Combination Therapy in Pediatric Myopia Control: Synergistic Effects of Optical and Pharmacological Interventions

This article systematically reviews the evidence for combination therapy in pediatric myopia control and examines the synergistic potential of optical and pharmacological interventions. A comprehensive narrative literature review of randomized controlled trials, observational studies, and meta-analyses evaluating combination approaches for myopia control in children was conducted, with a particular focus on orthokeratology, multifocal contact lenses, and defocus incorporated multiple segments (DIMS) or highly aspherical lenslet (HAL) spectacles combined with low-concentration atropine. Current evidence demonstrates that combination therapy achieves additional slowing of myopia progression compared to that with optical interventions alone. The combination of orthokeratology and low-dose atropine has been studied extensively. Although several studies have shown that combination therapies yield additional effects, these effects are not always statistically significant. Emerging evidence supports a similar efficacy for multifocal soft contact lenses and DIMS or HAL spectacles combined with atropine. Mechanistic synergy appears to involve complementary pathways; optical interventions modulate peripheral defocus signals, whereas atropine acts directly on choroidal and scleral tissues. Combination therapy may show promising effects in myopic management in specific patient groups. The convergence of evidence from multiple optical modalities combined with atropine suggests its broad applicability. However, the optimal treatment protocols, long-term efficacy beyond 2–3 years, population-specific response variations, and cost-effectiveness in different healthcare contexts require further investigation.