A Real-world Study Comparing Atropine Monotherapy vs. the Combined Treatment with Peripheral Defocus Lenses and Low-dose Atropine

Objective The objective of this study was to evaluate whether the combination of low-dose atropine (LDA) and peripheral defocus lenses (Defocus Incorporated Multiple Segments, DIMS) provides additional benefit for children undergoing myopia management. Methods This was a retrospective study including fifty-one patients aged 8 to 13 years who attended a private clinic between January 2020 and September 2021. Subjects were selected based on documented myopia progression of ≥0.50 D/year during the previous 12 months. Following the initial diagnosis of myopia, participants were advised to spend at least 2 hours per day outdoors for 6 months (Phase 1 – environmental control). If axial length (AL) increased by > 0.15 mm during this period, participants were prescribed nightly LDA (0.025%) for the following 12 months (Phase 2 – monotherapy). If, at the 12-month visit, AL continued to increase by > 0.17 mm/year, combination treatment with LDA and DIMS lenses was initiated for a further 12 months. Only data from the right eye were analyzed. Treatment efficacy was evaluated by comparing the differences in myopia progression across the treatment periods. Results The mean age of patients was 10.16 ± 1.63 years. Males comprised 25 (49.02%) of the subjects. At baseline, the mean spherical equivalent refraction, median keratometry, and AL were -3.01 ± 1.22 D, 43.13 ± 1.19 D, and 24.60 ± 1.03 mm, respectively. At phase 1, the mean progression in AL was estimated to be 0.39 ± 0.09 mm/year. The combined treatment significantly reduced the progression of myopia compared to LDA monotherapy (0.21 ± 0.03 versus 0.13 ± 0.05 mm, p < 0.0001). Discussion The pharmaceutical intervention that is most frequently employed in clinical settings is atropine 0.01%. Nevertheless, a number of studies demonstrated low efficacy in the long term, particularly when AL elongation was the desired outcome. Additionally, it has been proposed that the most effective LDA tested in the young Asian population is 0.05% atropine; however, in the Western population, there were reports of frequent side effects when using this LDA. The combined treatment using atropine 0.025% was one option to increase the efficiency of reduction in myopia progression. Conclusion The combination of DIMS spectacle lenses and LDA achieved the greatest reduction in myopia progression, as measured by axial length elongation, compared with LDA monotherapy or environmental control in this Brazilian population. Further randomized, double-blind clinical trials with longer follow-up are warranted to better determine the true impact of this combination therapy on myopia progression.