Efficacy of orthokeratology combined with atropine versus orthokeratology alone for myopia control in children: a meta-analysis
In brief
Atropine added to orthokeratology reduces eye-growth by two-thirds of a SD in children
A meta-analysis of 18 trials (1,669 kids) found that combining low-dose atropine with orthokeratology lenses slowed axial elongation significantly more than lenses alone, with modest improvements in tear stability and corneal shape. Visual acuity and tear lipid thickness were unchanged, and the combo caused larger pupils and weaker accommodation, highlighting a trade-off to consider.
- Journal
- Frontiers in medicine (Q1)
- Published
- 24 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Yuchan Li, Meichao Yi, Bing Liu
- PMID
- 42568973
- DOI
- 10.3389/fmed.2026.1786718
Why clinicians should know about it
- Picked for Ophthalmology (top studies of the week, 9 August 2026): Meta-analysis, orthokeratology + atropine improves myopia control
Abstract
OBJECTIVE: To systematically evaluate the efficacy of orthokeratology combined with atropine versus orthokeratology alone in treating myopia in children. METHODS: Randomized controlled trials (RCTs) comparing the efficacy of orthokeratology combined with atropine versus orthokeratology alone for pediatric myopia were retrieved from databases including CNKI, Wanfang, VIP, CBM, PubMed, Cochrane Library, Embase, and Web of Science from inception to April 2025. Data were analyzed using RevMan 5.2 software. RESULTS: A total of 18 randomized controlled trials involving 1,669 myopic children were included. The analysis showed that the intervention group had greater improvements in axial elongation (SMD = -0.66, 95% CI = -0.80 to -0.53, p < 0.001), tear film break-up time (SMD = 0.48, 95% CI = 0.33 to 0.63, p < 0.001), and corneal curvature (SMD = -2.47, 95% CI = -4.21 to -0.73, p = 0.005) compared to the control group. However, no statistically significant differences were found between the two groups in uncorrected visual acuity (SMD = 0.49, 95% CI = -0.27 to 1.24, p = 0.21) or tear film lipid layer thickness (SMD = -0.00, 95% CI = -1.09 to 1.09, p = 1.00). In addition, increased pupil diameter (SMD = 0.37, 95% CI = 0.09 to 0.64, p < 0.001) and reduced accommodative amplitude (SMD = -1.50, 95% CI = -2.58 to -0.43, p = 0.006) reflected the side effects associated with combined atropine treatment. CONCLUSION: Compared with orthokeratology alone, orthokeratology combined with atropine treatment reduces axial elongation, tear film break-up time, and corneal curvature in myopic children, but shows no significant advantage in uncorrected visual acuity or tear film lipid layer thickness, while incurring side effects of increased pupil diameter and reduced accommodative amplitude.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.