Which is the best option for myopia control?

• Treatment options for myopia control in children and teenagers include specific types of spectacle lenses, soft contact lenses, ortho-k and atropine eye drops. Each of these categories include effective options to slow myopia progression, and some have more evidence than others.
• Standard single-vision spectacles or contact lenses do not slow myopia progression and are considered an ineffective treatment.
• The best option for your child or teenager's myopia control treatment will include a variety of considerations such as their prescription, eye health, hobbies, activities and even what best suits you as a family.

Myopia control aims to slow down the progression or worsening of myopia in children and teenagers, so that their final amount of myopia is less than what it would have been without treatment.¹

Myopia control is important to both improve your child or teenagers' vision with less frequent changes in prescription in childhood, as well as reducing their lifelong risk of eye diseases and vision impairment associated with higher levels of myopia.²

Myopia control treatments include special types of spectacle lenses, soft contact lenses, ortho-k and atropine eye drops.

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 There are some treatments which are less effective, which will be described below.

This means that the best option for your child or teenager's myopia control treatment will include a variety of considerations such as their prescription, eye health, hobbies, activities and even what best suits you as a family.

Standard single-focus spectacles (glasses) do not slow the worsening of childhood myopia but specific designs do. Myopia controlling spectacles can both correct the blurred vision of myopia and work to slow down myopia progression.

They are safe to wear and adaptation is typically easy, with the only side effects being related to the limitations spectacles pose for sport and active lifestyles.

The most effective spectacle lens options for myopia control are special designs with 'lenslets' - numerous, 1mm sized mini-lenses scattered across the surface of the main spectacle lens.

New types of 'lenslet' designs appear to be the most effective in slowing childhood myopia progression than other types of spectacles, and have strong scientific evidence.^4,5 Another design which uses 'diffusion' of light has also shown a good result.⁶

Bifocal spectacle lenses can have a moderate effect in slowing myopia progression.⁷ Progressive addition lenses have a minimal impact and are not effective compared to these other options.³

Myopia control spectacles have been researched in children from ages 8 to 13 at the start of treatment, for 2 to 3 years of treatment. They could be worn for longer than this, but have not been researched as such. Evidence for their effectiveness in children younger than 8 or older than 15 to 16 is limited.

Standard single-focus contact lenses do not slow the worsening of childhood myopia but specific designs do. These specific designs can both correct the blurred vision of myopia and work to slow down myopia progression. The options include soft myopia controlling contact lenses and orthokeratology.

Soft contact lenses for myopia control are worn during waking hours. They may be daily disposable, or reusable for up to a month. They typically require more appointments for fitting than spectacles but less than ortho-k. Adaptation to the lens-on-eye feeling typically occurs in a few days. There are benefits in safety with daily disposables being the safest modality, and the number of lenses retained meaning loss or breakage is less of a practical issue.

There are numerous soft contact lens options with evidence for myopia control in children and teens, although some have more evidence than others.^8-12 The best option for your child or teenager will depend on many factors such as what is available in your country, your child's prescription and their eye health.

The effectiveness of myopia control soft contact lenses has been researched in children from ages 7 to 12 at the start of treatment, for up to 6 years of wear. They could be worn for longer than this, but have not been researched as such. Evidence for their effectiveness in children younger than 7 or older than 16 to 18 is limited.

Ortho-k contact lenses are worn overnight and removed upon waking, such that no spectacles or contact lenses are required for clear vision during the day. They can require more appointments for fitting than other types of myopia control treatment.

There are significant benefits for water sports and active lifestyles, and since the contact lenses are only worn at home there is low risk of them being lost or broken during wear.

Ortho-k lenses appear to be just as effective as the best options for spectacle lenses and soft contact lenses.³ They also have the largest volume of supportive research evidence, having been under research for many years.¹³ All of these options provide the dual benefit of correcting blurred vision from myopia as well as slowing myopia progression.

Ortho-k's effectiveness for myopia control has been researched in children from age 6, for several years of wearing time. Evidence for their effectiveness in children younger than 6 is limited.

Atropine eye drops in strong concentrations (typically 0.5% to 1%) are used to temporarily dilate the pupil of the eye and stop the focussing muscles working in a variety of clinical applications. Atropine eye drops for myopia control, though, are a low-concentration (0.01% to 0.05%) with much fewer such side effects. Side effects can include less clear vision up close (for reading) and more sensitivity to light, both of which can be managed with additional features in spectacle lenses.

With atropine eye drop treatment for myopia control, spectacles or contact lenses are still needed to correct the blurred vision from myopia, as atropine only acts to slow myopia progression.¹⁴

It is important to note that research information changes over time. Back in 2016, atropine 0.01% seemed to be the most effective concentration to slow myopia¹⁵ but then a new study in 2019 showed it wasn't very effective compared to atropine 0.025% or 0.05%.¹⁴ When atropine 0.01% is combined with ortho-k, though, it does appear to have an additive effect to slow myopia progression in some children.¹⁶

There is a lot of new research on atropine eye drops underway, but the current evidence indicates that atropine 0.05% is similarly effective to the best spectacle lens, soft contact lens and ortho-k options for myopia control.³ Atropine 0.025% is slightly less effective but may have lesser side effects in some children.

The effectiveness of atropine for myopia control has been researched in children from age 4 up to 15-16 years. They could be used for longer than this, but have not been researched as such. Evidence for their effectiveness in children younger than 4 or older than 15 to 16 is limited.

Based on current research evidence, many of these options are similarly effective. These are the new design 'lenslet' spectacle lenses,^4,5 myopia controlling soft contact lenses,^9,10 ortho-k¹³ and atropine 0.05%.¹⁴ All of these options have been shown to slow myopia progression in children and teenagers by at least half, compared to kids wearing single vision spectacle or contact lenses (which is considered a non-treatment).

As described above, these treatments have all been researched in kids aged from around 6 to 8 through to 14 to 16 years of age, but 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.

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 6-8. Teenagers may find the side-effects of atropine less tolerable.

The best option for your child will depend on many factors, as described above. Sometimes there may be quite a few options which could suit a particular child or teenager. Talk to your optometrist or eye doctor for personalized advice.

Your child’s eye care practitioner or eye doctor (optician, optometrist or ophthalmologist) may use the following Infographic from MyopiaProfile.com to summarize currently available myopia control treatment options across three podiums ranked best, next-best and less effective. These podium categories are based on outcomes of gold-standard clinical research (randomized controlled trials) of myopia control treatments where there is at least 12 months of data published. If you are interested in delving into a scientific research summary written for eye care professionals, follow the link to this article titled Which myopia control treatment works best?

On each podium are groups of treatments which have been shown in their individual studies to slow the excessive eye growth found in progressive myopia by at least 50% (at least half) or around 33% (around one third). Your child's optometrist or eye doctor will be able to provide advice on which treatments are available in your country, and what option(s) could suit your child best.

We developed the Infographics because using pictures in health communications has been shown to improve learning and application of advice between health professionals, patients and their parents or carers.¹⁷ 

This is part of a set of four infographic panels which describe visual environment advice, treatment options, contact lens wear in kids, and why myopia management is essential. 

1. 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)
2. Tideman JW, Snabel MC, Tedja MS, van Rijn GA, Wong KT, Kuijpers RW, Vingerling JR, Hofman A, Buitendijk GH, Keunen JE, Boon CJ, Geerards AJ, Luyten GP, Verhoeven VJ, Klaver CC. Association of Axial Length With Risk of Uncorrectable Visual Impairment for Europeans With Myopia. JAMA Ophthalmol. 2016 Dec 1;134(12):1355-1363. (link)
3. Brennan NA, Toubouti YM, Cheng X, Bullimore MA. Efficacy in myopia control. Prog Retin Eye Res. 2021 Jul;83:100923. (link)
4. Lam CSY, Tang WC, Tse DY, Lee RPK, Chun RKM, Hasegawa K, Qi H, Hatanaka T, To CH. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol. 2020;104:363-368. (link)
5. Bao J, Huang Y, Li X, Yang A, Zhou F, Wu J, Wang C, Li Y, Lim EW, Spiegel DP, Drobe B, Chen H. Spectacle Lenses With Aspherical Lenslets for Myopia Control vs Single-Vision Spectacle Lenses: A Randomized Clinical Trial. JAMA Ophthalmol. 2022 May 1;140(5):472-478. (link)
6. Rappon J, Chung C, Young G, Hunt C, Neitz J, Neitz M, Chalberg T. Control of myopia using diffusion optics spectacle lenses: 12-month results of a randomised controlled, efficacy and safety study (CYPRESS). Br J Ophthalmol. 2022 Sep 1:bjophthalmol-2021-321005. (link)
7. Cheng D, Woo GC, Drobe B, Schmid KL. Effect of bifocal and prismatic bifocal spectacles on myopia progression in children: three-year results of a randomized clinical trial. JAMA Ophthalmol. 2014 Mar;132(3):258-64. (link)
8. Walline JJ, Walker MK, Mutti DO, Jones-Jordan LA, Sinnott LT, Giannoni AG, Bickle KM, Schulle KL, Nixon A, Pierce GE, Berntsen DA; BLINK Study Group. Effect of High Add Power, Medium Add Power, or Single-Vision Contact Lenses on Myopia Progression in Children: The BLINK Randomized Clinical Trial. JAMA. 2020 Aug 11;324(6):571-580. (link)
9. Chamberlain P, Peixoto-de-Matos SC, Logan NS, Ngo C, Jones D, Young G. A 3-year Randomized Clinical Trial of MiSight Lenses for Myopia Control. Optom Vis Sci. 2019;96(8):556-567. (link)
10. Cheng X, Xu J, Brennan NA. Randomized trial of soft contact lenses with novel ring focus for controlling myopia progression. Ophthalmol Sci 2022:Oct 18. (link)
11. Cooper J, O'Connor B, Aller T, Dillehay SM, Weibel K, Benoit D. Reduction of Myopic Progression Using a Multifocal Soft Contact Lens: A Retrospective Cohort Study. Clin Ophthalmol. 2022 Jul 4;16:2145-2155. (link)
12. Sankaridurg P, Bakaraju RC, Naduvilath T, Chen X, Weng R, Tilia D, Xu P, Li W, Conrad F, Smith EL 3rd, Ehrmann K. Myopia control with novel central and peripheral plus contact lenses and extended depth of focus contact lenses: 2 year results from a randomised clinical trial. Ophthalmic Physiol Opt. 2019 Jul;39(4):294-307. (link)
13. Sun Y, Xu F, Zhang T, Liu M, Wang D, Chen Y, Liu Q. Orthokeratology to control myopia progression: a meta-analysis. PLoS One. 2015 Apr 9;10(4):e0124535. (link)
14. Yam JC, Jiang Y, Tang SM, Law AKP, Chan JJ, Wong E, Ko ST, Young AL, Tham CC, Chen LJ, Pang CP. Low-Concentration Atropine for Myopia Progression (LAMP) Study: A Randomized, Double-Blinded, Placebo-Controlled Trial of 0.05%, 0.025%, and 0.01% Atropine Eye Drops in Myopia Control. Ophthalmology. 2019 Jan;126(1):113-124. (link)
15. Chia A, Lu QS, Tan D. Five-Year Clinical Trial on Atropine for the Treatment of Myopia 2: Myopia Control with Atropine 0.01% Eyedrops. Ophthalmology. 2016 Feb;123(2):391-399. (link)
16. Tan Q, Ng AL, Cheng GP, Woo VC, Cho P. Combined 0.01% atropine with orthokeratology in childhood myopia control (AOK) study: A 2-year randomized clinical trial. Cont Lens Anterior Eye. 2022 May 30:101723. (link)
17. Houts PS, Doak CC, Doak LG, Loscalzo MJ. The role of pictures in improving health communication: A review of research on attention, comprehension, recall, and adherence. Patient Education and Counseling. 2006;61:173-90.