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In this retrospective cohort study, 101 children (199 eyes; age 8\u201313\u00a0years) with axial myopia initially treated with Ortho-K (2020\u20132024) were analyzed. Participants exhibiting suboptimal responses (axial elongation\u2009\u2265\u20090.15\u00a0mm\/6\u00a0months or \u2265\u20090.30\u00a0mm\/12\u00a0months) received sequential atropine therapy. Outcomes included axial length changes and adverse event rates across concentration groups. Sequential addition of 0.01%, 0.025%, and 0.05% atropine to Ortho-K reduced annual axial elongation by 28.4%, 31.4%, and 39.4%, respectively (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05 vs. Ortho-K monotherapy). While no severe adverse events occurred, photophobia incidence escalated with higher concentrations (0.05%: 26.3% vs. 0.01%: 8.9%, 0.025%: 11.8%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Near-vision blur occurred exclusively in the 0.05% group (15%). Stepwise atropine escalation following Ortho-K demonstrates clinically meaningful, concentration-dependent myopia control with acceptable tolerability. This sequential strategy provides personalized management for children with rapid progression, balancing efficacy and ocular tolerability.\n                  <\/jats:p>","DOI":"10.1038\/s41598-025-22722-8","type":"journal-article","created":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T13:47:35Z","timestamp":1762436855000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Efficacy and safety of orthokeratology sequentially combined with escalating atropine concentrations for myopia control in children"],"prefix":"10.1038","volume":"15","author":[{"given":"Ziqi","family":"Guo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyuan","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongfei","family":"Ming","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijun","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,6]]},"reference":[{"key":"22722_CR1","first-page":"156","volume":"118","author":"JR Landreneau","year":"2021","unstructured":"Landreneau, J. 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Ophthalmol."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-22722-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-22722-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-22722-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T15:02:57Z","timestamp":1762441377000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-22722-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,6]]},"references-count":55,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["22722"],"URL":"https:\/\/doi.org\/10.1038\/s41598-025-22722-8","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,6]]},"assertion":[{"value":"13 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 November 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"All procedures were performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. This study was approved by the Ethics Committee of Shenyang Sinqi Eye Hospital, with the ethics number: 2024-010-01. The study complied with the principles of the Helsinki Declaration. The parents and legal guardians of the children had fully understood the purpose and methods of this study and provided written consent for the use of data for scientific reasons in this study. The study was carried out in accordance with the applicable guidelines and regulations.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}],"article-number":"38911"}}