Three key myopia questions for 2026

Firstly, I will qualify this admittedly attention-grabbing headline. It looks to me like there will be a continuing place for atropine 0.01% as a combination treatment - the most runs on the board are for the combo with orthokeratology, although the effect appears strongest in the first 6 months of treatment. We have new data this year which has shown a combo effect with highly aspherical lenslet spectacles (Essilor Stellest) and previous data with DIMS spectacles (HOYA MiYOSMART). 

I do wonder, though, if the raft of studies published over the last few years, investigating commercially prepared formulations of atropine 0.01% - to address the stability issue of compounded preparations - are putting to rest the concept of atropine 0.01% as a useful monotherapy. These extremely well constructed, two and three-year randomized controlled trials (eg. CHAMP, PEDIG, MOSAIC), have shown quite modest results compared to optical treatments. These have been important studies to investigate the hypotheses of whether atropine 0.01% may be more effective if (1) it was a stable, consistent, commercially prepared formulation, and (2) used in children with blue eyes and/or of White European ethnicity. 

In 2025, the MOSAIC 3 year study was published, showing that in Irish kids who were over 80% White/Caucasian, one year of 0.05% was as effective as two years of 0.01% treatment. This indicates that higher concentrations like 0.05% appear to be best in kids of all ages and ethnicities. 

Companies who have invested much into R&D in this space deserve enormous respect for paving this path, even if it’s leading from what looked like a monotherapy freeway to a combination therapy road. That road, though, is still wide, given the volume of combo evidence. There also appears to be a role for atropine 0.01% in the delay of myopia onset for older, non-East Asian ethnicity children with pre-myopia. 

I’m hoping that 2026 brings us more atropine plus optical treatment combination studies, exploring other concentrations than 0.01%. We had a few of these in 2025, including DIMS with 0.025%; ortho-k with 0.05% and MiSight 1 day with 0.05%. Some of these studies, such as the latter on MiSight 1 day, actually used the optical treatment to boost the effect of atropine monotherapy. Another study on Essilor Stellest used the spectacles, instead of single vision, to boost 0.01% and 0.025%. I foresee more clinician-led studies on these will continue paving the atropine road. 

New research at ARVO in 2025 launched the second generation of myopia control spectacle lenses with lenslets - both Defocus Incorporated Multiple Segments (DIMS) and Highly Aspherical Lenslet Target (H.A.L.T.) Technology. 

For DIMS (HOYA MiYOSMART), the spherical +3.50D relative defocus lenslets in the current design was ‘powered up’ into two modified DIMS designs, featuring increased defocus power and altered central zones. Short-term visual performance showed comparative distance acuity in the new designs, compared to DIMS and single vision. Near vision was reduced in one of the new designs. We’re now eagerly awaiting efficacy data on one or both of these new designs.

For H.A.L.T. Technology (Essilor Stellest) the lenslets have been increased in both power and asphericity, to increase the volume of myopic defocus signal. Two studies presented at ARVO 2025 demonstrated that short-term visual performance was similar between the original H.A.L.T. and the new H.A.L.T. MAX design - high and low contrast distance acuity, and low contrast near acuity was reported as not different between the two designs. With this similar visual outcome, a contralateral cross-over study in Singapore showed improved treatment efficacy with the MAX design. 

The early results are promising. As more data comes to light on these new designs, the question may then turn to who the best candidates are for these second generation designs. Are they better for all myopes, or do further analyses show greater effects for younger children or those with other risk factors for faster progression? Availability and any cost differences may also influence how they fit into treatment algorithms.

Traditionally, when we say ‘combination therapy’, the mind jumps to atropine plus an optical treatment - spectacles or contact lenses designed for myopia control. The newest kids on the block for combination treatment are repeated low-level red light (RLRL) therapy, and MyopiaX, a blue-light head-mounted device (imagine a virtual reality headset), designed to target the ganglion cells at the optic nerve head. 

Two studies have looked at the combination of RLRL with orthokeratology. The first, a multi-site study in China, identified children who had progressed at least 0.5mm/year wearing ortho-k. Two-thirds had RLRL therapy added to their treatment regime while one-third continued in ortho-k alone. After 12 months, this latter group grew another 0.27mm while the combo group showed axial length stability with only -0.02mm change. 

Another study, the first RLRL data published in European (Spanish) children, did not use fast progression as a determinant for combo treatment - at outset, around half were prescribed ortho-k and the rest ortho-k plus RLRL. The ortho-k only group showed 0.1mm growth in a year - which is actually a great result, considering this would approximate an emmetropic eye growth rate - but the combo group showed a mean axial length reduction of -0.12mm. This reduction (>0.05mm) was observed in 80% of the combo group and none of the ortho-k only group. Acuity was at least 6/6 or 20/20 and no serious adverse events were reported. While it was a small study (n=26), this shows the strong potential of RLRL in a combination with optical treatments. Learn about this study in our Science Short video (under two minutes) on YouTube. Hopefully we get to see data on other optical treatments in combination with RLRL in 2026. 

You may not have heard of MyopiaX. We first told you about it after the International Myopia Conference in late 2024, where early data was presented. It is based on the theory of ocular growth being regulated by light-mediated dopamine release, and focuses on melanopsin, a blue-sensitive photopigment concentrated in intrinsically photosensitive retinal ganglion cells. Given these ganglion cells bundle at the optic nerve head, MyopiaX aims to selectively stimulating the optic nerve head (visual blind spot) to activate the melanopsin pathway. It uses a smartphone mini-game application with a virtual reality headset and wireless controller to deliver this ‘blind spot stimulation’. 

Recently published, a multi-site European study (n=101) allocated two-thirds to the MyopiaX treatment group, who used MyopiaX alone for 6 months, and then in combination with DIMS spectacle lenses for another 6 months. The ‘active control’ group used DIMS spectacles only. 

After 6 months, the MyopiaX group showed 0.06mm more axial elongation than the DIMS group, with no difference in refraction changes. In the second six months, where all were wearing DIMS but half using MyopiaX, the myopia progression outcomes were similar. This would appear to indicate that MyopiaX didn’t provide a ‘boost’ effect to DIMS wear, but indicates a likely similar effect in comparison to other monotherapies. These initial results showed a relationship between efficacy and compliance, as well as a high safety and acceptance profile - laying a fascinating foundation for the next stage. 

Last year we saw more data presented on interventions in diverse populations - adding knowledge of how treatments work in European AND Asian populations, rather than one or the other. These included new data on MiSight 1 day contact lenses and DOT spectacle lenses in Chinese children; and EDOF contact lenses in European children. The Abiliti 1-Day soft contact lens was also reported as effective in Chinese children over 12 months.  

We're ready to learn more about our newer soft contact lens designs: on the Abiliti 1-Day, we're keen to see the longer-term multi-site (China, US and Canada) data which showed strong results at 6 months. The NaturalVue Multifocal 1 day PROTECT study has released early data on their (not yet published) two-year RCT results. Once published, we will be able to understand more of its proposed role in correcting higher levels of astigmatism. 

In 2025, we also saw more long-term data published showing no rebound after six years of MiSight 1 day soft contact lens wear, six year efficacy of Essilor Stellest and up to eight years of data on DIMS spectacle lenses. As these pioneering studies wrap up, clever scientists will hopefully have interesting sub-plots to reveal on further understanding efficacy and the next questions to ask.

Finally, I'm hoping we will learn more about the rebound effects of higher atropine concentrations (0.05% or more) and light therapies, which appear to be higher than in optical treatments. Managing these, where present, will be key in determining how we apply these combination treatment options for sustained long-term results.

At Myopia Profile, we will continue to work hard to keep you abreast of the answers to these questions; all of the newest developments in the world of myopia management, and most importantly, what it all means for your patients and your practice.