Which is the best option for myopia control?

Understanding the options for myopia control

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.

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.

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

 

Spectacles for myopia control

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. Another design which uses 'diffusion' of light has also shown a good result.

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

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.

 

Soft contact lenses for myopia control

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

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. 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

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.

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.

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.