September 12, 2025
7 min read
Key takeaways:
- Experts advise not waiting until children progress to start myopia control.
- Options include atropine, orthokeratology, soft lenses, spectacles and red light therapy.
ORLANDO — Clinicians should consider a child’s anticipated level of compliance when choosing a modality for myopia control, according to a panelist speaking at Vision Expo East.
Today’s treatment choices include atropine, orthokeratology, dual-focus soft lenses, soft multifocals, progressive-addition spectacles and repeated low-level red light therapy.
“This is where you get to be the doctor,” panelist Mark Bullimore, FCOptom, PhD, FAAO, adjunct faculty at University of Houston College of Optometry, told attendees. “I get asked which treatment is the best, and I say, ‘The one the child will use.’ If there’s no compliance, there will be no treatment benefit.”
With a range of effective options — some of which are yet to be available in the U.S. — the clinician must take into account other factors, he said. The first consideration is prompt treatment in new myopes.
“Waiting for a myopic child to progress before you administer treatment is not good practice,” Bullimore said. “When you have a myopic child that’s diagnosed for the first time, you know from experience that they will progress. And the earlier the onset, the more myopia they’ll end up with. The younger myopes progress much faster than they do later in their childhood. The rate of progression slows about 11% every year as they get older.”
Panelist Ashley Wallace Tucker, OD, FAAO, FSLS, Dipl ABO, director of the Contact Lens Institute of Houston, a branch of Bellaire Family Eye Care, said her initial conversion rate to myopia management is 50%.
“Most of the time, parents are not adopting this mindset immediately,” she said.
She sends them home with information on myopia control to read, and a staff member follows up in about a week. If parents decline treatment for their child, a 6-month visit is scheduled.
“We’ll see that they’ve progressed maybe 0.5 D,” Tucker said. “The success rate at that point of conversion to myopia management is quite high.”
When deciding on a modality, Tucker said she spends a lot of time talking with the children to gauge their maturity level.
“I lean on my own clinical gut,” she said. “I rarely involve the parent for my initial recommendation. My decision is based on the child’s maturity level and what modality I believe they will be most compliant with. Cost can often be an issue. But we’re in the business of being a doctor and not determining what a family can afford. What’s best for the child should always lead our clinical decision-making.”
Available contact lens options
Tucker shared her experiences with a range of myopia control options.
She explained that the MiSight 1 Day (omafilcon A, CooperVision) lens has two correction zones and two treatment zones that create 2 D of myopic defocus.
Children fitted with MiSight as their first contact lens are rarely bothered by the design, she said.
“It may take longer to adjust if you are switching them from a single vision lens,” Tucker said. “Even though it’s studied in 8- to 12-year-olds, I use it in kids younger than 8 and older than 12. Most of my patients progress very little with this lens.”
To gauge compliance, she said she asks patients using the MiSight lenses to bring in their boxes so she can count the lenses.
Tucker noted that because she was practicing myopia control before MiSight was available, she still has many patients in off-label soft multifocal contact lenses, including Biofinity center distance (comfilcon A, CooperVision), NaturalVue MF (etafilcon A, VTI) or a custom design.
If using a soft multifocal lens, choose a center distance design with the highest add the child will tolerate, usually +2.50 D, she said.
The BLINK randomized clinical trial (Walline et al.) concluded that myopic children fitted with a high add power of +2.50 D progressed more slowly than those wearing +1.50 or single vision contact lenses, she said. In addition, 1 year after lens wear cessation, children returned to the normal age-expected rate of progression with no rebound.
In the ongoing PROTECT trial (Tuan et al.), for which Tucker is a principal investigator, children wearing the NaturalVue soft multifocal daily disposable contacts showed a 69% reduction in refractive error progression and 59% reduction in axial length elongation compared with controls wearing single vision lenses. The lens is currently available in a range of –0.25 D to –12 D.
Tucker said that overnight orthokeratology can also slow myopia in addition to correcting vision.
A number of orthokeratology lenses are available, including Boston Orthokeratology shaping lens (oprifocon A, Bausch + Lomb), Paragon Corneal Refractive Therapy lens (HDS 100, CooperVision), Euclid Emerald and Emerald Toric lenses (oprifocon A) and Acuvue Abiliti Overnight lens (senofilcon A, Johnson & Johnson).
Atropine in clinical trials
Healio reported in March that the FDA accepted a new drug application for SYD-101 (atropine sulfate ophthalmic solution 0.01% and 0.03%, Sydnexis) to slow the progression of pediatric myopia and has assigned a Prescription Drug User Fee Act date of Oct. 23.
In another Healio report, Sydnexis President Patrick Johnson, PhD, said that the company’s ongoing phase 3 STAR study of SYD-101 is being conducted among a population representative of the U.S. and is the “world’s largest study for the treatment of pediatric progressive myopia ever conducted.”
Bullimore said that the Atropine for the Treatment of Childhood Myopia studies (Lee et al., Saxena et al., Hieda et al.) showed that 0.01% atropine “was found to be pretty effective, slowing myopia by 0.71 D.”
A study by Zloto and colleagues “led to widespread adoption of 0.01% atropine for myopia treatment,” he added.
The LAMP study (Zhang et al.) was the most comprehensive trial of atropine, Bullimore said, comparing three different concentrations: 0.05%, 0.025% and 0.01%.
“Over the first year, there was a nice dose-response function,” he said. “Since then, there have been many more clinical trials.”
Tucker said she uses 0.05% atropine as monotherapy, but if coupling it with a soft contact lens, she starts with 0.01%.
Spectacle lenses
Bullimore outlined options for myopia control using spectacle lenses.
EssilorLuxottica’s lens, the Highly Aspherical Lenslet Target, or HALT, “is very effective,” he said. A clinical trial outside the U.S. is showing that “it slows myopia progression by about 1.75 D and axial elongation by 0.7 mm over 5 years.”
Healio reported in April that the Essilor Stellest lenses slowed myopia progression 57% over 6 years.
Hoya’s Defocus Incorporated Multiple Segments, or DIMS lens, “is also very effective,” Bullimore said.
Chun and colleagues saw significant choroidal thickening after 1 week that lasted 2 years, “which correlates well with the sustained effect of DIMS lens in slowing eye growth,” they said.
The Zeiss MyoCare and MyoCare S lenses, which are available in Canada, feature patented microstructures, called Cylindrical Annular Refractive Elements, to slow eye growth, according to the company website.
A recent study by Chen and colleagues showed that after 12 months of wear, both MyoCare and MyoCare S “significantly slowed myopia progression compared to [single vision] lenses.”
SightGlass Vision’s Diffusion Optics Technology, or DOT lenses, “don’t alter peripheral focus. They use diffusion optics to reduce contrast,” Bullimore said.
Results from the CYPRESS study (Laughton et al.) showed that the DOT 0.2 lenses “are safe and effective at reducing myopia progression, with additional benefit evident in year 4 of wear. These results support the hypothesis that a mild reduction in retinal contrast can slow myopia progression in young children.”
Red light therapy
Researchers are also evaluating repeated low-level red light therapy for myopia control.
Xu and colleagues found that 53.3% of children and adolescents with high myopia experienced “substantial axial shortening” after 12 months of treatment (twice-daily 3-minute sessions) with the Eyerising device, which has a wavelength of 650 nm.
“Recently, Chinese authorities reclassified these devices,” Bullimore said. “They’re class 3, significant risk, and we need more data before we can use it, they said.”
In China’s device classification system, class 1, 2 and 3 correspond to low, intermediate and high risk, according to Wang and colleagues. The China National Medical Products Administration initially designated repeated low-level red light devices as class 2 but changed it to class 3 in mid-2023, requiring more stringent oversight.
Bullimore said a colleague in Canada has been experimenting with LED red light therapy glasses in high myopes “and has seen good results as far as safety and efficacy.”
Treatment rebound
Bullimore commented on the issue of treatment rebound, saying the ATOM study involving atropine showed that previously treated myopic eyes were progressing three times the rate of untreated eyes (Bullimore et al.).
“In higher concentrations of atropine, above 0.1%, and with red light therapy, you do see rebound,” he said. “With optical technologies — soft lenses, spectacles — you don’t see rebound.”
With the MiSight lens, “There is no rebound effect after cessation of wear,” Tucker said. “If they stop wearing it, they will continue to progress at the age-expected norm.”
Healio reported in April that regardless of duration of treatment, children who stopped wearing the MiSight dual-focus contact lenses for myopia control maintained prior treatment gains, with eye growth rates similar to those of untreated myopic eyes, according to a study.
Healio also reported in June that there was no rebound effect in myopia progression 1 year after stopping long-term wear of the SightGlass Vision DOT spectacle lenses.
Bullimore summarized: Each diopter of myopia increases risk for myopic maculopathy by 60%, glaucoma by 20% and visual impairment by 30%.
“It would take less than 1 D of control to prevent 1 million cases of visual impairment in the U.S.,” he said. “The benefits of myopia control far outweigh the risks.”
“We should be administering the best evidence-based interventions to all myopes,” Tucker added.
References:
- Bullimore MA, et al. Ophthalmic Physiol Opt. 2024;doi:10.1111/opo.13403.
- Chen X, et al. Acta Ophthalmol. 2024;doi:10.1111/aos.16795.
- Chun RKM, et al. Eye Vis (Lond). 2023;doi:10.1186/s40662-023-00356-z.
- Hieda O, et al. Jpn J Ophthalmol. 2021;doi:10.1007/s10384-021-00822-y.
- Laughton D, et al. BMJ Open Ophthalmol. 2024;doi:10.1136/bmjophth-2024-001790.
- Lee SSY, et al. Clin Exp Ophthalmol. 2024;doi:10.1111/ceo.14368.
- Saxena R, et al. Ophthalmology. 2021;doi:10.1016/j.ophtha.2021.01.026.
- Tuan KA. Invest Ophthalmol Vis Sci. 2024;65(7):2697.
- Walline JJ, et al. JAMA. 2020;doi:10.1001/jama2020.10834.
- Wang YX, et al. JAMA Ophthalmol. 2025;doi:10.1001/jamaophthalmol.2024.5977.
- Xu Y, et al. Ophthalmology. 2024;doi:10.1016/j.ophtha.2024.05.023.
- Zhang XJ, et al. Ophthalmology. 2024;doi10.1016/j.ophtha.2024.03.013.
- Zloto O, et al. Graefes Arch Clin Exp Ophthalmol. 2018;doi:10.1007/s00417-018-4078-6.
For more information:
Mark Bullimore, FCOptom, PhD, FAAO, can be reached at bullers2020@gmail.com. Ashley Wallace Tucker, OD, FAAO, FSLS, ABO Dipl, can be reached at ashley.w.tucker@gmail.com.
Sources/Disclosures
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Bullimore M, et al. Myopia control program: In-depth exploration of myopia management solutions from lenses to pharmaceuticals. Presented at: Vision Expo East; Feb. 19-22, 2025; Orlando.
Disclosures:
Bullimore reports consulting for Alcon, Bruno Vision, CooperVision, Dopavision, EssilorLuxottica, Euclid Vision, Eyenovia, Genentech, Johnson & Johnson, Kubota Vision, Laboratoires Théa, Santen Pharmaceutical, SightGlass Vision, Sydnexis and Vyluma. Tucker reports consulting for Bausch + Lomb, CooperVision, MyopiaX, Myoptechs, SightGlass Vision, Sydnexis, Tarsus, Topcon and Visioneering Technologies.
