Adjunctive 0.05% Atropine for Children with Continued Rapid Myopia Progression During Defocus Incorporated Multiple Segments Spectacle Lens Treatment: A Retrospective Matched Cohort Study

Defocus Incorporated Multiple Segments (DIMS) lenses slow myopia progression, but some children continue to experience rapid axial elongation despite treatment. This study evaluated whether adjunctive 0.05% atropine was associated with additional myopia control in children with an insufficient response to DIMS monotherapy. This retrospective matched cohort study included 54 children with rapid myopia progression during initial DIMS lens wear. We matched 27 children receiving adjunctive 0.05% atropine with 27 children who continued DIMS monotherapy by age, sex, axial length, and spherical equivalent refraction (SER). A pre-intervention observation period of approximately 6 months was used to identify children with rapid axial elongation during initial DIMS monotherapy, followed by an approximately 12-month intervention period to compare progression outcomes between groups. Statistical analyses included t tests, chi-square tests, analysis of covariance, and multivariable linear regression. Baseline characteristics were comparable between groups. During the pre-intervention phase, the time-normalized axial elongation rate was similar between the monotherapy and combination groups (0.47 ± 0.03 vs. 0.54 ± 0.03 mm/year, P = 0.170), whereas the combination group showed greater myopic SER progression than the monotherapy group (− 0.98 ± 0.10 vs. − 0.61 ± 0.11 D/year, P = 0.016). During the intervention phase, after adjustment for the corresponding pre-intervention progression rate, the adjusted axial elongation rate was lower in the combination group than in the monotherapy group (0.12 ± 0.04 vs. 0.31 ± 0.04 mm/year, P = 0.001), as was SER progression (− 0.19 ± 0.08 vs. − 0.55 ± 0.08 D/year, P = 0.001). In children with rapid myopia progression during DIMS lens treatment, adjunctive 0.05% atropine was associated with a lower axial elongation rate and slower SER progression than continued DIMS monotherapy. These findings support further prospective evaluation of this treatment strategy.