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

The MOSAIC study (Loughman et al. 2024, JAMA Ophthalmol) and PEDIG study (2023, JAMA Ophthalmol) have shown that atropine 0.01% does not provide clinically significant efficacy in European and American children. This indicates that efficacy demonstrated in East Asian populations cannot be generalized. MiyoLab's CDS system considers population differences and evaluates recommending 0.025% or 0.05% doses instead of 0.01% atropine monotherapy.

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%.

Stellest (HAL Technology, Essilor)

Bao et al. (2022, JAMA Ophthalmol): In the HALT study, HAL (Highly Aspherical Lenslet) technology slowed SER by 55% and axial elongation by 51% over 2 years. Stellest 2.0 (HALT MAX, 2025) reports 58% efficacy.

Other Optical Treatments

• SightGlass DOT (Rappon et al. 2023, CYPRESS): point-diffusion optical technology; 40% efficacy (conservative estimate)
• ZEISS MyoCare (Chen et al. 2025, CARE RCT): multi-zone defocus; 48% SER slowing in Asia

Advantages of Spectacle Treatments

Non-invasive, no hygiene risk, applicable even in the youngest age groups (4-5 years). Highest compliance rate of any treatment modality (~93%, DIMS study). Minimal or no rebound effect (IMI 2025).

For patients with inadequate response to single treatment ("non-responder" or "partial responder"), combination therapy using different mechanisms may be applied.

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 evaluates treatment response using Yam et al. (2020, LAMP-2) criteria: responder, partial responder, and non-responder. When non-response is detected, combination therapy or treatment change is recommended.

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%: low-minimal rebound (Yam et al. 2022, LAMP Phase 3). However, gradual tapering is recommended
• Ortho-K: cornea returns to original shape on cessation but axial slowing is permanent; no significant rebound reported
• DIMS / HAL 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%.