Background/Objectives: Choroidal thickness (ChT) changes have been proposed as biomarkers of myopia-control response, but their regional pattern and relationship with axial elongation remain uncertain. We evaluated regional choroidal responses to adding. Defocus Incorporated Multiple Segments (DIMS) spectacles to 0.025% atropine, and asessed biomarker potential of regional and baseline ChT. Methods: This secondary analysis included ASPECT participants with enhanced-depth imaging OCT scans. In ASPECT, 111 myopic children aged 4–16 years were randomized to nightly 0.025% atropine plus DIMS or single-vision spectacles. ChT was measured subfoveally and 1000 µm nasally and temporally at baseline and 6, 12, 18, and 24 months using a validated automated segmentation pipeline. Linear mixed-effects models assessed longitudinal and between-group differences, associations with axial elongation, and effect modification by baseline ChT. Results: 101 children completed 24 months (53 atropine plus DIMS; 48 atropine plus single-vision). In the DIMS group, mean 24-month ChT increases were largest temporally (+22.2 µm), followed by nasally (+15.5 µm) and subfoveally (+10.6 µm). Between-group differences favored DIMS, significant temporally at all visits (p = 0.009–0.040) and nasally at 6, 12, and 24 months (p = 0.030–0.040); no significant subfoveal differences were found. Regional ChT changes were not significantly associated with axial elongation, and baseline ChT did not modify the treatment effect. Conclusions: Over 24 months, ChT showed a region-specific treatment response, most consistent temporally, less consistent nasally, and subfoveally. Regional ChT may offer an exploratory marker of treatment-related remodelling, but its predictive value for individualised treatment remains uncertain.

Background/Objectives: Long-term tear-film and symptom data for compounded 0.025% atropine remain limited in European children. We assessed changes in first non-invasive tear-film break-up time (fNIBUT) and Ocular Surface Disease Index (OSDI) scores over 24 months. Methods: This secondary analysis of the ASPECT trial included 101 children completing 24 months, all assigned nightly compounded 0.025% atropine with Defocus Incorporated Multiple Segments or single-vision spectacles. Available fNIBUT, OSDI, and corneal endothelial cell density (ECD) measurements at baseline, 12 months, and 24 months were analysed using longitudinal mixed-effects models. The six pairwise contrasts across the primary outcomes of this secondary analysis used Holm-adjusted p-values and simultaneous Bonferroni 95% confidence intervals (CIs). No untreated comparator was available. Results: fNIBUT was numerically higher at 24 months than at baseline (16.9 vs. 14.3 s; mean difference [MD], 2.60 s; 95% CI, −0.37 to 5.57; p = 0.103). OSDI decreased from 14.7 to 9.6 (MD, −5.15 points; 95% CI, −9.93 to −0.36; p = 0.028). This reduction was not statistically significant in all examined missing-not-at-random scenarios or in an analysis restricted to children aged ≥8 years. ECD showed no statistically significant longitudinal changes. The exploratory combined criterion of OSDI ≥ 13 and fNIBUT < 10 s decreased numerically from 13/98 (13.3%) to 5/86 (5.8%). Conclusions: No deterioration was detected in the measured parameters among 24-month completers. Selection of completers, differential missingness, limited paediatric symptom assessment, and absence of a concurrent untreated comparator preclude firm conclusions about long-term ocular surface tolerability.