Which Myopia Treatment Works Best? A Parent’s Guide to Choosing the Right Myopia Control Option

Author: Dr Val Phua
Estimated reading time: 25 minutes

Several treatments can slow childhood myopia, but no single option is best for every child.

The main evidence-supported treatments include:

Myopia-control spectacle lenses
Low-concentration atropine eye drops
Dual-focus or multifocal soft contact lenses
Orthokeratology
Selected combinations of optical treatment and atropine
Repeated low-level red-light therapy in selected settings, although important long-term safety questions remain

Each treatment has different:

Expected effectiveness
Side effects
Hygiene requirements
Wearing schedule
Prescription limits
Costs
Monitoring needs
Long-term evidence
Practical advantages

The treatment producing the largest average effect in one clinical trial is not automatically the best choice for an individual child.

Clinical studies differ in:

Age of the participating children
Baseline prescription
Ethnic and geographical population
Rate of untreated progression
Treatment duration
Axial-length measurement
Wearing time and adherence
Control group
Definition of treatment success

Directly comparing percentages from unrelated trials can therefore be misleading.

A treatment described as “60% effective” in one study cannot necessarily be assumed to outperform a treatment described as “50% effective” in another.

The more useful question is:

Which safe, evidence-supported treatment is the child most likely to use correctly and consistently, and does it slow that child’s axial elongation sufficiently?

For many families, myopia-control spectacles provide a practical first option because they are:

Non-invasive
Easy to use
Familiar to children
Free of contact-lens infection risk
Able to correct vision and provide treatment simultaneously

For a younger child with early-onset or rapidly progressive myopia, atropine may be considered alone or combined with an optical treatment.

For a mature child who plays sports and is able to manage lenses safely, daily disposable dual-focus contact lenses may be attractive.

Orthokeratology may suit a carefully selected child who wants clear unaided daytime vision and whose family can reliably manage overnight lens care.

Repeated low-level red-light therapy has produced some of the largest short-term treatment effects reported in clinical trials. However, rebound, device-specific retinal exposure, long-term safety and the biological meaning of apparent axial shortening remain less certain than for established spectacle, atropine and contact-lens treatments. It should therefore not be treated as a universal first-line solution simply because its short-term numerical effect appears large.

The central message for parents is:

There is no universal “best” myopia treatment. The right choice balances expected control, safety, age, prescription, eye health, lifestyle, adherence and the child’s measured response over time.

The Quick Answer

Which Myopia Treatment Is Most Effective?

There is no single answer.

Current evidence suggests that substantial myopia control can be achieved with:

Approximately 0.05% atropine
DIMS or highly aspherical lenslet spectacles
High-add multifocal or dual-focus soft contact lenses
Orthokeratology
Atropine combined with selected optical treatments
Repeated low-level red-light therapy

The apparent ranking changes according to:

Whether refractive progression or axial elongation is measured
Age of the child
Duration of follow-up
Treatment adherence
Which individual product or concentration is used
Whether the result comes from a randomised trial or observational comparison

The LAMP randomised trial found that 0.05% atropine produced greater one-year control than 0.025% or 0.01% atropine. DIMS, highly aspherical lenslet, high-add multifocal contact-lens and orthokeratology trials have each demonstrated meaningful reductions in axial elongation compared with conventional correction.

What Is the Best First Treatment for Most Children?

For many children, a modern myopia-control spectacle lens is a reasonable initial option because it combines:

Good clinical-trial evidence
Vision correction
Simple daily use
Minimal medical side effects
No requirement to touch the eye
No contact-lens infection risk

This does not mean that spectacles are always the strongest treatment or the best choice for every child.

Atropine may be preferred or added when:

The child is very young
Myopia began early
Progression is rapid
The child cannot use a suitable optical design
The optical treatment alone is insufficient

When Is Atropine the Best Option?

Atropine may be particularly useful when:

The child is too young for contact lenses
Contact-lens hygiene is unreliable
The prescription falls outside the range of a chosen optical lens
Myopia is progressing despite spectacle treatment
Combination treatment is appropriate
The cornea is unsuitable for orthokeratology
The child has substantial astigmatism that limits contact-lens options

Among the concentrations tested in the LAMP trial, 0.05% atropine produced the strongest average control, but it also caused greater pupil dilation and reduction in accommodation than lower concentrations.

When Are Contact Lenses the Best Option?

Dual-focus or high-add multifocal soft contact lenses may suit a child who:

Wants freedom from spectacles
Plays sports
Is mature enough to manage lenses
Has reliable parental support
Can attend follow-up
Has a healthy ocular surface

Orthokeratology may suit a child who:

Wants clear unaided vision during the day
Can tolerate rigid lenses
Has suitable corneal measurements
Can maintain strict overnight-lens hygiene
Has reliable parental supervision

Does Combining Treatments Work Better?

Sometimes.

Randomised studies show that adding low-concentration atropine to orthokeratology can reduce axial elongation more than orthokeratology alone. A two-year trial reported axial elongation of approximately 0.17 mm with combined treatment compared with 0.34 mm with orthokeratology alone.

However, not every combination produces an additional benefit.

In the BAM study, adding 0.01% atropine to high-add multifocal soft contact lenses did not provide a statistically demonstrated advantage over the contact lenses alone.

Combination treatment should therefore be selected according to evidence and the child’s response rather than assumed to be automatically superior.

What Does “Works Best” Actually Mean?

Slowing the Spectacle Prescription

A treatment may reduce the annual change in spherical equivalent refraction.

For example, a child who might otherwise progress by −1.00 D could progress by a smaller amount during treatment.

However, prescription measurements can be influenced by:

Accommodation
Cycloplegic drops
Corneal shape
Orthokeratology
Choroidal thickness
Measurement variability

Slowing Axial Elongation

Axial length measures the front-to-back length of the eye.

Because most childhood myopia is associated with excessive eye elongation, axial length provides important information about structural progression.

A treatment that slows axial elongation may reduce the child’s final risk of:

High myopia
Myopic macular degeneration
Retinal detachment
Glaucoma
Other myopia-related disease

Maintaining Clear Vision

A highly effective treatment is not useful when the child cannot see comfortably through it or refuses to use it.

Vision should remain adequate for:

School
Reading
Sports
Social activities
Night-time mobility
Daily life

Avoiding Harm

The best treatment should not create an unacceptable risk of:

Corneal infection
Persistent light sensitivity
Reading difficulty
Allergic reaction
Retinal injury
Significant visual distortion
Poor sleep
Treatment-related anxiety

Consistency

A theoretically strong treatment may perform poorly when it is used inconsistently.

Examples include:

Spectacles worn only during school
Contact lenses worn for too few hours
Atropine frequently forgotten
Orthokeratology worn irregularly
Red-light sessions missed
Poor frame positioning
Incorrect lens replacement

The best practical treatment is often the one that can be sustained safely for several years.

Understanding Treatment-Effect Percentages

Relative Treatment Effect

A relative percentage compares the treated group with a control group.

For example:

Control axial elongation: 0.60 mm
Treatment axial elongation: 0.30 mm

The relative reduction is 50%.

Absolute Treatment Effect

The absolute difference is 0.30 mm.

Absolute change is often more useful clinically because it represents the amount of eye growth potentially avoided.

Why Percentages Can Mislead

A treatment may appear to have a high percentage effect when the control group progresses slowly.

For example:

Control: 0.20 mm
Treatment: 0.10 mm
Relative effect: 50%
Absolute difference: only 0.10 mm

Another trial may report:

Control: 0.60 mm
Treatment: 0.35 mm
Relative effect: approximately 42%
Absolute difference: 0.25 mm

The second treatment appears to have a lower percentage but a larger absolute difference.

Why Trials Cannot Be Ranked Like a League Table

Differences include:

Baseline age
Baseline myopia
Geographic population
Duration
Control-group progression
Dropout
Adherence
Measurement technique
Previous treatment
Product design

Head-to-head trials provide more reliable comparisons than placing unrelated study percentages side by side.

Why Younger Children Often Need Stronger Control

Younger children generally progress faster and have more remaining years of eye growth.

Singaporean studies have shown that:

Younger children tend to progress more rapidly.
Earlier myopia onset predicts a greater risk of high myopia later in childhood.
Rapid childhood progression is associated with teenage high myopia.

A child who develops myopia at six years old may therefore need a different strategy from a child whose myopia begins at fourteen.

Treatment intensity may be influenced by:

Age of onset
Current age
Current prescription
Axial length
Rate of change
Parental myopia
Family history of high myopia
Previous treatment response

Option 1: Myopia-Control Spectacle Lenses

How Do They Work?

Modern myopia-control spectacle lenses provide a clear central distance prescription together with surrounding optical elements designed to alter retinal defocus.

Designs include:

Defocus Incorporated Multiple Segments
Highly aspherical lenslets
Other lenslet arrays
Diffusion-optics designs
Annular or peripheral defocus designs

Different products do not use identical optical mechanisms and should not be treated as interchangeable.

DIMS Spectacle Lenses

DIMS lenses contain a central distance zone surrounded by multiple small segments that create simultaneous myopic defocus.

In the original two-year randomised trial:

Children wearing DIMS lenses progressed by approximately −0.41 D.
Children wearing single-vision spectacles progressed by approximately −0.85 D.
Axial elongation averaged 0.21 mm with DIMS compared with 0.55 mm with single-vision lenses.

A six-year follow-up supported a sustained treatment effect and did not identify evidence of rebound after children stopped wearing DIMS lenses. The later phases were no longer a continuously randomised comparison, so the results should be interpreted accordingly.

Highly Aspherical Lenslets

Highly aspherical lenslet spectacles use multiple aspherical lenslets surrounding a clear central zone.

A randomised trial found slower axial elongation and refractive progression with highly aspherical lenslets than with single-vision spectacles. Wearing time influenced the effect.

A five-year extension found continued slowing among children who remained in highly aspherical lenslet spectacles. Its long-term control group was mathematically extrapolated rather than observed throughout the full five years, which is an important limitation.

Advantages of Myopia-Control Spectacles

Non-invasive
Familiar to most children
No corneal infection risk
Simple for parents
Suitable for many prescriptions
Can correct astigmatism
Can be combined with atropine
No need to insert or remove lenses
Suitable for younger children
Long-term treatment is practical

Limitations

Must be worn consistently
Frame position matters
The child may look over the lens
Lenses may be thicker or more expensive than ordinary spectacles
Some children notice peripheral blur or distortion
Scratches may affect the optical zones
The exact treatment effect varies between designs
Spectacles may be inconvenient for selected sports

Who May Benefit Most?

Myopia-control spectacles are often suitable for:

Younger children
First-time myopia-control treatment
Children with astigmatism
Children unable to use contact lenses
Families preferring a low-maintenance option
Children with ocular-surface problems
Children receiving atropine

Who May Be Less Suitable?

They may be less practical when:

The child refuses spectacles
The frame repeatedly slips
The child plays a high-contact sport
Peripheral optics are poorly tolerated
The prescription is outside the product’s range
The spectacles are worn only occasionally

Does One Spectacle Design Work Best?

No single spectacle design has been proven superior in every age and prescription group.

A 2025 observational comparison suggested that highly aspherical lenslets may outperform orthokeratology in younger children with low myopia, while orthokeratology performed better in selected children with moderate myopia. Because the comparison was not a randomised head-to-head trial, it should inform rather than dictate treatment choice.

The important questions are:

Is the design supported by controlled clinical evidence?
Is the prescription range suitable?
Is the frame fitted correctly?
Will the child wear it most of the day?
Is progression actually slowing?

Option 2: Low-Concentration Atropine

How Does Atropine Work?

Atropine is an antimuscarinic medication.

Its myopia-control mechanism is not explained simply by relaxation of accommodation.

Research suggests that atropine influences signalling within structures such as:

Retina
Choroid
Sclera
Other ocular tissues involved in growth regulation

Atropine may produce concentration-dependent choroidal thickening, which is associated with slower refractive progression and axial elongation.

Which Concentration Is Best?

Commonly studied concentrations include:

0.01%
0.025%
0.05%
Higher concentrations in selected circumstances

In the one-year LAMP trial:

0.05% produced the greatest control.
0.025% produced an intermediate effect.
0.01% produced a smaller average effect.
Higher concentrations caused greater pupil dilation and accommodative reduction.

The five-year LAMP extension continued to support good long-term efficacy with 0.05% atropine. Most children assigned to stop treatment after year three subsequently met the study criteria for restarting atropine.

Why Is 0.01% Still Used?

Possible reasons include:

Fewer light-sensitivity symptoms
Less effect on near focus
Better tolerance
Availability
Previous response
Use in combination treatment
Clinician preference

However, 0.01% should not be assumed to provide adequate control for every child.

A low side-effect concentration that does not slow the child’s axial elongation sufficiently is not necessarily the best treatment.

Advantages of Atropine

No contact lens required
Simple once-nightly dosing in many regimens
Can be used in young children
Can be combined with spectacles or contact lenses
Does not depend on spectacle optical-zone positioning
May suit high prescriptions and astigmatism
Strong randomised-trial evidence, particularly for 0.05%

Limitations and Side Effects

Possible effects include:

Light sensitivity
Larger pupils
Reduced accommodation
Near blur
Eye irritation
Allergy
Difficulty reading small print
Need for photochromic or tinted lenses
Need for a near addition in selected children
Rebound after stopping
Need for long-term adherence

Who May Benefit Most?

Atropine may be considered for:

Younger children
Early-onset myopia
Rapid progression
Children with a strong family history
High or increasing axial length
Children unable to tolerate optical myopia-control designs
Children progressing despite spectacle treatment
Combination treatment

Who May Be Less Suitable?

Extra caution may be needed when the child has:

Severe light sensitivity
Significant near-vision demands poorly tolerated with the selected concentration
Previous allergy to the formulation
Certain pupil, lens or anterior-segment abnormalities
Poor adherence to daily drops

Does Atropine Correct Vision?

No.

The child still requires appropriate optical correction.

Atropine controls progression; it does not replace glasses or contact lenses.

Is Stronger Atropine Always Better?

Not necessarily.

Higher concentrations may provide greater control but also produce:

More near blur
More photophobia
Greater pupil dilation
Greater rebound after abrupt cessation

The best concentration is the lowest concentration that provides adequate control with acceptable side effects—not automatically the weakest or strongest available option.

Option 3: Dual-Focus and Multifocal Soft Contact Lenses

How Do They Work?

These lenses provide:

A central or distributed distance correction
Additional treatment zones creating myopic defocus

The exact optical design varies between products.

High-Add Multifocal Contact Lenses

The BLINK randomised trial compared:

High-add multifocal lenses
Medium-add multifocal lenses
Single-vision contact lenses

After three years, adjusted axial growth was:

0.42 mm with high-add lenses
0.58 mm with medium-add lenses
0.66 mm with single-vision lenses

The high-add design performed better than both the medium-add and single-vision designs.

This finding shows that “multifocal contact lens” is not one uniform treatment.

The optical add and design matter.

Dual-Focus Contact Lenses

A six-year multicentre study found sustained slowing of myopia progression with a daily disposable dual-focus contact lens. Children who changed from the control lens to the treatment lens also showed slowing after the switch.

During a subsequent one-year cessation phase, eye growth returned towards age-expected levels while much of the accumulated treatment benefit was retained.

Advantages

Clear vision without spectacles
Suitable for sports
Daily disposable options reduce cleaning complexity
Good randomised-trial evidence
Can provide both correction and treatment
No overnight lens wear for daily soft lenses
Less visible than spectacles

Limitations

Requires maturity and hygiene
The child must insert and remove lenses
Daily wearing time matters
The prescription and astigmatism range may be limited
Lenses may cause dryness or discomfort
Regular corneal review is required
Infection is uncommon but potentially serious
Cost continues throughout treatment

Infection Risk

Microbial keratitis is uncommon, but its risk is not zero.

Risk increases with:

Sleeping in lenses not intended for overnight wear
Water exposure
Poor hand hygiene
Reusing daily disposable lenses
Inadequate cleaning
Continuing wear during redness or pain

Risk modelling suggests that the lifetime visual risk associated with high axial myopia may exceed the microbial-keratitis risk of appropriately managed childhood contact-lens wear. This does not remove the need for careful selection and hygiene.

Who May Benefit Most?

Soft myopia-control contact lenses may suit:

Active children
Children involved in sports
Children who dislike spectacles
Mature and motivated wearers
Families able to supervise hygiene
Children with prescriptions within the lens range
Children with a healthy ocular surface

Who May Be Less Suitable?

They may be unsuitable or require caution when there is:

Poor hygiene
Frequent swimming without lens removal
Severe allergy
Significant dry eye
Recurrent corneal inflammation
Inability to handle lenses
Unreliable follow-up
Significant astigmatism outside available ranges

Option 4: Orthokeratology

How Does Orthokeratology Work?

Orthokeratology uses rigid lenses worn during sleep.

The lens temporarily reshapes the corneal epithelium, producing:

Central flattening
Mid-peripheral steepening
Clearer unaided daytime vision
A retinal defocus pattern that can slow axial elongation

How Effective Is It?

In the two-year ROMIO randomised trial, mean axial elongation was:

0.36 mm with orthokeratology
0.63 mm with single-vision spectacles

This represented approximately 43% slower average axial elongation.

Younger control-group children progressed particularly rapidly, supporting early treatment in appropriate children.

Advantages

Clear unaided daytime vision
Useful for sports and swimming after lenses are removed
Established myopia-control evidence
Can treat selected degrees of astigmatism
Parents may supervise lens wear at home
Can be combined with atropine
Treatment effect can be monitored with axial length

Limitations

Lenses are worn overnight
Requires strict cleaning
Requires corneal topography
Initial fitting may take several visits
Lens loss or damage can interrupt correction
Vision may fluctuate
Glare or halos may occur
The refractive effect is temporary
Corneal infection is possible
Not every cornea or prescription is suitable

Who May Benefit Most?

Orthokeratology may suit:

Children wanting freedom from daytime spectacles
Children active in sport
Families capable of careful overnight-lens management
Children with suitable corneal shape
Children with low to moderate myopia
Younger children with rapid progression under close parental supervision

Who May Be Less Suitable?

It may be unsuitable or require caution in children with:

Poor hygiene
Recurrent eye infections
Severe allergy
Significant dry eye
Corneal scars
Keratoconus or suspicious tomography
Vigorous eye rubbing
Poor follow-up
Inability to tolerate rigid lenses
Very high or irregular prescriptions outside fitting limits

Does Orthokeratology Cure Myopia?

No.

Its corneal reshaping is temporary.

When lens wear stops:

The cornea returns towards its original shape.
The previous refractive error returns.
Unaided distance vision becomes blurred again.

The structural myopia-control objective is slower axial elongation, not permanent corneal correction.

Option 5: Combination Treatment

Why Combine Treatments?

Combination treatment may be considered when:

A child progresses despite good adherence
Myopia began very early
Axial elongation remains fast
The child has a strong family history
Baseline myopia is already significant
The predicted risk of high myopia is substantial

The aim is to use different mechanisms to achieve greater control.

Atropine Plus Orthokeratology

This is the best-studied combination.

Several randomised trials have found additional slowing when low-concentration atropine is added to orthokeratology.

A two-year AOK trial found mean axial elongation of:

0.17 mm with combination treatment
0.34 mm with orthokeratology alone

Photophobia was more common in the combined group.

Another stratified randomised trial found that combined atropine and orthokeratology outperformed monotherapy overall, although the size of the additional benefit varied by age.

A 2026 multicentre trial also found less two-year axial elongation with 0.01% atropine plus orthokeratology than with orthokeratology alone.

Atropine Plus Myopia-Control Spectacles

This is increasingly used when a child continues progressing on one treatment.

A Singapore prospective cohort studied children progressing rapidly despite low-dose atropine. Adding highly aspherical lenslet spectacles was associated with substantial slowing over the following six to twelve months. Because this was not a randomised control trial, the result supports but does not definitively prove synergy.

A randomised European comparison also found less one-year axial elongation with DIMS spectacles than with 0.01% atropine, illustrating that a weak response to low-concentration atropine does not mean all myopia-control treatments will perform poorly.

Atropine Plus Soft Multifocal Contact Lenses

The evidence is less convincing.

The BAM study did not demonstrate a clear additional benefit from adding 0.01% atropine to high-add multifocal soft lenses.

Possible explanations include:

The contact lens already produced substantial control.
The atropine concentration was too low to add a measurable effect.
The biological mechanisms overlapped.
The study was not designed as a new parallel randomised trial between the two active groups.

Parents should not assume that combining any two treatments automatically doubles the benefit.

Should Combination Treatment Be Used from the Start?

Not always.

Starting with combination treatment may be reasonable when the child has a particularly high-risk profile, such as:

Very early onset
Rapid pre-treatment progression
Long axial length for age
Strong family history of high myopia
Significant myopia at a young age

For many children, starting one appropriate treatment and monitoring the response is reasonable.

Combination treatment can then be introduced if control is inadequate.

Option 6: Repeated Low-Level Red-Light Therapy

How Is It Performed?

A dedicated device exposes both eyes to a specified red-light wavelength for brief sessions.

Common research schedules involve:

Approximately three minutes per session
Twice daily
Several days per week
A minimum interval between sessions

These parameters are device-specific and should not be reproduced using ordinary lamps or consumer light products.

How Effective Does It Appear?

A multicentre randomised trial reported one-year axial elongation of approximately:

0.13 mm with red-light treatment
0.38 mm with single-vision spectacles

The difference was approximately 0.26 mm.

A double-masked trial comparing active treatment with a low-power sham device also reported significant control.

Some studies have reported apparent axial shortening during active treatment.

Why Is It Not Automatically the Best Treatment?

Questions remain about:

Long-term retinal exposure
Device calibration
Variation between devices
Rebound after treatment stops
Whether axial shortening represents scleral shortening or temporary choroidal change
Long-term outcomes outside Chinese populations
Optimal treatment duration
Appropriate monitoring
Retinal safety in susceptible eyes

A post-trial study identified a modest rebound after treatment cessation. A 2026 synthesis concluded that short-term efficacy is promising but device-specific safety validation and standardised implementation remain incomplete.

What Should Parents Know?

“Red light” is not one standardised treatment.
Different devices may deliver different retinal doses.
A consumer red lamp is not a substitute.
Looking at laser pointers or intense lights can damage the retina.
Short-term efficacy does not establish lifelong safety.
Retinal examination and imaging may be appropriate.
Cessation should be monitored for rebound.
It should be used only under appropriately trained professional supervision.

Option 7: Outdoor Time and Visual Habits

Does Outdoor Time Control Existing Myopia?

Outdoor time is most strongly supported for reducing the risk of myopia developing.

It appears less powerful as a sole method for slowing established myopia.

Outdoor time should therefore accompany treatment rather than replace an effective intervention in a child who is already progressing.

How Much Outdoor Time?

Trials and consensus recommendations generally encourage substantial regular outdoor exposure.

The practical aim is approximately two hours a day when feasible, spread across the day.

A school-based cluster-randomised trial found that increasing outdoor time and light exposure reduced the incidence of myopia.

Outdoor activity should include:

Sun protection
Hydration
Safe supervision
Heat precautions
Regular breaks from close work

Do Screens Cause Myopia?

Myopia is influenced by:

Genetics
Age
Outdoor exposure
Education
Near-work intensity
Viewing distance
Individual eye-growth biology

Screens are one form of near work.

The concern is not that ordinary screens burn the retina but that prolonged, close and uninterrupted viewing may combine with reduced outdoor time.

Practical Habits

Children should be encouraged to:

Avoid holding devices extremely close
Take regular distance breaks
Use adequate lighting
Blink normally
Alternate near and distance activities
Spend regular time outdoors
Avoid unnecessary prolonged recreational screen sessions

These habits support eye comfort and healthy routines but are not substitutes for clinical myopia control.

Treatments That Do Not Reliably Control Myopia

Ordinary Single-Vision Spectacles

They provide clear vision but do not usually offer meaningful myopia control.

Deliberate Undercorrection

Leaving a child blurred is not recommended as a myopia-control strategy.

A randomised study found that undercorrection increased rather than reduced progression.

Ordinary Soft Contact Lenses

Standard single-vision soft lenses correct vision but are not established myopia-control treatments.

Eye Exercises

Eye exercises do not shorten an axially elongated eye.

They may help selected binocular-vision conditions, but that is different from myopia control.

Blue-Light Glasses

Blue-light filtration is not an established method of slowing axial elongation.

Vitamins and Supplements

No vitamin or supplement has been shown to provide reliable control of ordinary childhood axial myopia.

Pinhole Glasses

Pinhole apertures may temporarily improve clarity but do not control eye growth.

LASIK, SMILE and ICL Surgery

These procedures correct an adult’s existing refractive error.

They do not prevent a child’s eye from elongating and are not routine childhood myopia-control treatments.

Comparing the Main Options

Treatment	Main strength	Main limitation	Often suits
Myopia-control spectacles	Simple, non-contact and broadly suitable	Requires consistent wear and good frame fit	Younger children and first-line treatment
Approximately 0.05% atropine	Strong pharmacological efficacy	Light sensitivity and near-focus effects	Young or fast-progressing children
Lower-dose atropine	Often easier to tolerate	May provide inadequate control in some children	Mild progression or combination treatment
Dual-focus soft lenses	Good control with spectacle-free sport use	Contact-lens hygiene and prescription limits	Mature, active children
Orthokeratology	Clear unaided daytime vision and established efficacy	Overnight-lens infection and fitting burden	Suitable corneas with strong family supervision
Combination treatment	May improve control in high-risk or poorly controlled cases	Greater cost, complexity and side effects	Fast progressors or inadequate monotherapy
Red-light therapy	Large short-term treatment effects in trials	Long-term, device-specific safety and rebound uncertainty	Selected closely monitored children
Outdoor time	Reduces myopia-onset risk and benefits general health	Insufficient as sole treatment for established fast progression	Every child as an adjunct

The table provides a general framework, not an individual treatment prescription.

Which Treatment Is Best for Different Children?

A Young Child with Newly Diagnosed Myopia

Priorities include:

Early treatment
Simple adherence
Minimising contact-lens risk
Monitoring axial length

A myopia-control spectacle lens is often a practical starting point.

Atropine may be considered when:

The child is particularly young
Baseline risk is high
Progression is already fast

A Child Progressing Rapidly in Ordinary Glasses

Ordinary single-vision glasses should be replaced or supplemented with an evidence-supported treatment.

Options include:

Myopia-control spectacles
Atropine
Dual-focus contact lenses
Orthokeratology
Combination treatment

The choice depends on eye health, maturity and prescription.

A Child Progressing Despite 0.01% Atropine

The next step should not simply be to continue indefinitely without reassessment.

Consider:

Confirming adherence
Cycloplegic refraction
Measuring axial length
Increasing atropine concentration
Adding a myopia-control optical treatment
Changing to another treatment
Reviewing near-work and outdoor habits

Evidence from LAMP shows a concentration-dependent response, while Singapore data support adding highly aspherical lenslet spectacles in selected children progressing despite low-dose atropine.

A Child Who Plays Competitive Sport

Possible options include:

Daily disposable dual-focus contact lenses
Orthokeratology
Sports spectacles with myopia-control spectacles outside sport
Atropine combined with appropriate correction

The choice should consider:

Water exposure
Contact sports
Hygiene
Need for protective eyewear
Ability to handle lenses

A Child with Significant Astigmatism

Possible options include:

Myopia-control spectacles
Atropine
Toric orthokeratology in suitable corneas
Selected toric or customised contact-lens options
Combination treatment

The prescription and corneal topography determine suitability.

A Child with Eye Allergy and Vigorous Rubbing

Contact-lens options may be more difficult.

Priorities include:

Treating allergy
Reducing rubbing
Assessing the cornea
Considering keratoconus risk
Using spectacle or atropine treatment when appropriate

Orthokeratology should not be started without careful corneal assessment.

A Child with Poor Hygiene

A spectacle-based treatment with or without atropine is usually safer than a contact-lens-based strategy.

A Child Who Refuses Glasses

Possible alternatives include:

Dual-focus soft contact lenses
Orthokeratology
Atropine with ordinary correction when required
Continued counselling about spectacle options

The child should not be placed into contact lenses solely for cosmetic reasons when safe handling is unlikely.

A Child with High Myopia

Treatment goals include:

Slowing further axial growth
Maintaining clear vision
Monitoring the retina
Reducing the probability of even higher final myopia

Options may include:

Atropine
Myopia-control spectacles within the product range
Orthokeratology within appropriate correction limits
Soft lenses where available
Combination treatment

High myopia does not mean that treatment is too late.

Slowing additional elongation remains valuable.

A Child Who Progresses Despite Treatment

The first step is not necessarily to declare treatment failure.

Review:

Was the prescription accurate?
Was cycloplegia used when necessary?
Is axial-length measurement reliable?
Is the treatment worn correctly?
Is the frame slipping?
Are contact lenses worn for enough hours?
Are atropine doses missed?
Has the child entered a faster growth phase?
Has another eye condition developed?

The treatment can then be:

Optimised
Changed
Strengthened
Combined

How Treatment Should Be Chosen

Step 1: Confirm True Myopia

The examination may include:

Visual acuity
Cycloplegic refraction
Axial length
Keratometry
Corneal topography when indicated
Eye alignment
Dilated retinal examination

Cycloplegia is particularly important in younger children and when pseudomyopia or accommodative spasm is possible.

Step 2: Estimate Progression Risk

Important risk factors include:

Younger age
Earlier onset
More myopic starting prescription
Rapid previous progression
Longer axial length
Two myopic parents
Sibling with high myopia
Limited outdoor time
Significant educational or near-work load

Younger age is one of the most consistent predictors of faster progression.

Step 3: Consider Eye Health

Assess:

Corneal shape
Tear film
Allergy
Eye rubbing
Pupil size
Accommodation
Strabismus
Retinal health
Contact-lens suitability

Step 4: Consider Lifestyle

Ask whether the child:

Plays sport
Swims frequently
Can use drops
Can handle contact lenses
Regularly loses glasses
Has strong night-vision demands
Has reliable parental supervision
Can attend follow-up

Step 5: Discuss Evidence and Uncertainty

Parents should understand:

Expected benefit is an average, not a guarantee.
Treatment may need to continue for years.
Side effects vary.
The treatment may need to be changed.
Axial length may still increase during successful treatment.
No treatment eliminates all future risk.

Step 6: Monitor Response

A child receiving active myopia control is commonly reviewed approximately every six months, with earlier visits after:

Starting contact lenses
Starting or increasing atropine
Changing treatment
Developing side effects
Identifying rapid progression

A 2024 expert consensus recommended six-monthly axial-length monitoring after myopia-control treatment has begun.

How Do We Know Whether Treatment Is Working?

Compare with Previous Progression

For example:

Before treatment: −1.00 D and 0.40 mm in one year
During treatment: −0.25 D and 0.15 mm in one year

This suggests meaningful slowing.

Consider Age-Expected Growth

A small axial-length increase may represent excellent control in a young child.

The same increase may be less satisfactory in an older teenager.

Use More Than One Measurement

Assessment may include:

Cycloplegic refraction
Axial length
Visual acuity
Corneal topography
Treatment adherence
Wearing time
Side effects

Do Not Judge Treatment Too Early

Short-term axial measurements may be affected by:

Choroidal thickening
Diurnal variation
Instrument variability
Atropine
Orthokeratology
Red-light treatment

A trend over several visits is generally more reliable than one isolated result.

What Is an Inadequate Response?

There is no universal definition.

Concern may arise when:

Myopia continues progressing at approximately −0.50 D or more per year
Axial elongation remains faster than expected for age
The rate remains similar to pretreatment progression
The child is approaching high myopia rapidly
Adherence is good but control is poor

The treatment plan should be individualised rather than based on one rigid cut-off.

When Should Treatment Stop?

Treatment may be reconsidered when there has been sustained stability and the child is older.

Factors include:

Age
Pubertal development
Duration of stability
Axial-length trend
Previous rebound
Family history
Treatment type
Side effects
Child and parent preference

Myopia can continue progressing through the teenage years and into early adulthood.

One stable six-month period does not prove that treatment can safely stop.

Rebound After Treatment Stops

Atropine

Rebound can occur, particularly with:

Higher concentrations
Younger age at cessation
Abrupt discontinuation
Previously rapid progression

In the five-year LAMP extension, most children assigned to stop after year three subsequently required retreatment.

Orthokeratology

The corneal refractive effect reverses when lens wear stops.

Axial progression may continue according to the child’s underlying growth pattern.

Myopia-Control Spectacles

The optical treatment stops when the lenses are no longer worn.

The DIMS extension did not identify a clear rebound signal after cessation, although participant numbers were relatively small.

Dual-Focus Contact Lenses

A seven-year study found that post-treatment growth returned towards age-normal rates while retaining previous treatment gains.

Red-Light Therapy

Rebound has been documented after cessation and remains an important area of investigation.

Common Myths

“There Is One Best Treatment for Every Child”

False.

Treatment must be individualised.

“The Treatment with the Highest Percentage Is Always Best”

False.

Percentages from different trials are not directly comparable.

“The Weakest Atropine Is Always Safest and Best”

Not necessarily.

A very well-tolerated treatment that does not control progression may provide inadequate protection.

“Stronger Atropine Is Always Better”

Not necessarily.

Greater efficacy must be balanced against side effects and rebound.

“Myopia-Control Glasses Work Even When Worn Occasionally”

The treatment is expected to work best with consistent wear.

“All Multifocal Contact Lenses Control Myopia”

False.

The optical design and add power matter.

“Orthokeratology Permanently Cures Myopia”

False.

The corneal effect is temporary.

“Combining Treatments Always Doubles the Effect”

False.

Some combinations produce additional control; others have not demonstrated it.

“Red-Light Therapy Is Proven Safest Because It Is Non-Contact”

False.

Non-contact treatment can still deliver energy to the retina.

Long-term, device-specific safety remains important.

“Outdoor Time Replaces Medical Treatment”

Usually false once a child has established, progressive myopia.

“Axial Length Should Never Increase During Treatment”

False.

The goal is usually slower growth, not necessarily zero growth.

“A Stable Prescription Means Treatment Is Working”

Not always.

Accommodation or corneal change may hide axial elongation.

“The Most Expensive Treatment Must Be the Best”

False.

Price is not a measure of biological effectiveness.

“Once Myopia Control Starts, It Cannot Be Changed”

False.

Treatment should be adjusted according to response and tolerability.

Frequently Asked Questions

Which Treatment Would You Usually Start First?

A myopia-control spectacle lens is often a practical first choice for a young child because of its safety and ease of use.

Atropine may be added or selected first when progression risk is high.

The final recommendation depends on the child.

Is 0.05% Atropine Better Than 0.01%?

In the LAMP trial, 0.05% produced stronger average control.

It also had greater effects on pupil size and accommodation.

Are Myopia-Control Glasses as Good as Atropine?

Both can be effective.

Their relative performance depends on the exact lens design and atropine concentration.

A recent randomised trial found less one-year axial elongation with DIMS lenses than with 0.01% atropine, but this does not establish that every spectacle design is superior to every atropine concentration.

Are Contact Lenses Stronger Than Spectacles?

Not universally.

High-quality myopia-control spectacles and contact lenses both produce meaningful control.

Suitability and adherence often matter more than a small average difference between products.

Is Orthokeratology Better Than Atropine?

It depends on:

Age
Prescription
Corneal shape
Hygiene
Atropine concentration
Side effects
Treatment goals

Combination treatment may outperform either alone in selected children.

Can a Six-Year-Old Use Orthokeratology?

Some young children can use orthokeratology with close parental supervision.

Age alone is not the only consideration.

The child must have:

Suitable corneal measurements
Reliable hygiene
Good follow-up
A family capable of managing overnight lenses safely

Can a Child Use Atropine and Myopia-Control Glasses Together?

Yes.

This may be considered from the start in a high-risk child or added when one treatment provides inadequate control.

Should Every Child Start Combination Treatment?

No.

Combination treatment increases:

Cost
Complexity
Side effects
Monitoring burden

Many children respond adequately to one well-chosen treatment.

Which Treatment Has the Best Long-Term Evidence?

Atropine, orthokeratology, DIMS spectacles and dual-focus soft contact lenses have follow-up extending beyond the initial one- or two-year trial period.

The long-term studies differ in design and do not all retain randomised controls throughout.

Which Treatment Has the Best Safety?

Myopia-control spectacles generally have the lowest medical risk because they do not touch the eye and do not involve medication or retinal light exposure.

They can still produce:

Adaptation symptoms
Peripheral blur
Frame-related problems

Atropine and contact lenses have different, generally manageable risks when used appropriately.

Which Treatment Works Fastest?

Some early physiological effects occur quickly, including:

Choroidal thickening with atropine
Corneal reshaping with orthokeratology
Apparent axial change with red-light therapy

Myopia control should be judged over meaningful follow-up rather than by an immediate change.

Can We Try One Treatment and Change Later?

Yes.

Treatment should be reassessed when:

Side effects are unacceptable
The child refuses it
Adherence is poor
Axial elongation remains fast
Prescription limits are reached
Lifestyle changes

Does My Child Need Axial-Length Measurement?

Axial length is highly useful for:

Baseline risk assessment
Monitoring treatment
Identifying continued structural growth
Comparing treatments

Myopia control can still be managed when axial-length technology is unavailable, but refraction alone provides less complete information.

What if the Prescription Is Stable but Axial Length Is Increasing?

This may occur because changes in the cornea, lens or choroid partly compensate for elongation.

Continued axial growth may justify maintaining or intensifying treatment.

What if Axial Length Shortens?

Possible explanations include:

Measurement variation
Choroidal thickening
Time-of-day effects
Atropine
Red-light therapy
Instrument or fixation differences

Small apparent shortening does not automatically mean permanent structural reversal.

Will My Child Still Need Glasses?

Often yes.

Myopia-control treatment aims to slow worsening.

It does not usually eliminate the prescription already present.

Orthokeratology and contact lenses may provide spectacle-free vision while in use.

Is Treatment Worthwhile for Mild Myopia?

Yes.

Mild myopia may progress, particularly when it begins early.

Early treatment provides more opportunity to reduce the child’s final prescription.

Is Treatment Worthwhile Once Myopia Is Already High?

Yes.

Preventing further progression remains valuable.

Does Treatment Prevent Retinal Detachment?

It cannot guarantee prevention.

Slowing axial elongation may reduce the child’s future risk compared with allowing greater progression.

Can My Child Stop Once They Reach Thirteen?

Not automatically.

Progression commonly continues during adolescence.

Is Myopia Control Only for Asian Children?

No.

Myopia-control treatments can benefit children from different ethnic backgrounds.

However, much of the evidence was generated in East Asian populations, and treatment effects may not be identical in every population.

When to Seek Earlier Eye Assessment

Do not wait for the next routine myopia review when a child develops:

Sudden loss of vision
New flashes
A sudden shower of floaters
A curtain or shadow
Distorted central vision
Severe eye pain
Marked redness
Light sensitivity
Contact-lens-related pain
Discharge
Eye injury
Sudden double vision

These symptoms may indicate:

Retinal tear
Retinal detachment
Corneal infection
Inflammation
Acute glaucoma
Another ocular emergency

A Parent’s Myopia-Treatment Checklist

Before Choosing Treatment

Confirm the prescription with appropriate refraction.
Measure axial length when available.
Review previous progression.
Discuss the child’s age and risk.
Assess corneal and ocular-surface health.
Discuss sports and daily routines.
Consider the child’s maturity.
Review the family’s ability to supervise treatment.
Ask about costs over several years.
Discuss possible side effects.
Plan how treatment response will be measured.

Questions About Spectacle Treatment

Which optical design is being prescribed?
What evidence supports it?
How many hours should it be worn?
How should the frame fit?
What happens if the frame slips?
Is the child’s astigmatism within range?

Questions About Atropine

Which concentration is recommended?
Why was this concentration selected?
What side effects may occur?
Will near glasses or tinted lenses be needed?
How will adherence be monitored?
How will treatment eventually be stopped?
What is the plan if progression continues?

Questions About Contact Lenses

Is the child mature enough?
Is the lens daily disposable?
Can the child swim in it?
What symptoms require immediate lens removal?
How often will the cornea be checked?
Is the prescription within the treatment range?

Questions About Orthokeratology

Is corneal topography normal?
Who will manage lens insertion and cleaning?
How often are reviews required?
What if the child develops a red eye?
Is atropine likely to be added?
How quickly will unaided vision return if treatment stops?

Questions About Red-Light Therapy

What device is used?
Is its retinal exposure independently validated?
What safety monitoring is performed?
Is OCT required?
What happens after treatment stops?
How will rebound be monitored?
What long-term data support this device?

Questions About Follow-Up

What is the axial-length target?
How often will measurements be repeated?
How will age-expected growth be considered?
When would treatment be intensified?
When would treatment be changed?
How will we decide when to stop?

The Bottom Line

There is no single best myopia-control treatment for every child.

The strongest established options include:

Myopia-control spectacle lenses
Low-concentration atropine
Dual-focus or high-add soft contact lenses
Orthokeratology
Selected combination treatment

Myopia-control spectacles are often the simplest first option because they are:

Non-invasive
Easy to use
Suitable for younger children
Able to correct vision and provide control simultaneously

Approximately 0.05% atropine has stronger average clinical-trial efficacy than 0.025% or 0.01%, but causes greater pupil dilation and accommodative effects.

Dual-focus and high-add soft contact lenses provide useful control and freedom from spectacles, but require reliable hygiene.

Orthokeratology provides clear unaided daytime vision and meaningful control, but carries the responsibilities and risks of overnight rigid-lens wear.

Combining atropine with orthokeratology can provide additional control in selected children.

Adding atropine to every optical treatment does not automatically improve the result.

Repeated low-level red-light therapy has produced large short-term effects, but long-term retinal safety, device standardisation, rebound and the meaning of apparent axial shortening require further clarification.

Treatment choice should be based on:

Age
Age at myopia onset
Current prescription
Axial length
Rate of progression
Corneal and ocular-surface health
Side effects
Lifestyle
Adherence
Family preference
Monitoring results

The best treatment is not merely the one with the highest percentage in a study.

It is the treatment that:

Has credible evidence
Is suitable for the child’s eyes
Can be used safely
Fits the child’s life
Is used consistently
Produces sufficient slowing when measured over time

Myopia-control treatment may need to be adjusted, strengthened or combined as the child grows.

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