The Rotterdam Erasmus Academic Medical Center in the Netherlands has started prescribing atropine to kids who develop myopia at a young age. Studies at the Rotterdam Institute found a severe impact of high myopia on visual performance: one in three high myopes (6D or more and with an axial length of 26mm) has a risk of severe vision loss during his or her lifetime (a VA of less than 0.3). A study from Sydney, presented at the recent ARVO 2016 meeting in Seattle (US), indicated that the reason for vision loss is not always clear (Jong et al, poster #2470). In a group of high myopes (8.7±2.9D) with no obvious retinal pathology, a significant percentage of eyes (35%) had mild visual impairment (VA between <1.0 to ≥0.3) while 1.2% had moderate visual impairment (VA between <0.3 to ≥0.1) and 0.3% showed severe visual impairment (VA <0.1). The Rotterdam protocol calls for three types of action for young myopes to prevent them from becoming highly myopic: pharmaceutical, optical and lifestyle interventions. In addition to atropine, and/or as a stand-alone treatment, optical intervention with dual-focus center-distance soft lenses is prescribed. Orthokeratology could serve the same purpose, being very effective. The only limitation in this regard is that for low myopes (under -2D), the added plus power in the periphery would potentially not be high enough to gain enough peripheral plus with standard orthokeratology treatment. The added benefit of combining contact lenses with atropine would be that loss of accommodation with atropine (much less of an issue with 0.01% than with 1%, but still potentially noticeable) could be countered by the contact lenses - while targeting another myopia controlling mechanism at the same time. Also, an optical treatment may fail in some patients, while atropine treatment works - or the reverse. It may be time to join forces?