Combination Therapy Slows Myopia Progression in Children with Premyopia

The global rise in childhood myopia has sharpened attention on strategies to intervene before full disease onset. Premyopia—a refractive state that signals increased risk for progression—has emerged as an key stage for prevention. A randomized clinical trial from China, published in Ophthalmology and Therapy, now provides one of the most detailed head-to-head assessments of pharmacologic and optical approaches in this setting .

Study designed for early intervention
The trial enrolled 400 children aged six to twelve years with premyopia. Participants were randomized equally into four groups: nightly 0.01% atropine eye drops, novel lenslet-array–integrated spectacle lenses (LARI), a combination of both, or no intervention. Outcomes were tracked for one year, focusing on the incidence of myopia, fast myopic shift, changes in refractive error and axial length, and exploratory measures including choroidal thickness and uncorrected visual acuity.

Marked reductions in myopia onset and progression
By twelve months, myopia incidence was 13% with atropine, 10% with LARI, 2% with combination therapy, and 60% in the control group. Similarly, fast myopic shift occurred in 37% of children using atropine, 25% using LARI, and 11% on combination therapy, compared with nearly 79% in controls. Combination therapy reduced progression by almost 78% relative to control, with clear benefits across refractive and axial length outcomes.

Optical intervention showed strong individual effect
LARI monotherapy outperformed atropine alone, reducing axial elongation by 0.31 mm versus 0.26 mm over one year. Combination therapy offered additional benefit, particularly in younger children (ages six to eight), while monotherapy sufficed for older age groups. Subfoveal choroidal thickness increased significantly in all intervention groups but declined in controls, suggesting a structural correlate of treatment effect.

Safety and tolerability
No serious adverse events were observed. Children tolerated the spectacle lenses well, reporting high comfort scores by six months. Atropine was associated with no cases of elevated intraocular pressure or vision-threatening complications. These findings support the feasibility of both pharmacologic and optical interventions in routine pediatric care.

Limits to consider
The study population was ethnically homogeneous, raising questions about generalizability. Its single-center design, reliance on parent- and child-reported adherence, and one-year follow-up also limit broader application. Longer-term, multicenter studies are needed to confirm whether early intervention can meaningfully shift lifetime risk of high myopia.

Clinical takeaway
For children at risk of myopia, both 0.01% atropine and lenslet-array spectacles significantly delayed disease onset and slowed progression. Combination therapy delivered the strongest effect, especially in younger children, highlighting the value of starting intervention at the premyopic stage. For clinicians, these results strengthen the rationale for moving prevention earlier in the myopia care continuum.

Reference
Gao M, Hou Y, Lu Y, Shi Z, Zhao Q. Efficacy and safety of 0.01% atropine eye drops and novel lenslet-array–integrated spectacle lenses for the prevention of myopia progression among children with premyopia: a randomized clinical trial. Ophthalmol Ther. 2025;14:2481–2496. doi:10.1007/s40123-025-01214-y.