3fd0c09f-cbbd-4232-83dd-16f2e1aa23ba","order_by":0,"name":"Minfeng Chen","email":"","orcid":"","institution":"Affiliated Eye Hospital of Wenzhou Medical College","correspondingAuthor":false,"prefix":"","firstName":"Minfeng","middleName":"","lastName":"Chen","suffix":""},{"id":493064290,"identity":"d2ebc89b-5519-4701-8a82-175e41b87b28","order_by":1,"name":"Huihui Lei","email":"","orcid":"","institution":"Affiliated Eye Hospital of Wenzhou Medical 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College","correspondingAuthor":false,"prefix":"","firstName":"Jia","middleName":"","lastName":"Qu","suffix":""},{"id":493064294,"identity":"56d4ade4-1cf4-47e1-93c1-6f422541ad33","order_by":5,"name":"Xinjie Mao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIiWNgGAWjYHCCxAcMDBIyJGlJNgBq4SFJC5sEkCBBi+6MhGdVN2oseBjYewwfMNTYMfDPbsCvxezMgbTbOceADuM5Y2zAcCyZQeLOAQJajjcAtbABtUjkmEkwsB1gMJBIIKDlMENacc4/oBb5N+Y/GP4RowVoC3NuG8gWHjMGxjZitJw5kCyd2yfBw8aTViyR2JfMI3GDkJYbOYmfc77VyfGzH9744cM3Ozn+GQS0AGMEooKNgcOAIYG4CGI/AGM8IEL1KBgFo2AUjEQAAKZROapjOJt2AAAAAElFTkSuQmCC","orcid":"","institution":"Affiliated Eye Hospital of Wenzhou Medical College","correspondingAuthor":true,"prefix":"","firstName":"Xinjie","middleName":"","lastName":"Mao","suffix":""}],"badges":[],"createdAt":"2025-07-15 05:53:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7126632/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7126632/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12886-025-04523-9","type":"published","date":"2025-11-26T15:58:48+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":88229622,"identity":"7da842ac-4ff7-4fde-95d8-5db01e5e831b","added_by":"auto","created_at":"2025-08-04 09:16:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":26336,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGrouping of subjects.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7126632/v1/adec2d8c840fd74c125f9b07.png"},{"id":88231330,"identity":"b6fbd278-8bbf-479b-b74b-6fe84772a4bc","added_by":"auto","created_at":"2025-08-04 09:32:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":16353,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFrequency distribution of myopic children in different groups under different AL elongation.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7126632/v1/fd226aeadc9dff3cda512013.png"},{"id":97179622,"identity":"9c23f8f3-7ec7-4ae7-84ab-1b5002ac6dbe","added_by":"auto","created_at":"2025-12-01 16:16:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":710062,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7126632/v1/27b635c2-f737-4746-9e05-ca9bc576d7b2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparative Efficacy of Optical Correction Methods Combined with 0.01% Atropine in Myopia Control","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe global myopia epidemic has led to a dramatic increase in prevalence rates, earlier onset, and rising incidence of high myopia, creating significant public health challenges due to associated complications \u003csup\u003e[1-2]\u003c/sup\u003e. Effective interventions for children with established myopia are critically needed.\u003c/p\u003e\n\u003cp\u003eAmong various myopia control strategies, orthokeratology (OK) lenses, atropine eye drops, and specialized myopia-control spectacles have demonstrated efficacy in multiple clinical studies \u003csup\u003e[3]\u003c/sup\u003e. OK lenses can reduce axial length (AL) progression by approximately 36-56% \u003csup\u003e[3-8]\u003c/sup\u003e. Regarding myopia-control spectacles, Bao et al. reported that highly aspherical lenslets (HAL) limited AL elongation to 0.13±0.02 mm over one year (64% efficacy versus 0.36±0.02 mm in controls) \u003csup\u003e[9-10]\u003c/sup\u003e, while Lam et al. demonstrated that defocus-incorporated multiple segments (DIMS) lenses reduced elongation to 0.11±0.02 mm (66% efficacy versus 0.32±0.02 mm)\u003csup\u003e[11]\u003c/sup\u003e. Long-term studies have shown that sustained 0.01% atropine therapy effectively slows myopia progression with minimal rebound effects, demonstrating excellent durability \u003csup\u003e[12]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eTsai's meta-analysis revealed superior efficacy when combining OK lenses with 0.01% atropine compared to monotherapy \u003csup\u003e[13]\u003c/sup\u003e, while Tang et al. reported similar enhancement for DIMS lenses combined with atropine \u003csup\u003e[14]\u003c/sup\u003e. Although existing evidence supports combination therapy for OK lenses and DIMS spectacles with atropine, the efficacy of HAL lenses combined with 0.01% atropine and the real-world effectiveness of optical-atropine combinations require further investigation.\u003c/p\u003e\n\u003cp\u003eThis retrospective study evaluates AL changes in children receiving various optical corrections combined with 0.01% atropine, providing clinical evidence for these combined interventions\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e1 Study Participants\u003c/p\u003e\n\u003cp\u003eThis retrospective study included 366 myopic children (366 eyes) who met the inclusion criteria at the Eye Hospital of Wenzhou Medical University from January 2021 to December 2024. Inclusion criteria: (1) Age 8-13 years; (2) Spherical refraction -0.25 to -6.00 D, cylindrical refraction 0.00 to -2.00 D, spherical equivalent ≤-0.50 D, with best-corrected visual acuity ≥5.0 in both eyes; (3) No history of ocular trauma, systemic diseases, or ocular pathologies; (4) For atropine users: confirmed 0.01% atropine use during the 1-year observation period per medical records; for non-users: no atropine use before or during observation; (5) No strabismus, amblyopia, or binocular vision disorders that might affect AL measurements. This study was performed in accordance with the Declaration of Helsinki and was approved by the Wenzhou Medical University Eye Hospital’s Ethics Committee (2025-165-K-135). As this was a retrospective study, the ethics committee agreed that children were not required to provide written informed consent.\u003c/p\u003e\n\u003cp\u003e2 Equipment and Lenses\u003c/p\u003e\n\u003cp\u003eOrthokeratology lenses (Euclid, USA) and highly aspherical lenslet (Stellest, Essilor) were used. AL was measured using the IOLMaster 500 (Carl Zeiss), with five measurements averaged per eye. Individual measurements required a signal-to-noise ratio (SNR) \u0026gt;2.0, and composite SNR \u0026gt;32.\u003c/p\u003e\n\u003cp\u003e3 Group Allocation and Follow-up\u003c/p\u003e\n\u003cp\u003eParticipants were divided into six groups: OK lens (n=52), OK lens combine with atropine (OKA, n=50), HAL ( n=83), HAL combine with atropine (HALA, n=69), single-vision spectacles (SP, n=65), and SP combine with atropine (SPA, n=47), as shown in Figure 1. OK lens wearers followed standard fitting protocols with follow-ups at 1 day, 1 week, 1 month, and then every 2-3 months. HAL wearers were instructed to use lenses ≥12 hours/day, and atropine was administered once nightly to both eyes. AL changes were compared between baseline and the final follow-up visit.\u003c/p\u003e\n\u003cp\u003e4 Statistical Analysis\u003c/p\u003e\n\u003cp\u003eData were analyzed using SPSS 24.0. Normality was assessed using the Shapiro-Wilk test, with normally distributed data presented as mean±SD. Paired t-tests compared baseline and 1-year AL within groups, while one-way ANOVA compared changes between groups. Statistical significance was set at P\u0026lt;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e1\u0026nbsp;\u003c/strong\u003eBaseline Characteristics\u003c/p\u003e\n\u003cp\u003eComparative analysis of baseline characteristics among 366 eyes from 366 myopic children across six refractive correction methods revealed no statistically significant differences in age, spherical equivalent, sphere power, cylinder power, or baseline AL between any two groups (all P\u0026gt;0.05, Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2\u0026nbsp;\u003c/strong\u003eComparison of the AL elongation of myopic children in different groups\u003c/p\u003e\n\u003cp\u003eAfter one year of treatment, all six groups showed significantly increased AL compared to baseline: OK (24.83±0.68 mm, t=-13.972, P\u0026lt;0.001), OKA (25.00±0.70 mm, t=-9.391, P\u0026lt;0.001), HAL (24.71±1.24 mm, t=-9.004, P\u0026lt;0.001), HALA (26.67±0.83 mm, t=-3.226, P=0.002), SP (25.06±0.75 mm, t=-15.755, P\u0026lt;0.001), and SPA (24.85±0.87 mm, t=-8.483, P\u0026lt;0.001). Significant differences in AL elongation were observed among groups (F=25.345, P\u0026lt;0.001). The OK (0.25±0.13 mm), OKA (0.18±0.14 mm), HAL (0.16±0.16 mm), HALA (0.08±0.19 mm), and SPA (0.23±0.18 mm) groups demonstrated significantly less axial growth than the SP group (0.39±0.20 mm, all P\u0026lt;0.001). Pairwise comparisons are detailed in Table 2. Compared to SP, myopia control efficacy was 35.9% (OK), 53.8% (OKA), 60.0% (HAL), 79.5% (HALA), and 41.0% (SPA). The OKA and HALA combinations showed approximately 28% and 50% greater efficacy than OK and HAL monotherapies, respectively. Figure 1 displays the frequency distribution of axial growth among groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3 Comparison of the AL elongation of myopic children in different groups under different ages and SE.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs presented in Table 3, adjunctive 0.01% atropine therapy significantly attenuated AL elongation in older children with myopia, with the most pronounced reduction observed in the OKA group (0.03±0.14 mm). Among subjects with higher baseline refractive error, both OKA (0.12±0.13 mm) and SPA (0.16±0.19 mm) groups demonstrated significantly slower AL progression, whereas the HALA (0.12±0.21 mm) cohort exhibited comparatively less effective control of AL growth.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe increasing prevalence, younger onset age, and rising incidence of high myopia pose a growing global health burden\u003csup\u003e\u0026nbsp;[1-2]\u003c/sup\u003e. Effective interventions for myopic children remain an urgent priority. Our retrospective analysis demonstrates that both orthokeratology (OK) lenses and highly aspherical lenslets (HAL) combined with 0.01% atropine effectively slow myopia progression, with combination therapies showing superior efficacy.\u003c/p\u003e\n\u003cp\u003eBoth orthokeratology (OK) lenses and myopia control spectacles utilize peripheral defocus principles to convert hyperopic defocus into myopic defocus on the peripheral retina, thereby achieving myopia progression control\u003csup\u003e\u0026nbsp;[3-11]\u003c/sup\u003e. Bullimore's meta-analysis\u003csup\u003e\u0026nbsp;[15]\u003c/sup\u003e reported AL changes ranging from 0.19±0.21 mm to 0.47±0.18 mm after one year of OK lens wear. Walline et al.\u003csup\u003e\u0026nbsp;[16]\u003c/sup\u003e documented a change of 0.25±0.22 mm in myopic children, which aligns with our study's findings (0.25±0.13 mm) with OK lenses. Bao's research\u003csup\u003e\u0026nbsp;[12-13]\u003c/sup\u003e showed AL changes of 0.13±0.02 mm with highly aspherical lenslets, while Lam's study reported 0.11±0.02 mm changes with differently designed DIMS lenses. These results are comparable to our HAL lens findings (0.16±0.16 mm). Clinically, both OK lenses and highly aspherical lenslets demonstrate effective AL elongation control, producing intervention outcomes consistent with cohort studies.\u003c/p\u003e\n\u003cp\u003eThe precise mechanism by which low-dose atropine slows myopia progression remains unclear, though it may involve M-receptor modulation in the retina and sclera, inhibiting scleral fibroblast proliferation and subsequent AL elongation\u003csup\u003e\u0026nbsp;[13-14]\u003c/sup\u003e. With the treating of 0.01% atropine, Li et al. reported AL elongation of 0.36±0.29 mm after 1 year\u003csup\u003e\u0026nbsp;[17]\u003c/sup\u003e, while Hao et al. observed 0.20±0.03 mm in children wearing single-vision lenses with atropine\u003csup\u003e\u0026nbsp;[18].\u003c/sup\u003e Xu et al. documented 0.25±0.20 mm changes\u003csup\u003e\u0026nbsp;[19]\u003c/sup\u003e, and Sun's meta-analysis of four studies found a range of 0.31±0.21 to 0.37±0.22 mm\u003csup\u003e\u0026nbsp;[20]\u003c/sup\u003e. These findings are consistent with our study's results (0.23±0.18 mm AL elongation) for children using single-vision lenses with 0.01% atropine.\u003c/p\u003e\n\u003cp\u003eAmong optical interventions combined with 0.01% atropine for myopia control, the most widely reported approach is the combination of orthokeratology (OK) lenses and low-dose atropine. Xu\u003csup\u003e\u0026nbsp;[19]\u003c/sup\u003e observed an AL change of 0.20±0.23 mm in myopic children after one year of combined OK lens and 0.01% atropine therapy. Similarly, a meta-analysis by Wang\u003csup\u003e\u0026nbsp;[21]\u0026nbsp;\u003c/sup\u003ecompiling 10 studies reported AL elongation ranging from 0.06±0.03 mm to 0.21±0.15 mm after one year of combined treatment, which aligns with our OKA group findings (0.18±0.14 mm). Fewer studies have explored myopia control spectacles combined with low-dose atropine. A recent study reported an AL change of 0.15±0.15 mm after one year of DIMS lenses combined with 0.01% atropine, which is comparable to our HALA group results (0.08±0.19 mm)\u003csup\u003e\u0026nbsp;[14]\u003c/sup\u003e. In this study, compared to the SP group, the myopia control efficacy of the OK, OKA, HAL, HALA, and SPA groups was 35.9%, 53.8%, 60.0%, 79.5%, and 41.0%, respectively, OKA and HALA showed greater effect on myopia control than SPA. Furthermore, compared to OK and HAL alone, the OKA and HALA groups exhibited approximately 28% and 50% greater efficacy in slowing AL elongation, indicating that combining OK lenses or HAL with 0.01% atropine enhances myopia control. The synergistic effect of OK or HAL combined with 0.01% atropine on AL elongation control was predominantly observed in older children with moderate baseline myopia. The improved efficacy of combining OK lenses or myopia control spectacles with low-dose atropine is generally attributed to atropine-induced pupil dilation, which enhances peripheral defocus signals and thereby optimizes myopia intervention outcomes\u003csup\u003e\u0026nbsp;[14,19-21]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eAge-stratified analysis revealed significantly slower axial elongation in the 11-13-year cohort across all interventions (OKA: 0.03±0.14 mm; HALA: -0.03±0.06 mm; SPA: 0.11±0.20 mm) compared to the 8-10-year group (OKA: 0.20±0.12 mm; HALA: 0.09±0.20 mm; SPA: 0.26±0.17 mm), with the most pronounced difference observed in the orthokeratology augmented with 0.01% atropine (OKA) group. This age-dependent efficacy pattern aligns with Xu et al.'s findings \u003csup\u003e[19]\u003c/sup\u003e, where 8-10-year-olds exhibited greater axial elongation (0.42±0.20 mm) than 10-12-year-olds (0.18±0.19 mm) after 2-year combined orthokeratology and low-dose atropine therapy. The superior myopia control efficacy in older children likely reflects the well-documented age-related decline in myopia progression rates \u003csup\u003e[4-7]\u003c/sup\u003e, consistent with evidence that older baseline age enhances orthokeratology outcomes. Refractive error stratification demonstrated enhanced intervention efficacy for higher myopia in both OKA and standalone 0.01% atropine (SPA) groups, whereas highly aspherical lenslets with atropine (HALA) showed no significant refractive dependence. The inverse correlation between baseline spherical equivalent error and progression rate – previously established for orthokeratology \u003csup\u003e[4-7]\u003c/sup\u003e – explains OKA's superior performance in high myopia. Conversely, HALA maintained consistent efficacy across low-to-moderate myopia potentially attributable to its fixed -6.00D peripheral defocus design, which optimally targets this refractive range \u003csup\u003e[9-10]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eAs a retrospective study, this research has inherent limitations. We could not verify perfect adherence to nightly 0.01% atropine use, but ensured medication availability through prescription records during the 1-year follow-up period. Additionally, with growing awareness of myopia interventions, many parents only added atropine after observing suboptimal efficacy with OK lenses or HAL alone, resulting in asynchronous initiation of optical and pharmacological therapies. After rigorous data screening, the OK-atropine cohort showed relatively small sample size. The enrolled participants (mean age 9-10 years, spherical equivalent -2.00 to -3.00D) were younger with milder myopia, potentially explaining the slightly inferior efficacy of OK lenses compared to HAL, consistent with Liu's findings\u003csup\u003e\u0026nbsp;[22]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eIn summary, combined therapy utilizing OK, HAL, or SP with adjunctive 0.01% atropine demonstrated significant efficacy in retarding myopia progression. And OKA and SPA exhibited superior control efficacy in older children with higher myopia, while HALA achieved greater outcomes specifically in older myopic children across refractive strata.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in accordance with the Declaration of Helsinki and was approved by the Wenzhou Medical University Eye Hospital’s Ethics Committee (2025-165-K-135). As this was a retrospective study, the ethics committee agreed that children were not required to provide written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are available from the authors upon reasonable request and with permission of corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eM.C. wrote the main manuscript text and prepared figures. H.L. X.Y. and Z. D. helped collect data. J.Q. and X.M. guided the article, All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eHolden BA, Fricke TR, Wilson DA, et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology. 2016 May;123(5):1036-42.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSantodomingo-Rubido J, Villa-Collar C, Gilmartin B, et al. Myopia control with orthokeratology contact lenses in Spain: refractive and biometric changes. Invest Ophthalmol vis Sci 2012;53(8):5060\u0026ndash;5.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eHuang J, Wen D, Wang Q, et al. Efficacy Comparison of 16 Interventions for Myopia Control in Children: A Network Meta-analysis. Ophthalmology. 2016 Apr;123(4):697-708.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSantodomingo-Rubido J, Villa-Collar C, Gilmartin B, et al. 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Efficacy of atropine, orthokeratology, and combined atropine with orthokeratology for childhood myopia: A systematic review and network meta-analysis. J Formos Med Assoc. 2022 Dec;121(12):2490-2500.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eTang T, Lu Y, Li X, et al. Comparison of the long-term effects of atropine in combination with Orthokeratology and defocus incorporated multiple segment lenses for myopia control in Chinese children and adolescents. Eye (Lond). 2024 Jun;38(9):1660-1667.\u003c/li\u003e\n \u003cli\u003eBullimore MA, Johnson LA. Overnight orthokeratology. Cont Lens Anterior Eye. 2020 Aug;43(4):322-332.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWalline JJ, Jones LA, Sinnott LT. Corneal reshaping and myopia progression. Br J Ophthalmol. 2009 Sep;93(9):1181-5.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLi FF, Yam JC. Low-Concentration Atropine Eye Drops for Myopia Progression. Asia Pac J Ophthalmol (Phila). 2019 Sep-Oct;8(5):360-365.\u003c/li\u003e\n \u003cli\u003eHao Q, Zhao Q. Changes in subfoveal choroidal thickness in myopic children with 0.01% atropine, orthokeratology, or their combination. Int Ophthalmol. 2021 Sep;41(9):2963-2971.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eXu S, Li Z, Zhao W, et al. Effect of atropine, orthokeratology and combined treatments for myopia control: a 2-year stratified randomised clinical trial. Br J Ophthalmol. 2023 Nov 22;107(12):1812-1817.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSun W, Hasebe S. Efficacy of 0.01% Atropine Eye Drops in Controlling Myopia Progression and Axial Elongation in Children: A Meta-analysis Based on Randomized Controlled Trials. Acta Med Okayama. 2022 Aug;76(4):457-463.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWang Z, Wang P, Jiang B, et al. The efficacy and safety of 0.01% atropine alone or combined with orthokeratology for children with myopia: A meta-analysis. PLoS One. 2023 Jul 26;18(7):e0282286.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLiu Q, Chen Y, Feng Y, et al. Comparison of two-year myopia control efficacy between spectacle lenses with highly aspherical lenslets and orthokeratology lenses. Cont Lens Anterior Eye. 2025 Jan 16:102376. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"654\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 654px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1. Comparison of the baseline parameters of myopic children\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eGroups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003eAge,year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003eSE (D)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eS (D)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003eC (D)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003eBaseline AL (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eOK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e9.13\u0026plusmn;1.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e-2.52\u0026plusmn;1.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e-2.25\u0026plusmn;1.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e-0.55\u0026plusmn;0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e24.58\u0026plusmn;0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eOKA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e9.12\u0026plusmn;1.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e-2.82\u0026plusmn;1.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e-2.62\u0026plusmn;1.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e-0.40\u0026plusmn;0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e24.83\u0026plusmn;0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eHAL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e9.33\u0026plusmn;1.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e-2.66\u0026plusmn;1.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e-2.39\u0026plusmn;1.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e-0.54\u0026plusmn;0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e24.55\u0026plusmn;1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eHALA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e9.16\u0026plusmn;1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e-2.42\u0026plusmn;1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e-2.21\u0026plusmn;1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e-0.43\u0026plusmn;0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e24.59\u0026plusmn;0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eSP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e9.58\u0026plusmn;1.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e-2.70\u0026plusmn;1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e-2.48\u0026plusmn;1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e-0.45\u0026plusmn;0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e24.67\u0026plusmn;0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eSPA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e9.45\u0026plusmn;1.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e-2.52\u0026plusmn;1.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e-2.27\u0026plusmn;1.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e-0.51\u0026plusmn;0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e24.62\u0026plusmn;0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e1.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.719\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.894\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e1.148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e0.675\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e0.390\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.609\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.485\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e0.335\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e0.643\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 654px;\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e, the number of cases. SE, spherical equivalent refraction; S, spherical refraction; C, cylinder refraction; AL, axial length; SP, Single vision spectacles, HAL, highly aspherical lenslets, OK, Orthokeratology lenses, A, add atropine drop.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"746\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 746px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2. Comparison of the AL elongation of myopic children in different groups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eGroups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eAL elongation (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 519px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eOK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.25\u0026plusmn;0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" style=\"width: 519px;\"\u003e\n \u003cp\u003eP\u003csub\u003eOK VS OKA\u003c/sub\u003e=0.036, P\u003csub\u003eOK VS HAL\u003c/sub\u003e=0.003, P\u003csub\u003eOK VS HALA\u003c/sub\u003e\u0026lt;0.001, P\u003csub\u003eOK VS SP\u0026nbsp;\u003c/sub\u003e\u0026lt;0.001, P\u003csub\u003eOK VS SPA\u003c/sub\u003e= 0.562\u003c/p\u003e\n \u003cp\u003eP\u003csub\u003eOKA VS HAL\u003c/sub\u003e=0.520, P\u003csub\u003eOKA VS HALA\u003c/sub\u003e=0.002, P\u003csub\u003eOKA VS SP\u0026nbsp;\u003c/sub\u003e\u0026lt;0.001, P\u003csub\u003eOKA VS SPA\u0026nbsp;\u003c/sub\u003e= 0.141\u003c/p\u003e\n \u003cp\u003eP\u003csub\u003eHAL VS HALA\u003c/sub\u003e=0.004, P\u003csub\u003eHAL VS SP\u0026nbsp;\u003c/sub\u003e\u0026lt;0.001, P\u003csub\u003eHAL VS SPA\u003c/sub\u003e= 0.024\u003c/p\u003e\n \u003cp\u003eP\u003csub\u003eHALA VS SP\u0026nbsp;\u003c/sub\u003e\u0026lt;0.001, P\u003csub\u003eHALA VS SPA\u003c/sub\u003e\u0026lt;0.001\u003c/p\u003e\n \u003cp\u003eP\u003csub\u003eSP VS SPA\u003c/sub\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eOKA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.18\u0026plusmn;0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eHAL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.16\u0026plusmn;0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eHALA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.08\u0026plusmn;0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eSP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.39\u0026plusmn;0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eSPA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.23\u0026plusmn;0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 746px;\"\u003e\n \u003cp\u003eAL, axial length; SP, Single vision spectacles, HAL, highly aspherical lenslets, OK, Orthokeratology lenses, A, add atropine drop.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\n \n\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"746\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 746px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3. Comparison of the AL elongation of myopic children in different groups under different ages and SE.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eGroups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eAL elongation (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 519px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 746px;\"\u003e\n \u003cp\u003eAge: 8-10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eOK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.25\u0026plusmn;0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 519px;\"\u003e\n \u003cp\u003eP\u003csub\u003eOK VS OKA\u003c/sub\u003e=0.258, P\u003csub\u003eOK VS HAL\u003c/sub\u003e=0.014, P\u003csub\u003eOK VS HALA\u003c/sub\u003e\u0026lt;0.001, P\u003csub\u003eOK VS SP\u0026nbsp;\u003c/sub\u003e\u0026lt;0.001, P\u003csub\u003eOK VS SPA\u003c/sub\u003e= 0.741\u003c/p\u003e\n \u003cp\u003eP\u003csub\u003eOKA VS HAL\u003c/sub\u003e=0.230, P\u003csub\u003eOKA VS HALA\u003c/sub\u003e=0.001, P\u003csub\u003eOKA VS SP\u0026nbsp;\u003c/sub\u003e\u0026lt;0.001, P\u003csub\u003eOKA VS SPA\u0026nbsp;\u003c/sub\u003e= 0.160\u003c/p\u003e\n \u003cp\u003eP\u003csub\u003eHAL VS HALA\u003c/sub\u003e=0.009, P\u003csub\u003eHAL VS SP\u0026nbsp;\u003c/sub\u003e\u0026lt;0.001, P\u003csub\u003eHAL VS SPA\u003c/sub\u003e= 0.007\u003c/p\u003e\n \u003cp\u003eP\u003csub\u003eHALA VS SP\u0026nbsp;\u003c/sub\u003e\u0026lt;0.001, P\u003csub\u003eHALA VS SPA\u003c/sub\u003e\u0026lt;0.001\u003c/p\u003e\n \u003cp\u003eP\u003csub\u003eSP VS SPA\u003c/sub\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eOKA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.20\u0026plusmn;0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eHAL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.16\u0026plusmn;0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eHALA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.09\u0026plusmn;0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eSP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.43\u0026plusmn;0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eSPA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.26\u0026plusmn;0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 746px;\"\u003e\n \u003cp\u003eAge: 11-13 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eOK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.25\u0026plusmn;0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" style=\"width: 519px;\"\u003e\n \u003cp\u003eP\u003csub\u003eOK VS OKA\u003c/sub\u003e=0.003 P\u003csub\u003eOK VS HAL\u003c/sub\u003e=0.037, P\u003csub\u003eOK VS HALA\u003c/sub\u003e\u0026lt;0.001, P\u003csub\u003eOK VS SP\u0026nbsp;\u003c/sub\u003e=0.822, P\u003csub\u003eOK VS SPA\u003c/sub\u003e= 0.043\u003c/p\u003e\n \u003cp\u003eP\u003csub\u003eOKA VS HAL\u003c/sub\u003e=0.150, P\u003csub\u003eOKA VS HALA\u003c/sub\u003e=0.488, P\u003csub\u003eOKA VS SP\u0026nbsp;\u003c/sub\u003e\u0026lt;0.001,, P\u003csub\u003eOKA VS SPA\u0026nbsp;\u003c/sub\u003e= 0.214\u003c/p\u003e\n \u003cp\u003eP\u003csub\u003eHAL VS HALA\u003c/sub\u003e=0.033, P\u003csub\u003eHAL VS SP\u0026nbsp;\u003c/sub\u003e=0.005, P\u003csub\u003eHAL VS SPA\u003c/sub\u003e= 0.915\u003c/p\u003e\n \u003cp\u003eP\u003csub\u003eHALA VS SP\u0026nbsp;\u003c/sub\u003e\u0026lt;0.001, P\u003csub\u003eHALA VS SPA\u003c/sub\u003e=0.057\u003c/p\u003e\n \u003cp\u003eP\u003csub\u003eSP VS SPA\u003c/sub\u003e=0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eOKA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.03\u0026plusmn;0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eHAL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.12\u0026plusmn;0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eHALA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e-0.03\u0026plusmn;0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eSP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.27\u0026plusmn;0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eSPA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.11\u0026plusmn;0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 746px;\"\u003e\n \u003cp\u003eSE: -0.25~-3.00 D\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eOK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.27\u0026plusmn;0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 519px;\"\u003e\n \u003cp\u003eP\u003csub\u003eOK VS OKA\u003c/sub\u003e=0.122, P\u003csub\u003eOK VS HAL\u003c/sub\u003e=0.001, P\u003csub\u003eOK VS HALA\u003c/sub\u003e\u0026lt;0.001, P\u003csub\u003eOK VS SP\u0026nbsp;\u003c/sub\u003e\u0026lt;0.001, P\u003csub\u003eOK VS SPA\u003c/sub\u003e= 0.973\u003c/p\u003e\n \u003cp\u003eP\u003csub\u003eOKA VS HAL\u003c/sub\u003e=0.108, P\u003csub\u003eOKA VS HALA\u003c/sub\u003e\u0026lt;0.001, P\u003csub\u003eOKA VS SP\u0026nbsp;\u003c/sub\u003e\u0026lt;0.001, P\u003csub\u003eOKA VS SPA\u0026nbsp;\u003c/sub\u003e= 0.141\u003c/p\u003e\n \u003cp\u003eP\u003csub\u003eHAL VS HALA\u003c/sub\u003e=0.003, P\u003csub\u003eHAL VS SP\u0026nbsp;\u003c/sub\u003e\u0026lt;0.001, P\u003csub\u003eHAL VS SPA\u003c/sub\u003e= 0.001\u003c/p\u003e\n \u003cp\u003eP\u003csub\u003eHALA VS SP\u0026nbsp;\u003c/sub\u003e\u0026lt;0.001, P\u003csub\u003eHALA VS SPA\u003c/sub\u003e\u0026lt;0.001\u003c/p\u003e\n \u003cp\u003eP\u003csub\u003eSP VS SPA\u003c/sub\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eOKA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.21\u0026plusmn;0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eHAL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.15\u0026plusmn;0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eHALA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.06\u0026plusmn;0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eSP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.46\u0026plusmn;0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eSPA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.27\u0026plusmn;0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 746px;\"\u003e\n \u003cp\u003eSE: \u0026le; -3.125 D\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eOK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.19\u0026plusmn;0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 519px;\"\u003e\n \u003cp\u003eP\u003csub\u003eOK VS OKA\u003c/sub\u003e=0.202, P\u003csub\u003eOK VS HAL\u003c/sub\u003e=0.704, P\u003csub\u003eOK VS HALA\u003c/sub\u003e=0.197, P\u003csub\u003eOK VS SP\u0026nbsp;\u003c/sub\u003e=0.042, P\u003csub\u003eOK VS SPA\u003c/sub\u003e= 0.594\u003c/p\u003e\n \u003cp\u003eP\u003csub\u003eOKA VS HAL\u003c/sub\u003e=0.278, P\u003csub\u003eOKA VS HALA\u003c/sub\u003e=0.991, P\u003csub\u003eOKA VS SP\u0026nbsp;\u003c/sub\u003e\u0026lt;0.001, P\u003csub\u003eOKA VS SPA\u0026nbsp;\u003c/sub\u003e= 0.461\u003c/p\u003e\n \u003cp\u003eP\u003csub\u003eHAL VS HALA\u003c/sub\u003e=0.269, P\u003csub\u003eHAL VS SP\u0026nbsp;\u003c/sub\u003e=0.004, P\u003csub\u003eHAL VS SPA\u003c/sub\u003e= 0.820\u003c/p\u003e\n \u003cp\u003eP\u003csub\u003eHALA VS SP\u0026nbsp;\u003c/sub\u003e\u0026lt;0.001, P\u003csub\u003eHALA VS SPA\u003c/sub\u003e=0.458\u003c/p\u003e\n \u003cp\u003eP\u003csub\u003eSP VS SPA\u003c/sub\u003e=0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eOKA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.12\u0026plusmn;0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eHAL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.17\u0026plusmn;0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eHALA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.12\u0026plusmn;0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eSP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.30\u0026plusmn;0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eSPA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.16\u0026plusmn;0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 746px;\"\u003e\n \u003cp\u003eAL, axial length; SE, spherical equivalent refraction; SP, Single vision spectacles, HAL, highly aspherical lenslets, OK, Orthokeratology lenses, A, add atropine drop.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Myopia, Orthokeratology, Axial length, Atropine ","lastPublishedDoi":"10.21203/rs.3.rs-7126632/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7126632/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePurpose\u003cstrong\u003e:\u003c/strong\u003e To evaluate axial length changes in myopic children treated with different optical correction methods combined with 0.01% atropine eye drops.\u003c/p\u003e\n\u003cp\u003eMethods\u003cstrong\u003e:\u003c/strong\u003e This retrospective study included 366 myopic children (366 eyes) from the Eye Hospital of Wenzhou Medical University (January 2021-December 2024). Participants were stratified into six groups: orthokeratology (OK, n=52), OK + atropine (OKA, n=50), highly aspherical lenslets (HAL, n=83), HAL + atropine (HALA, n=69), single-vision spectacles (SP, n=65), and SP + atropine (SPA, n=47). Axial length (AL) elongation after one year was compared using one-way ANOVA.\u003c/p\u003e\n\u003cp\u003eResults\u003cstrong\u003e:\u003c/strong\u003e After one year, AL elongation differed significantly across groups (F=25.345 P\u0026lt;0.001). The OK (0.25±0.13 mm), OKA (0.18±0.14 mm), HAL (0.16±0.16 mm), HALA (0.08±0.19 mm), and SPA (0.23±0.18 mm) groups all showed significantly less AL elongation than the SP group (0.39±0.20 mm; all P\u0026lt;0.001). The HALA group demonstrated the strongest effect (P\u0026lt;0.01 vs. others), and both OKA and HALA outperformed OK (P=0.036) and HAL (P=0.004). Adjunctive 0.01% atropine therapy significantly attenuated AL elongation in older children with myopia, with the most pronounced reduction observed in the OKA group (0.03±0.14 mm). Among subjects with higher baseline refractive error, both OKA (0.12±0.13 mm) and SPA (0.16±0.19 mm) groups demonstrated significantly slower AL progression, whereas the HALA (0.12±0.21 mm) cohort exhibited comparatively less effective control of AL growth.\u003c/p\u003e\n\u003cp\u003eConclusion\u003cstrong\u003e:\u003c/strong\u003e Combining OK, HAL, or SP with 0.01% atropine demonstrated significant efficacy in retarding myopia progression. And OKA and SPA exhibited superior control efficacy in older children with higher myopia, while HALA achieved greater outcomes specifically in older myopic children across refractive strata.\u003c/p\u003e","manuscriptTitle":"Comparative Efficacy of Optical Correction Methods Combined with 0.01% Atropine in Myopia Control","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-04 09:16:40","doi":"10.21203/rs.3.rs-7126632/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-08-04T09:04:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"146949068543805996165670404101223185967","date":"2025-07-30T09:11:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"91010846093062366264878676810696577076","date":"2025-07-30T01:54:02+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-30T01:28:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-24T11:58:54+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-22T10:26:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-19T00:54:56+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Ophthalmology","date":"2025-07-19T00:52:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dfb6f650-06da-46e7-8bf7-21b494dafafa","owner":[],"postedDate":"August 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-01T16:12:13+00:00","versionOfRecord":{"articleIdentity":"rs-7126632","link":"https://doi.org/10.1186/s12886-025-04523-9","journal":{"identity":"bmc-ophthalmology","isVorOnly":false,"title":"BMC Ophthalmology"},"publishedOn":"2025-11-26 15:58:48","publishedOnDateReadable":"November 26th, 2025"},"versionCreatedAt":"2025-08-04 09:16:40","video":"","vorDoi":"10.1186/s12886-025-04523-9","vorDoiUrl":"https://doi.org/10.1186/s12886-025-04523-9","workflowStages":[]},"version":"v1","identity":"rs-7126632","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7126632","identity":"rs-7126632","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}