A recent trial showed that 0.05% atropine was the most effective in controlling both axial length and refractive error progression, and should be the starting point for drug treatment.
While multiple studies are underway to explore the combination of drug and device treatments, we still lack sufficient evidence about when to add another treatment or when to switch treatments. Unfortunately, there is no way to determine which treatment will be most effective for which children. Online calculators may overestimate the myopia control effect, but current work aims to develop standard “ocular growth curves” that may help better determine whether a treatment is effective.
Until then, the best treatment plan includes regular monitoring of cycloplegic autorefraction and axial length, and discussions about general expectations for progression (i.e., 0.50 to 1.00 D/year). Due to expected seasonal variations in progression, it’s not recommended to change treatments before at least a year, unless there are issues with intolerance or noncompliance.