Efficacy of Combined Highly Aspherical Lenslet Target (HALT) Spectacles and Low-Dose Atropine in Children with Poor Response to Atropine Monotherapy over 24 Months

Objectives: To evaluate the 24-month efficacy of combining highly aspherical lenslet target (HALT) spectacle lenses with low-dose atropine (LDA) in children with poor response to atropine monotherapy. Methods: This prospective interventional cohort study included myopic children aged 6–11 years who continued to progress despite LDA (0.01–0.025%). Fifty children completed 12 months of follow-up and 48 completed 24 months. At 12 months, atropine dosage was maintained, reduced, or increased according to clinical discretion. Cycloplegic spherical equivalent refraction (SER) and axial length (AL) were measured at baseline, 12 months, and 24 months. Results: Myopia progression during the first year (SER: −0.07 ± 0.45 D; AL: 0.13 ± 0.14 mm) was markedly lower than during the 6 months before treatment (SER: −0.61 ± 0.39 D; AL: 0.24 ± 0.12 mm). During the second year, atropine dosage was reduced in 23%, maintained in 67%, and increased in 10% of participants. Mean second-year progression was −0.26 ± 0.41 D and 0.17 ± 0.17 mm, with no significant differences between treatment groups. Although second-year SER progression exceeded first-year progression (p = 0.003), both SER and AL progression remained significantly lower than pre-treatment rates (p = 0.004). Over 24 months, 73.9% of eyes progressed ≤ 0.50 D and 71.7% progressed ≤ 0.40 mm. Younger age and greater first-year progression independently predicted greater 24-month SER and AL progression. Conclusions: Myopia progression was relatively well sustained over 24 months after combination treatment was started in children previously progressing on LDA. Younger children and those with greater early progression may warrant closer monitoring.