Understanding the current evidence for myopia control methods

Paper title: Current and Emerging Strategies for Myopia Control in Children: A Comprehensive Evidence-Based Review

Authors: Aldo Vagge (1,2); Matteo Baldi (1,2); Maria Musolino (1,2); Veronica Rivarone (1,2); Carlo Catti (1,2); Michele Iester (1,2)

1. University Eye Clinic of Genoa, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Viale Benedetto XV, 5, 16132 Genoa, Italy.
2. IRCCS "San Martino" Polyclinic Hospital, Largo Rosanna Benzi, 10, 16132 Genova, Italy.

Date: Feb 2026

References: Vagge A, Baldi M, Musolino M, Rivarone V, Catti C, Iester M. Current and Emerging Strategies for Myopia Control in Children: A Comprehensive Evidence-Based Review. J Clin Med. 2026 Feb 15;15(4):1545

[Link to open access paper]

Although many interventions have demonstrated slowing of myopic eye growth, their mechanisms, comparative performance and long‑term outcomes remain unclear, prompting this review of current evidence. Findings from randomised controlled trials and meta‑analyses that included children aged 6–13 years and follow‑up periods between one to six years were synthesized. Interventions included spectacle lenses designed to alter retinal focus, such as Defocus Incorporated Multiple Segments (DIMS), Highly Aspherical Lenslet Target (HALT) and HALT Max, Diffusion Optics Technology (DOT) and Cylindrical Annular Refractive Element (CARE), Lenslet Array refractive Index (LARI) designs, alongside dual‑focus (MiSight) and extended‑depth‑of‑focus (EDOF) soft contact lenses, orthokeratology (OK), low‑dose atropine (0.01–0.05%) and lifestyle factors such as time outdoors. Outcomes were changes in refractive error and axial elongation.

Key findings were as follows:

• DIMS lenses reduced myopia progression by 0.44 diopters and axial elongation by 0.34 mm over 2 years vs single vision (SV) lenses
• HALT spectacle lenses demonstrated 0.99 diopters less progression and 0.41 mm less axial elongation over 2 years in full-time wearers (at least 12 hrs/day); and 0.80D / 0.35mm in the full participant group. 
• HALT MAX showed additional myopia slowing (-0.21D vs 0.42D and 0.107mm less axial elongation over 1 year) relative to HALT lenses.
• LARI lenses slowed myopia progression and axial length by approximately 0.36–0.45 D and 0.15–0.17 mm over one year, compared with SV lenses
• Dual-focus soft contact lenses slowed progression and axial elongation by 0.73 diopters and 0.32 mm over 3 years, vs SV correction
• Orthokeratology reduced axial elongation by 0.30 mm over 2 years vs conventional correction
• Low-dose atropine (0.05%) showed 67% reduction in spherical equivalent progression and 51% reduction in axial elongation at 1 year
• Increased outdoor time provided a modest benefit for reducing the onset of myopia, but had limited effect on slowing progression of existing myopia
• Combination therapy may offer addition myopia slowing if monotherapy is insufficient

The authors also cited their own suggested step-wise clinical approach (from their setting of European ophthalmology practice), based on axial length–based risk stratification. They suggested that myopic children with axial length above the 50th percentile for age and sex be actively treated. For children below the 50th percentile, close monitoring was suggested to "detect percentile drift over time. A jump of more than 10–15 percentiles between visits indicates accelerated growth and should prompt treatment initiation regardless of absolute axial length value." Follow up was suggested every 6-12 months, with treatment success referenced to normative or near-normative age-matched emmetropic axial length change. 

Specific treatments for specific patients were not suggested, but treatment was recommended until axial growth was  less than approximately 0.1 mm per year for more than one year at age 15, and/or when the growth rate was 0.05 mm per year or less. Rebound effects in atropine and in ortho-k (before age 14) were cited for awareness.

This review reinforces that several evidence‑based options can meaningfully slow myopia progression, but also suggests that treatment should be tailored to each child’s age, progression rate and family preferences. Axial length should be measured at baseline using age‑ and sex‑matched normative data to help guide when to begin treatment, and then monitored at six‑monthly intervals to assess stability against expected growth trajectories, although it should still be interpreted alongside refractive change, which continues to serve as the principal outcome measure in most regulatory evaluations. The suggestion of monitoring versus treatment at the 50th percentile is an expert opinion, rather than a validated protocol tested in a clinical trial.  

Multiple optical interventions demonstrate clinically meaningful reductions in axial elongation, with treatment effects ranging from 0.13 to 0.41 mm over one to two years. Spectacle lenses designed to create simultaneous myopic defocus or modulate contrast offer a starting point for many families. HALT MAX lenses showed additional slowing compared with HALT, but these values are relative to HALT rather than single vision correction, and are therefore not stand-alone clinical effect sizes. 

Contact lenses, including dual‑focus designs and orthokeratology, may be suitable for motivated children, though orthokeratology requires discussion of potential rebound if discontinued before age 14.

Low‑dose atropine provides a pharmacological option as a monotherapy or in combination with optical treatments, particularly for children progressing more quickly. The 0.05% concentration showed greater treatment effect in Asian populations, while response to lower concentrations appears more variable and may be influenced by ethnicity. 

Outdoor time is beneficial for general eye health and may offer modest additional benefit against myopia onset. It is recommended as part of the clinical guidance for patient and parent discussions; however, it should not replace active treatment to slow myopia progression.

Despite encouraging results across multiple interventions, some uncertainties remain. Many optical and pharmacological treatments have only short‑ to medium‑term data, and it is unclear how long benefits persist or how best to discontinue treatment without triggering rebound. Evidence for combination therapy is promising but largely derived from small studies and observational cohorts, so robust multicentre randomised trials comparing combination and monotherapy are still needed.

The underlying mechanisms of action also require clarification. The finding that lenslet designs with opposite powers can produce similar outcomes suggests that factors beyond peripheral defocus, such as contrast modulation, may contribute, but these hypotheses remain unproven and limit the ability to predict which children respond best to specific designs.

Ethnic and geographic differences in atropine response highlight the need for studies in more diverse populations, including guidance on tailoring concentration to iris pigmentation, or combination therapy initiated on baseline progression rate.

Emerging modalities such as repeated low‑level red‑light therapy show short‑term effects but currently have limited safety data, uncertain durability and reported rebound after cessation, requiring further study before wider adoption.

This review reports effect sizes drawn from studies with differing follow‑up durations (one, two or three years) and from trials that vary in design, baseline characteristics and population profiles. These differences mean the effect sizes are not directly comparable. Several recommendations in the review, such as suggested axial‑length thresholds for intervention, treatment selection based on child characteristics and indications for combination therapy, reflect expert interpretation rather than validated clinical decision guidance. Longer, large‑scale randomised studies are needed to clarify long‑term outcomes, discontinuation strategies and criteria for initiating, adjusting and stopping treatment.

Myopia has emerged as a global public health crisis, with prevalence exceeding 80% in East Asian urban populations and rising rapidly worldwide. High myopia substantially increases the lifetime risk of sight-threatening complications, including myopic macular degeneration, retinal detachment, and glaucoma. Multiple interventions have been investigated to slow myopia progression in children. Behavioral strategies, particularly increased outdoor exposure, demonstrate protective effects against myopia onset and may modestly slow progression, whereas several historically used approaches show no clinically meaningful benefit. Spectacle lens interventions include simultaneous defocus designs (e.g., DIMS, HALT, CARE) and contrast-modulating diffusion optics (DOT) lenses; collectively, these technologies have demonstrated consistent and clinically meaningful reductions in axial elongation across randomized clinical trials. Contact lens modalities, including dual-focus soft lenses and orthokeratology, have also demonstrated substantial efficacy in slowing progression in controlled studies. Low-dose atropine remains a cornerstone pharmacological therapy, particularly at concentrations between 0.01% and 0.05%, offering significant efficacy with minimal side effects. Repeated low-level red-light therapy has shown promising short-term reductions in axial elongation, although long-term safety and rebound effects remain uncertain. Combination therapy targeting complementary optical and pharmacological pathways shows additive benefits, particularly in children inadequately controlled with monotherapy. Contemporary clinical management emphasizes risk stratification based on axial length, age-specific growth targets, and structured longitudinal monitoring. The goal of modern myopia management is not merely to slow progression, but to prevent high myopia and reduce the lifetime burden of vision-threatening complications through a proactive, individualized approach increasingly regarded as the standard of care.

[Link to open access paper]