Understanding expectations in myopia control

• Myopia control treatments can slow down (but not stop) myopia progression, with a number of effective treatments available which appear to have a similar effect in slowing progression by at least half.
• When starting the myopia management journey, you should expect to be able to discuss treatment options with your child's optometrist or eye doctor, understand the treatment process and schedule, and prepare for regular appointments over time.
• It's extremely important to understand that some myopia progression can still occur with myopia control, but this should be at a slower rate than it would be without treatment.

Myopia (also called short-sightedness or near-sightedness) typically develops between ages 6 and 12 and tends to worsen or progress every few to several months until the late teenage years.¹ Myopia progression is fastest in children 7 to 10 years,² and then usually slows down a little each year thereafter.

Myopia progression means that a child's vision gets blurred again, with their previous glasses or contact lenses no longer providing the full correction for clear vision.

The aim of myopia control is to slow down myopia progression or worsening, so that the individual ends up with less myopia as an adult compared to if they'd not had myopia control treatment.³

Younger children tend to show faster myopia progression. Earlier age of myopia onset gives a child more years for their myopia to worsen, and increases the likelihood of ending up with high myopia.⁴

The chart below shows the average amount of myopia progression per year for children based on their age. A 7-year-old typically progresses by at least -1.00D per year (4 steps of prescription) while a 12-year-old typically progresses by around -0.50D per year (2 steps of prescription). Progression is a bit faster in children of Asian ethnicity than in non-Asian children.⁵

Myopia control treatments include special types of spectacle lenses, soft contact lenses, ortho-k and atropine eye drops. The effectiveness of these treatments is typically described as a percentage: how much the treatment slowed myopia progression compared to a non-treatment of single vision glasses or contact lenses, which result in the fastest myopia progression.³

A percentage reduction in myopia progression can be measured by changes in refraction (the power of glasses or contact lenses) and axial length (the front-to-back measure of the growth of the eye). You can read more about how these measures of refraction and axial length are used to determine outcomes in myopia control in How do I know if myopia control is working?

There is no single treatment which is clearly better than the rest, with specific spectacle lenses, soft contact lenses, ortho-k and the best concentration of atropine eye drops appearing to have a similar effect to slow myopia progression in children.³

The best class of treatments have been shown to slow myopia progression by at least half (at least 50%) compared to single vision glasses or contact lenses.³

Because children under age 10 tend to show the fastest myopia progression,^1,2 they will also be likely to show some small amounts of myopia progression even with a myopia control treatment. There are no treatments than can promise to stop myopia progression, but the evidence indicates that these treatments will slow it down.

Myopia progression is still typically occurring until the late teenage years and even into the early 20s, but is usually slower than in pre-teenage children.¹

Your child's age can influence selection of a myopia control treatment, based on the scientific evidence available. Generally, these treatments have been researched in children aged from around 6 to 8 years through to 14 to 16 years. There are less studies including children younger or teenagers older than this.

If your child falls outside of these age ranges as described by the scientific evidence, the treatment may still work for them, but the expectations for treatment may need to be adjusted. Learn more about ages and treatments in Which is the best option for myopia control?

Your child's age can also factor into suitability of specific treatments. For example, younger children may find handling contact lenses more challenging, although they can typically handle them well from age 6 to 8. Teenagers may find the side-effects of atropine less tolerable.

In a research study, a specific percentage treatment effect will be reported, for example 53% or 62%. This is a valid way to compare that treatment to the control group who wore the non-treatment of single vision glasses or contact lenses.

However, It is not valid to directly compare the percentage rates of two different studies and to conclude that the 62% outcome is better than the 53% outcome. This may not be true, because many factors can influence that final percentage, and these factors can vary between studies.³

Scientists are still determining the best way to talk about myopia control treatments as either a total effect³ or a proportional effect.⁶

When your child or teenager is starting myopia control, you should expect the following.

1. Discussing the options. Your optometrist or eye doctor will discuss the options with you and your child, and help you to decide on the most suitable treatment based on their clinical findings and recommendations. Your child's activities, capabilities and preferences are also important factors in choosing a treatment.^3,7
2. Understanding the why, how and when. You should feel comfortable that you and your child or teenager understand why myopia control is important, and the risks, benefits and process of the selected treatment.
3. Setting the appointment schedule. Myopia control treatments typically require 2-6 appointments in the first six months, to ensure suitability for your child and effectiveness of the treatment. The schedule can be discussed with your optometrist or eye doctor, and will depend on the treatment.⁷
4. Expect small changes in myopia. Myopia control treatments aren't expected to stop myopia progression, but instead to slow it down. Expect to see a small amount of myopia progression per year for your child, which should be slower than what it would be for a child of their age without treatment. This will especially be the case for children under age 10, who undergo the fastest myopia progression.
5. Review every six months. Children and teenagers undergoing myopia control treatment are recommended to have an eye examination every six months.⁷ It is best to assess how well a treatment is working after one year, to give it time and account for seasonal changes in myopia progression.³
6. Commit to the myopia management journey. Myopia control treatment should ideally continue throughout childhood, until myopia is stable and no longer worsening. Your optometrist or eye doctor will want to ensure that the treatment continues to suit your child or teenager over time, and is working well to provide them clear vision as well as slow their myopia progression.

1. Hou W, Norton TT, Hyman L, Gwiazda J; COMET Group. Axial Elongation in Myopic Children and its Association With Myopia Progression in the Correction of Myopia Evaluation Trial. Eye Contact Lens. 2018 Jul;44(4):248-259. (link)
2. Tricard D, Marillet S, Ingrand P, Bullimore MA, Bourne RRA, Leveziel N. Progression of myopia in children and teenagers: a nationwide longitudinal study. Br J Ophthalmol. 2022 Aug;106(8):1104-1109. (link)
3. Brennan NA, Toubouti YM, Cheng X, Bullimore MA. Efficacy in myopia control. Prog Retin Eye Res. 2021 Jul;83:100923. (link)
4. Chua SY, Sabanayagam C, Cheung YB, Chia A, Valenzuela RK, Tan D, Wong TY, Cheng CY, Saw SM. Age of onset of myopia predicts risk of high myopia in later childhood in myopic Singapore children. Ophthalmic Physiol Opt. 2016 Jul;36(4):388-94. (link)
5. Donovan L, Sankaridurg P, Ho A, Naduvilath T, Smith EL 3rd, Holden BA. Myopia progression rates in urban children wearing single-vision spectacles. Optom Vis Sci. 2012 Jan;89(1):27-32. (link)
6. Chamberlain P, Bradley A, Arumugam B, Hammond D, McNally J, Logan NS, Jones D, Ngo C, Peixoto-de-Matos SC, Hunt C, Young G. Long-term Effect of Dual-focus Contact Lenses on Myopia Progression in Children: A 6-year Multicenter Clinical Trial. Optom Vis Sci. 2022 Mar 1;99(3):204-212. (link)
7. Gifford KL, Richdale K, Kang P, Aller TA, Lam CS, Liu YM, Michaud L, Mulder J, Orr JB, Rose KA, Saunders KJ, Seidel D, Tideman JWL, Sankaridurg P. IMI - Clinical Management Guidelines Report. Invest Ophthalmol Vis Sci. 2019 Feb 28;60(3):M184-M203. (link)