Treatment and Management of Myopia in Children
In 2021, the World Council of Optometry (WCO) passed a resolution supporting myopia management as the standard of care by optometrists. This resolution identifies three main components of myopia treatment:
- Mitigation – counselling children and their families, during early and regular eye examinations, about lifestyle and other factors to prevent or delay the onset of myopia.
- Measurement – regular and comprehensive eye health and vision examinations to evaluate ocular status through measurement of refractive error and ocular biometry, where available.
- Management – addressing patients’ needs through correcting myopic refractive error while also providing evidence-based interventions to slow myopia progression.
For many years, myopia treatment focused primarily on correcting blurred vision with glasses or contact lenses. In adults with stable myopia, laser surgery is also an option. However, research now shows that myopia management therapies can slow the rate of refractive error progression and axial elongation of the eye while ensuring proper optical correction for clear distance and near vision.
Children diagnosed with myopia should be encouraged to wear their prescription lenses full-time, as research indicates that consistent correction is associated with better treatment outcomes. In contrast, under-correcting myopia may actually increase its progression.
Myopia treatment management strategies
Current strategies for myopia disease treatment fall into five main categories, all supported by peer-reviewed, published studies from randomised controlled trials:
- Specialised spectacles – e.g. defocus incorporated multiple segment, highly aspherical lenslet, common and diffusion optic (not currently available in Australia) designs.
- Specialised contact lenses – e.g. multifocal, multi-zone, extended-depth-of-focus, and orthokeratology.
- Pharmaceutical agents – while the response to various concentrations of low dose atropine varies with children’s ethnicity, genetics and degree of myopia, recent evidence suggests that 0.01% atropine is likely to be ineffective or only slightly effective in controlling the axial elongation associated with myopia progression and current evidence suggests the use of 0.05% atropine eye drops. Eikance (0.01% atropine minims) is available commercially and was approved by the Therapeutics Goods Administration (TGA) in 2021 for the treatment of progressive myopia in 4–14-year-old children, where myopia progresses ≥ 1.00 D per year. Other concentrations (0.025-0.05%), and other indications (children outside these age ranges or with less than 1.00 D of myopia progression in a year), are considered an off-label use of atropine.
- Combination therapy – for example, a combination of orthokeratology contact lenses and low dose (0.01%) atropine which has the strongest evidence base. There is limited evidence for other combination therapies with some early evidence suggesting reduced progression of SER in European children using 0.01% atropine combined with defocus incorporated multiple segment spectacles lenses, however, there was no significant additive benefit for axial elongation of the eye. Combining 0.01% atropine eye drops with soft multifocal contact lenses (Biofinity D lenses with a +2.50D add power) failed to demonstrate better myopia control than soft multifocal contact lenses alone in the Bifocal & Atropine in Myopia study.
- Repeated low-level red light (RLRL) therapies – which is an emerging area of myopia management treatment which has been shown to slow the progression of myopia through the emission of visible red light. A recent meta-analysis has found RLRL to be an effective and safe short-term myopia management treatment, however, further longer-term studies for efficacy, standardisation and safety are required, particularly in comparison with other myopia management options. Currently in Australia, a home-based RLRL instrument has been TGA registered as a Class IIa medical device.
Can Myopia Be Stopped?
While myopia cannot be fully stopped, research has shown that early intervention can slow its progression. By combining lifestyle changes, optical corrections, and pharmaceutical treatments, myopia management can significantly reduce the risk of high myopia and its associated complications, such as retinal detachment, glaucoma, and macular degeneration.
Myopia Treatments with Limited or No Proven Efficacy
Current evidence does not support the use of the following therapies as there is insufficient or contradictory evidence for the efficacy in slowing myopia progression:
- Spectacle under-correction.
- Progressive Addition Lenses.
- Single vision spectacles, soft contact lenses, and rigid gas permeable contact lenses .
These options may correct vision but have not been shown to slow myopia progression effectively.
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