Myopia Research Review
A look at recent studies evaluating methods to control myopia and prevent its progression.
Myopia affects a growing portion of the global population and is a common cause of visual impairment.1 A recent systematic review and meta-analysis found that more than one-third of children globally were nearsighted, with projections indicating this number could approach 40% by 2050.2 These data reflect a more than threefold increase in global myopia prevalence in children and adolescents over the past 3 decades, highlighting a significant public health concern worldwide.
Over the past decade, interventions aimed at slowing axial elongation, including low-dose atropine drops, orthokeratology (ortho-k), soft multifocal contact lenses, and specialized spectacle lenses, have gained traction. More recently, combination therapies, emerging spectacle lens designs, and light-based technologies have garnered attention. This article reviews recent clinical trials evaluating standalone and combined modalities.
ATROPINE AND ORTHO-K
Recent research has increasingly focused on the combination of low-dose (typically 0.01%) atropine and ortho-k for myopia control in children. A 2-year randomized clinical trial compared ortho-k alone versus ortho-k plus 0.01% atropine in patients with a spherical equivalent refraction of -1.00 D to -3.00 D.3 The combined treatment were found to slow axial elongation by approximately 0.18 mm over 2 years (0.30 mm in the combination group vs 0.48 mm in the monotherapy group). However, no statistically significant differences in axial length were observed between the groups for patients with myopia greater than 3.00 D.3
Additionally, although the study spanned 2 years, the combined treatment effect was more pronounced during the first 12 months. In another study, Yu et al found that, after 12 months, axial elongation was significantly slower in the ortho-k plus 0.01% atropine group (0.10 ±0.14 mm) versus the ortho-k plus placebo group (0.20 ±0.15 mm).4 Notably, the difference was seen mainly in the first 4 months; afterward, the effects were similar.
In 2023, Tan et al reported axial elongation to be significantly slower in the ortho-k plus 0.01% atropine group (0.17 ±0.19 mm) versus ortho-k alone (0.35 ±0.20 mm) over 2 years, with the strongest additive effect occurring during the first 6 months.5 Chen et al explored whether combination therapy benefitted children whose axial lengths increased by more than 0.3 mm despite 1 year of ortho-k therapy.6 Chinese children less than 7 years of age were retrospectively assigned to either ortho-k plus 0.01% atropine or ortho-k alone for 2 additional years. The results showed no significant difference in axial length progression between the two groups, which is consistent with other earlier studies, suggesting the efficacy of combination therapy declines over time. The evidence supports that combining 0.01% atropine with ortho-k enhances myopia control, especially in the first year and in patients with low myopia; however, efficacy appears to plateau, suggesting there is room to explore different atropine concentrations with longer durations of action.
NOVEL SPECTACLE LENS DESIGN
Lenslet-array-integrated (LARI) spectacle lenses are a new lens design that features alternating positive and negative lenslets to induce peripheral defocus. They have shown promising results in myopia control.7 A randomized trial evaluated the efficacy of spectacle lenses with highly aspheric lenslets (HAL) and slightly aspheric lenslets (SAL) compared with standard single-vision lenses (SVLs) over 2 years in 157 children 8 to 13 years of age.7 The authors reported that lenses with HAL demonstrated significantly greater myopia control than lenses with SAL and SVLs, with a 0.80 D reduction in spherical equivalent progression and 0.35 mm reduction in axial elongation compared with SVLs after 2 years.7 HAL efficacy demonstrated a dose-response effect that was sustained over 2 years, with higher lenslet asphericity providing better control. The study also found that children wearing HAL lenses for at least 12 hours daily experienced even greater myopia control effects.
A 3-year follow-up study investigated the long-term effects of HAL lenses. Children either continued with HAL lenses or switched from SAL lenses or SVLs to HAL lenses in the third year.8 Myopia progression and axial elongation remained consistently lower in all HAL groups compared with a newly recruited SVL control group. Continued HAL lens wear preserved myopia control efficacy into the third year, and children who switched to HAL lenses also showed slower progression than those in SVLs, suggesting benefits of delayed switching to HAL lenses.8
A 2024 trial evaluated the effectiveness of LARI spectacle lenses featuring either positive- (+3.00 D) or negative-powered (-3.00 D) lenslets compared with standard SVLs in 240 Chinese children with myopia 6 to 12 years of age.9 After 1 year, both groups showed significantly less myopia progression and axial elongation than the SVL group. Both lenslet designs slowed myopia progression by more than 50% compared with SVLs, with high compliance, good adaptability, and no treatment-related adverse events, indicating that LARI lenses, regardless of lenslet polarity, are safe and effective for myopia control in children.
These studies suggest spectacle lenslet technology is an effective standalone myopia control treatment option with minimal lifestyle disruption and could serve as an attractive alternative or complement to contact lens and pharmacologic interventions.
LOW-LEVEL RED LIGHT THERAPY
Recent randomized controlled trials have demonstrated that repeated low-level red light (RLRL) therapy is a promising intervention for slowing myopia progression in children. In one large multicenter study by Jiang et al, children 8 to 13 years of age who underwent RLRL therapy (650 nm, 0.29 mW) twice daily for 3 minutes showed significantly less axial elongation and myopic progression over 12 months compared with those wearing SVLs alone.10 Specifically, the RLRL group experienced only 0.13 mm of axial length growth and -0.20 D of spherical equivalent progression, compared with 0.38 mm and -0.79 D, respectively, in the control group. No adverse effects or structural damage was reported, affirming the treatment’s safety and tolerability.
A complementary study by Zhou et al explored the dose-response effect of RLRL by comparing three power settings (0.37 mW vs 0.60 mW vs 1.20 mW) over 6 months in children 6 to 15 years of age.11 All three treatment arms showed significantly reduced axial elongation and even mild hyperopic shifts compared with controls. Notably, the 1.20-mW group demonstrated the greatest inhibition of axial growth, although no statistically significant differences were found between the different power levels. These findings suggest lower RLRL powers may be sufficient for efficacy, potentially favoring safety in long-term use. To strengthen the evidence, Dong et al conducted a double-blind, placebo-controlled trial using a sham device (10% power) to control for expectation bias.12 Over 6 months, children receiving full-strength RLRL therapy had significantly less axial elongation and refractive progression compared with those using the sham device, again with no adverse events. This trial reinforced the efficacy of RLRL therapy while addressing methodological limitations of earlier open-label designs. Collectively, these studies provide support for RLRL as a safe, noninvasive, and effective modality for pediatric myopia control.
GIVE IT ALL WE GOT
Recent evidence supports a range of emerging and established interventions as effective, well-tolerated strategies for slowing myopia progression in children, offering clinicians a growing toolkit for individualized and evidence-based myopia management. As myopia incidence continues to rise, robust clinical evidence must be blended with scalable public health strategies such as encouraging outdoor time, regular vision screenings, and access to myopia control treatments. Ultimately, the goal is to slow childhood myopia progression to prevent long-term ocular disease.
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