As myopia prevalence continues to climb, interest is growing in combination therapies that target multiple pathways of eye growth. New data from the ASPECT randomized controlled trial suggest that pairing low-dose atropine with Defocus Incorporated Multiple Segments (DIMS) spectacle lenses may offer enhanced control of axial elongation compared with pharmacological treatment alone.
The 12-month results, published in the British Journal of Ophthalmology, provide some of the strongest evidence to date supporting a multimodal approach to myopia management – particularly in pediatric populations.
Trial design and outcomes
The study enrolled children aged 4–16 years with myopia between −1.00D and −6.00D, randomizing them to receive either 0.025% atropine plus single-vision (SV) spectacles (group A) or 0.025% atropine combined with DIMS lenses (group B). A total of 102 participants completed the 12-month follow-up.
The primary endpoint – axial length (AL) change – favored combination therapy. Axial elongation at 12 months was 0.18 mm in the atropine-only group compared with just 0.07 mm in the combination group, a statistically significant difference of 0.11 mm.
Importantly, nearly 40% of children receiving combination therapy showed no axial elongation over the study period, compared with just 12% in the control group. This finding is clinically meaningful, as axial elongation is a key driver of long-term myopia-related complications.
Changes in spherical equivalent refraction (SER) were directionally favorable but did not reach statistical significance, with progression of −0.09D in the combination group versus −0.19D in controls at 12 months.
One of the more compelling aspects of the study is its comparison to physiological eye growth. Using the age-matched myopia control framework, the study authors demonstrate that children in the combination group achieved axial elongation rates comparable to emmetropic peers.
As illustrated in the study, most patients receiving DIMS plus atropine fell within the “green zone,” representing normal physiological growth, whereas many in the monotherapy group exceeded expected elongation rates.
This reframes treatment success: rather than simply slowing progression, the goal becomes normalizing eye growth trajectories.
Both atropine and DIMS lenses are well-established monotherapies, each reducing myopia progression by approximately 50–60% in previous studies. However, their mechanisms differ. Atropine is thought to act via biochemical pathways influencing scleral remodeling and neurotransmission, while DIMS lenses impose peripheral myopic defocus to modulate retinal signaling.
The additive effect observed in ASPECT suggests these pathways may be complementary. One hypothesis is that atropine-induced pupil dilation enhances exposure to the defocus segments in DIMS lenses, amplifying their effect – although this study did not find a direct association between pupil size and outcomes.
For clinicians, the findings support a more proactive, tailored approach to myopia management – particularly in younger or fast-progressing patients. Achieving near-physiological axial growth could translate into reduced lifetime risk of complications such as myopic maculopathy and retinal detachment.
Encouragingly, tolerability was good, with few discontinuations due to side effects. However, adherence remains a practical challenge in combination regimens, requiring both consistent drop instillation and spectacle wear.
These 12-month results represent an interim analysis of a 24-month trial, and longer-term data will be critical in confirming durability of effect. Questions also remain around optimal atropine dosing and how combination therapy compares with other strategies, such as orthokeratology-based approaches.
Nonetheless, ASPECT adds to a growing body of evidence that myopia control may be most effective when approached from multiple angles. For eye care professionals, it signals a shift toward combination strategies as a new standard in managing this increasingly prevalent condition.
