Efficacy of orthokeratology combined with atropine versus orthokeratology alone for myopia control in children: a meta-analysis

Objective To systematically evaluate the efficacy of orthokeratology combined with atropine versus orthokeratology alone in treating myopia in children. Methods Randomized controlled trials (RCTs) comparing the efficacy of orthokeratology combined with atropine versus orthokeratology alone for pediatric myopia were retrieved from databases including CNKI, Wanfang, VIP, CBM, PubMed, Cochrane Library, Embase, and Web of Science from inception to April 2025. Data were analyzed using RevMan 5.2 software. Results A total of 18 randomized controlled trials involving 1,669 myopic children were included. The analysis showed that the intervention group had greater improvements in axial elongation (SMD = −0.66, 95% CI = −0.80 to −0.53, p < 0.001), tear film break-up time (SMD = 0.48, 95% CI = 0.33 to 0.63, p < 0.001), and corneal curvature (SMD = −2.47, 95% CI = −4.21 to −0.73, p = 0.005) compared to the control group. However, no statistically significant differences were found between the two groups in uncorrected visual acuity (SMD = 0.49, 95% CI = −0.27 to 1.24, p = 0.21) or tear film lipid layer thickness (SMD = −0.00, 95% CI = −1.09 to 1.09, p = 1.00). In addition, increased pupil diameter (SMD = 0.37, 95% CI = 0.09 to 0.64, p < 0.001) and reduced accommodative amplitude (SMD = −1.50, 95% CI = −2.58 to −0.43, p = 0.006) reflected the side effects associated with combined atropine treatment. Conclusion Compared with orthokeratology alone, orthokeratology combined with atropine treatment reduces axial elongation, tear film break-up time, and corneal curvature in myopic children, but shows no significant advantage in uncorrected visual acuity or tear film lipid layer thickness, while incurring side effects of increased pupil diameter and reduced accommodative amplitude.