Editor’s Perspective

Combination Therapy

October 3, 2022

By Dwight Akerman, OD, MBA, FAAO, FBCLA, FIACLE

Combination therapy is widely prescribed in medicine. The simultaneous use of multiple drugs as part of a treatment regimen against a specific disease often improves effectiveness, prevents drug resistance, and minimizes side effects.

For example, combination therapy is a hallmark of cancer treatment. The complexity of the disease, its tendency to spread beyond its original site and become resistant to certain drugs, and its genetic diversity underscore the need for various approaches to attack it. Although juvenile-onset myopia may not be as complex as cancer, combination therapy is increasingly being explored to improve the efficacy of myopia progression control strategies.

It is proposed that the aim of managing juvenile-onset myopia is to slow axial elongation to levels no greater than experienced by emmetropes, i.e., normal physiological eye growth. Chamberlain et al. proposed placing axial elongation in the context of normal eye growth in emmetropic children. Achieving axial length elongation no greater than normal physiological eye growth is not always possible with a single therapy.

Combination therapy is a logical and systematic approach to improving the patient experience and/or efficacy obtained with monotherapy alone. Therefore, researchers and clinicians are increasingly exploring combination therapy. Examples of combination therapy for myopia control include:

  • orthokeratology combined with topical low-dose atropine 
  • myopia control soft lenses combined with topical low-dose atropine
  • novel myopia control spectacles combined with topical low-dose atropine 
  • myopia control soft lenses combined with increased outdoor time 

Triple combination therapy is also possible. For example, myopia control soft lenses combined with novel myopia control spectacles and topical low-dose atropine may be prescribed for fast-progressing myopic children with multiple risk factors for high myopia.

Although further work is needed to understand the underlying mechanisms and optimization of treatment methods, the results from studies published thus far are encouraging for combination treatments. None of the above-mentioned combination regimens are FDA approved, so if prescribed, informed consent is recommended.

For more information on this fascinating topic, I recommend reading Combination Strategies for Myopia Management by Huy Tran, MD, and Padmaja Sankaridurg, PhD.

Best professional regards,

Dwight H. Akerman, OD, MBA, FAAO, FBCLA, FIACLE
Chief Medical Editor

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