Treatment compendium
The main myopia control options for children, with the evidence from their principal trials, who each suits and what needs care. Effects are averages; individual response varies.
Defocus spectacle lenses
MiyoSmart (DIMS), Stellest (HAL)
Lenses with a clear centre for distance vision and a ring of small lenslets that add myopic defocus, which is thought to signal the eye to slow its growth.
Who it suits
Young children, children who cannot use contact lenses or drops, and families who want a simple option.
Cautions
- Benefit depends on wearing them all waking hours; trials counted 12 or more hours a day.
- Regulatory approval and availability differ by country.
Follow-up
Check wearing time, fit and visual comfort at every visit; measure axial length every 6 months.
Trial evidence
| Option | Refraction | Axial |
|---|---|---|
| MiyoSmart (DIMS) spectacle lenses | 52% | 62% |
| Essilor Stellest (HAL) spectacle lenses | 55% | 51% |
Percent reduction versus control, from Lam CSY et al., Br J Ophthalmol 2020;104:363-368; Bao J et al., JAMA Ophthalmol 2022; .
Soft myopia-control contact lenses
MiSight 1 day
Daily disposable lenses with alternating zones that correct distance vision and add myopic defocus.
Who it suits
Children about 8 and over who can insert, remove and care for lenses, and who are active in sport.
Cautions
- Contact lens infection is rare but can be serious; strict hygiene is essential.
- Does not correct higher astigmatism fully.
- In studies, adding 0.01% atropine gave no extra benefit.
Follow-up
Review lens fit, hygiene and comfort at each visit.
Trial evidence
| Option | Refraction | Axial |
|---|---|---|
| MiSight 1 day contact lenses | 59% | 52% |
Percent reduction versus control, from Chamberlain P et al., Optom Vis Sci 2019;96:556-567; .
Orthokeratology (ortho-k)
Night lenses that reshape the cornea
Rigid gas-permeable lenses worn overnight flatten the central cornea so vision is clear by day without glasses. Peripheral reshaping adds myopic defocus.
Who it suits
Children who want no daytime glasses, play sport or swim, and can manage overnight wear and cleaning; myopia within the usual correction range.
Cautions
- Needs an experienced fitter and corneal topography.
- Risk of corneal infection; hygiene and regular checks are essential.
- Adding 0.01% atropine helped in some trials, mainly in younger children and shorter eyes, and not in children whose eyes kept growing.
Follow-up
Aftercare checks of the cornea and lens fit, then axial length every 6 months.
Trial evidence
| Option | Refraction | Axial |
|---|---|---|
| Orthokeratology night lenses | 43% * | 43% |
Percent reduction versus control, from Cho P, Cheung SW, Invest Ophthalmol Vis Sci 2012;53:7077-7085 (ROMIO); .
Low-dose atropine eye drops
0.01%, 0.025%, 0.05%
A diluted drop used each night. It slows eye growth through a mechanism that is not fully understood.
Who it suits
Children who accept a nightly drop, including those who cannot wear contact lenses; higher doses suit faster progression.
Cautions
- Possible light sensitivity and near blur, more at higher doses.
- Some children show a rebound in growth if it is stopped suddenly; tapering is often used.
- Products and concentrations available vary by country.
Follow-up
Check comfort, pupil size effects and near vision; review dose if growth stays fast.
Trial evidence
| Option | Refraction | Axial |
|---|---|---|
| Atropine 0.05% | 67% | 51% |
| Atropine 0.025% | 43% | 29% |
| Atropine 0.01% | 27% | 12% |
Percent reduction versus control, from Yam JC et al., Ophthalmology 2019;126:113-124 (LAMP); Yam JC et al., Ophthalmology 2019;126:113-124 (LAMP); Yam JC et al., Ophthalmology 2019;126:113-124 (LAMP); .
Repeated low-level red light
Home-use red light devices
Short daily sessions of low-power red light, which in trials slowed or even shortened axial length.
Who it suits
Children whose families can supervise two sessions a day, and for whom other options are not suitable or are not working, under specialist care.
Cautions
- Long-term safety data are still being gathered, and reports of retinal changes mean regular retinal checks are needed.
- Not approved for myopia control in many countries.
- Rebound can occur after stopping; no trial has tested combinations with other treatments.
Follow-up
Regular retinal examination and axial length measurement, as directed by the treating specialist.
Trial evidence
| Option | Refraction | Axial |
|---|---|---|
| Repeated low-level red light | 75% | 66% |
Percent reduction versus control, from Jiang Y et al., Ophthalmology 2022;129:509-519.
Not medical advice. Choose a treatment with an eye doctor who examines the child and measures axial length. Build a plan · Evidence tables and references