The synergistic efficacy and safety of combined low‐concentration atropine and orthokeratology for slowing the progression of myopia: A meta‐analysis

Abstract Purpose To explore the efficacy and safety of combined low‐concentration atropine and orthokeratology (OK) for slowing the progression of myopia. Methods We performed a systematic search of English and Chinese databases to collect potentially eligible randomised controlled trials (RCTs), nonrandomised controlled trials (non‐RCTs) and retrospective cohort studies (REs) published between the establishment of the database and 1 January 2022. The weighted mean difference (WMD) and 95% confidence interval (CI) were calculated for each outcome. Results Fifteen studies were ultimately included in the meta‐analysis, which indicated that compared with OK lenses alone, the combination of low‐concentration atropine with OK lenses significantly slowed axial growth (WMD = −0.12 mm; 95% CI: −0.13 to −0.11, p < 0.001) and reduced the rate of change of the spherical equivalent refraction (WMD = 0.15 D; 95% CI: 0.06 to 0.24, p < 0.001). Additionally, the combined treatment may cause a slight increase in pupil diameter (WMD = 0.62 mm; 95% CI: 0.42 to 0.81, p < 0.001). No significant difference in the amplitude of accommodation, intraocular pressure, tear film break‐up time or corneal endothelial cell density was found between the OK and combination therapy groups. Conclusions The combination therapy of low‐concentration atropine and OK lenses had a greater effect in slowing myopia progression during a 6‐to‐12‐month treatment interval and was still effective over a 24‐month period. Increased pupil diameter was the major side effect of the combination therapy, with no negative impact on the amplitude of accommodation, intraocular pressure, tear film break‐up time or corneal endothelial cell density.