Effectiveness of Atropine vs. Orthokeratology in Controlling Myopia Progression

Background: The global rise in childhood myopia has intensified the need for effective interventions that can slow its progression and prevent long-term ocular complications. Objective: To evaluate and compare the effectiveness of atropine and orthokeratology in controlling myopia progression in children. Methods: This retrospective comparative study was conducted at Alshifa Eye Trust Hospital Rawalpindi from June 2024 to June 2025 included 165 children diagnosed with progressive myopia who received either atropine therapy (n = 82) or orthokeratology lenses (n = 83). Clinical records were reviewed to collect baseline refractive error, axial length, age, gender, and follow-up data at 6 and 12 months. Outcomes measured included change in spherical equivalent refractive error, axial length elongation, and treatment-related complications. Results: At 12 months, children in the atropine group showed a smaller mean increase in axial length (0.22 ± 0.09 mm) compared with the orthokeratology group (0.32 ± 0.11 mm). Refractive progression was also lower in the atropine group (−0.38 ± 0.24 D) than in the orthokeratology group (−0.59 ± 0.28 D). Treatment-related complications were more frequently observed in the orthokeratology group (18.1%) compared with the atropine group (7.3%), primarily due to lens intolerance and mild superficial keratitis. Conclusion: Atropine demonstrated greater overall effectiveness in controlling myopia progression than orthokeratology over the 12-month period, with fewer complications and more consistent results across patients.