Current Evidence on Options and Efficacy of Combination Therapy for Myopia Control-A Narrative Review

Combination therapy for controlling myopia progression has become a topic of interest among both clinicians and researchers because of the rising demand to control rapidly progressing myopia. This review recapitulates the need and basis of combination therapy, the different classes of combination options available, their safety and efficacy.

Overall, combination therapies demonstrated greater control of axial elongation than monotherapy. Myopia control spectacles with atropine showed axial elongation of 0.05-0.28 mm/year compared with 0.13-0.41 mm/year with monotherapy. Orthokeratology plus atropine reduced axial elongation by an additional 0.09-0.29 mm compared to orthokeratology alone, 0.19 to 0.48 mm over 12-24 months. Evidence for multifocal contact lenses with atropine remains limited. Emerging combinations, including light therapy and pharmacological agents (other than atropine) with optical strategies, need more evidence. Combination therapy appears to be well tolerated with reports showing minimal adverse effects, which need to be carefully assessed on a case-by-case manner. By potentially targeting multiple biological pathways, combination therapy is becoming one of the promising approaches to enhance myopia control efficacy, particularly in fast progressors. Combination therapy presents challenges, including issues with compliance with both modalities, managing side-effects and increased expense. Therefore, combination therapy may be better reserved for individuals with fast progression, be it predicted or established.