Adjunctive 0.05% Atropine for Children with Continued Rapid Myopia Progression During Defocus Incorporated Multiple Segments Spectacle Lens Treatment: A Retrospective Matched Cohort Study.

INTRODUCTION: Defocus Incorporated Multiple Segments (DIMS) lenses slow myopia progression, but some children continue to experience rapid axial elongation despite treatment. This study evaluated whether adjunctive 0.05% atropine was associated with additional myopia control in children with an insufficient response to DIMS monotherapy. METHODS: This retrospective matched cohort study included 54 children with rapid myopia progression during initial DIMS lens wear. We matched 27 children receiving adjunctive 0.05% atropine with 27 children who continued DIMS monotherapy by age, sex, axial length, and spherical equivalent refraction (SER). A pre-intervention observation period of approximately 6 months was used to identify children with rapid axial elongation during initial DIMS monotherapy, followed by an approximately 12-month intervention period to compare progression outcomes between groups. Statistical analyses included t tests, chi-square tests, analysis of covariance, and multivariable linear regression. RESULTS: Baseline characteristics were comparable between groups. During the pre-intervention phase, the time-normalized axial elongation rate was similar between the monotherapy and combination groups (0.47 ± 0.03 vs. 0.54 ± 0.03 mm/year, P = 0.170), whereas the combination group showed greater myopic SER progression than the monotherapy group (- 0.98 ± 0.10 vs. - 0.61 ± 0.11 D/year, P = 0.016). During the intervention phase, after adjustment for the corresponding pre-intervention progression rate, the adjusted axial elongation rate was lower in the combination group than in the monotherapy group (0.12 ± 0.04 vs. 0.31 ± 0.04 mm/year, P = 0.001), as was SER progression (- 0.19 ± 0.08 vs. - 0.55 ± 0.08 D/year, P = 0.001). CONCLUSIONS: In children with rapid myopia progression during DIMS lens treatment, adjunctive 0.05% atropine was associated with a lower axial elongation rate and slower SER progression than continued DIMS monotherapy. These findings support further prospective evaluation of this treatment strategy.