# Efficacy and safety of orthokeratology sequentially combined with escalating atropine concentrations for myopia control in children

## TL;DR

Combining orthokeratology with increasing atropine concentrations helps control myopia in children, with higher atropine offering better results but more side effects.

## Contribution

A stepwise regimen combining orthokeratology and escalating atropine concentrations for myopia control is evaluated for efficacy and safety.

## Key findings

- Adding 0.01%, 0.025%, and 0.05% atropine reduced axial elongation by 28.4%, 31.4%, and 39.4%, respectively.
- Higher atropine concentrations caused more photophobia and near-vision blur.
- The sequential strategy offers personalized myopia control with acceptable tolerability.

## Abstract

To evaluate the concentration-dependent efficacy and safety of sequential orthokeratology (Ortho-K) combined with atropine eye drops (0.01%, 0.025%, 0.05%) for controlling axial elongation in children with progressive myopia, and to characterize clinical outcomes of this stepwise regimen. In this retrospective cohort study, 101 children (199 eyes; age 8–13 years) with axial myopia initially treated with Ortho-K (2020–2024) were analyzed. Participants exhibiting suboptimal responses (axial elongation ≥ 0.15 mm/6 months or ≥ 0.30 mm/12 months) received sequential atropine therapy. Outcomes included axial length changes and adverse event rates across concentration groups. Sequential addition of 0.01%, 0.025%, and 0.05% atropine to Ortho-K reduced annual axial elongation by 28.4%, 31.4%, and 39.4%, respectively (p < 0.05 vs. Ortho-K monotherapy). While no severe adverse events occurred, photophobia incidence escalated with higher concentrations (0.05%: 26.3% vs. 0.01%: 8.9%, 0.025%: 11.8%, p < 0.001). Near-vision blur occurred exclusively in the 0.05% group (15%). Stepwise atropine escalation following Ortho-K demonstrates clinically meaningful, concentration-dependent myopia control with acceptable tolerability. This sequential strategy provides personalized management for children with rapid progression, balancing efficacy and ocular tolerability.

The online version contains supplementary material available at 10.1038/s41598-025-22722-8.