Treatment Options

Atropine is the most extensively researched myopia control agent. As a muscarinic receptor antagonist, it is thought to slow scleral remodeling. Applied as eye drops at low concentrations (0.01%–0.05%).

LAMP Study (Yam et al. 2019-2022)

This double-blind, placebo-controlled randomized clinical trial conducted in Hong Kong provides the gold-standard evidence for low-dose atropine:

• Atropine 0.01%: 27% SER slowing at 1 year (however, MOSAIC and PEDIG studies failed to show significant effect in European and American children)
• Atropine 0.025%: 43% SER slowing at 1 year
• Atropine 0.05%: 67% SER slowing at 1 year; most effective dose, but pupil dilation and near blur side effects more pronounced

Population Differences: Important Caveat

MOSAIC and PEDIG did not demonstrate a refractive benefit of atropine 0.01% in European/US children, so the LAMP effect size cannot automatically be generalized to other populations. There is no direct randomized evidence for 0.025% outside East Asia, while European evidence exists for 0.05%. The application presents this uncertainty as an information note and does not infer automatic dose escalation or treatment switching from a single-arm before/after change.

Custom-designed gas permeable rigid contact lenses worn overnight temporarily reshape the corneal epithelium, eliminating the need for daytime lenses/glasses and slowing axial elongation by producing peripheral myopic defocus.

Sun et al. (2015) meta-analysis: Ortho-K slowed axial elongation by an average of 45% over 2 years. Efficacy is most pronounced in children with low-moderate myopia (−1 to −4 D).

Risks: Microbial keratitis risk of approximately 1/5,000-1/10,000 per year (minimized with proper hygiene and monitoring). Regular corneal topography monitoring is required.

Developed by CooperVision, MiSight combines corrective and therapeutic (myopic defocus) zones in a center-distance design daily disposable soft contact lens. It is the first contact lens approved by the FDA with a myopia control indication.

Chamberlain et al. (2019): In a 3-year randomized controlled trial (n=144, ages 8-12), MiSight slowed myopia progression by 59% (SER) and axial elongation by 52%. Six-year long-term data shows sustained efficacy.

Spectacle-based myopia control options for children who cannot or prefer not to wear contact lenses have been supported by strong evidence in recent years.

MiYOSMART (DIMS Technology, Hoya)

The lens center zone provides full myopia correction while hundreds of small surrounding segments produce +3.5 D myopic defocus. Lam et al. (2020, Br J Ophthalmol): In a 2-year RCT (n=183), SER progression was slowed by 52% and axial elongation by 62%.

Essilor Stellest (H.A.L.T.) / Stellest 2.0 (H.A.L.T. MAX)

Bao et al. (2022, JAMA Ophthalmol): first-generation H.A.L.T. slowed SER by 55% and axial elongation by 51% over 2 years. In TVST 2025, H.A.L.T. MAX showed additional axial benefit versus standard H.A.L.T.; phase SER differences were not significant, so the engine does not add an extra SER percentage.

Other Optical Treatments

• SightGlass DOT (Laughton et al. 2024, 4-year CYPRESS): point-diffusion optical technology; approximately 32% cumulative slowing of SER progression
• ZEISS MyoCare (Chen et al. 2025, C.A.R.E. RCT): multi-zone defocus; 48% SER slowing in Asia

Advantages of Spectacle Treatments

Non-invasive and does not require contact-lens hygiene. Studies report high wear time, but cohort-average adherence is not converted into an individual efficacy coefficient. Post-discontinuation evidence is assessed separately by treatment and design.

A combination-treatment decision is not tied to a ‘non-response’ label derived from a single-arm before/after SER slope; axial length, comparable measurements, safety, adherence, and examination findings must be assessed together.

Kinoshita et al. (2020): Ortho-K + atropine 0.01% combination slowed axial elongation by 74% over 2 years; significantly superior to ortho-K alone (45%).

MiyoLab does not generate an individual responder/non-responder class or infer a treatment switch from single-arm SER change. With sufficient cycloplegic data it only reports descriptive pre-treatment and on-treatment rates; orthokeratology is monitored with axial length.

Some myopia control treatments (especially atropine) may show temporary acceleration of myopia progression ("rebound") when discontinued. This effect is dose-dependent:

• Atropine 0.5% (high dose): significant rebound on cessation; the ATOM-1 study showed much of the treatment benefit was lost to rebound (Tong et al. 2009)
• Atropine 0.1%: moderate rebound (Chia et al. 2014, ATOM-2)
• Atropine 0.01%–0.05%: rebound was concentration-dependent in LAMP Phase 3 and greater with 0.05%, although differences among the three low concentrations were clinically small. Stopping age and a gradual discontinuation plan matter (Yam et al. 2022)
• Ortho-K: the corneal refractive effect reverses after stopping; axial course and possible acceleration should be followed with measured axial length
• DIMS / H.A.L.T. spectacles: minimal or zero rebound (IMI 2025)

Outdoor time has the strongest evidence for reducing myopia onset risk among lifestyle interventions. It is positioned as a prevention and supportive strategy, not a treatment.

He et al. (2015, JAMA): 40 minutes of additional outdoor activity per day reduced myopia incidence by 23% over 3 years. Rose et al. (2008): Spending a total of 2+ hours outdoors daily reduces myopia onset risk by ~50%.