Impact of orthokeratology and low‐dose atropine on corneal biomechanics and myopia progression in children

Abstract Purpose This study evaluated the effects of orthokeratology and 0.01% atropine on corneal biomechanical properties (CBPs) and myopia progression in children, focusing on their association with axial length (AL) changes and treatment outcomes. Methods In this 1‐year prospective study, 53 children (aged 8–17 years) were enrolled, with 30 undergoing orthokeratology and 23 receiving 0.01% atropine. CBP parameters, including the Corvis Biomechanical Index (CBI), central corneal thickness (CCT), biomechanically corrected intraocular pressure (bIOP) and stress–strain index (SSI), were assessed at baseline and during follow‐ups at 1, 3, 6, 9 and 12 months. The orthokeratology group was further stratified into good and poor responders based on early myopia reduction. Results The orthokeratology group exhibited a significant increase in CBI over time, particularly among good responders, while CCT, bIOP and SSI remained stable. In contrast, no significant changes in CBPs were observed in the atropine group. AL elongation showed no significant correlation with CBP changes in either group. The orthokeratology group achieved superior control of myopia progression compared to the atropine group at 12 months, with poor responders exhibiting better long‐term AL control. Conclusions Both orthokeratology and 0.01% atropine were effective in controlling myopia. While atropine had no impact on CBPs, the increase in CBI with orthokeratology may predict early treatment outcomes. However, the initial response to orthokeratology did not guarantee long‐term effectiveness, highlighting the need for individualised treatment monitoring.