Combination therapy for myopia control using defocus incorporated multiple segments spectacles in children refractory to higher-dose atropine.

PURPOSE: To explore the efficacy of myopia control by adding defocus incorporated multiple segments (DIMS) spectacles in children who are refractory to higher-dose atropine control.

METHODS

This prospective cohort study included children aged 6-14 who had previously used ≥0.125% atropine for at least one year and were later treated with DIMS plus atropine for over six months. Annual axial length (AL) changes during monotherapy and combination therapy were compared using paired t-tests. Generalized estimating equations were used to analyze correlations with outcome variables.

RESULTS

In total, 57 eyes from 29 patients (mean age 9.8 years) were included in our final analysis. The mean AL value at the baseline was 24.6 mm. The mean follow-up duration was 27.9 months in the atropine-alone period and 18.2 months in the combination therapy period. Annual AL changes in the combination therapy period were significantly less than in the atropine-alone period (0.19 ± 0.18 mm/year vs. 0.29 ± 0.20 mm/year, P = 0.004). After adjusting for age, pupil size, and atropine concentration and compliance for DIMS together, both annual AL change and spherical power changes were associated with age negatively (P = 0.003 and P = 0.035, respectively).

CONCLUSIONS

Combination therapy of atropine and DIMS was effective in myopia control in children with poor response to atropine treatment alone. Further large-scale and long-term studies are needed to confirm these observations.