ARVO 2026: Anti-inflammatory agents and refractive development in children

In the ARVO 2026 session “The role of systemic anti-inflammatory agents on refractive development: a retrospective study in children,” R. Michael Siatkowski, MD, and Jody Summers, PhD, focused on the emerging evidence that inflammation may play a key role in myopia development and progression in children, and that systemic anti-inflammatory therapy might slow or alter this trajectory.

Siatkowski, a pediatric and neuro-ophthalmologist and chair of ophthalmology at the University of Oklahoma (Dean McGee Eye Institute), opens by framing myopia as a major and growing public health problem, particularly in the United States. He noted that up to 50% of children are now becoming myopic, placing them at increased risk for serious complications such as glaucoma, myopic maculopathy, and retinal detachment. Although atropine initially appeared promising as a pharmacologic strategy to slow myopic progression, more recent data have tempered that enthusiasm, suggesting it may not be the long-term solution.

Against this backdrop, Siatkowski and his colleague Summers began discussing the role of inflammation in progressive myopia. Summers, a professor of cell biology and adjunct in ophthalmology, has over 30 years of experience using animal models (particularly chicks) to study scleral remodeling during ocular growth and myopia development. Her animal research suggested that inflammatory pathways are involved in scleral changes, and that dexamethasone, a potent anti-inflammatory and immunosuppressant, can reverse myopia-related remodeling in these models.

Building on these insights, they designed a retrospective chart review as a pilot human study. The study compared three groups of children:

1. Control group: Otherwise normal children who presented for routine eye exams. These children typically became myopic around age 10, with a relatively rapid progression, aligning with global concerns about rising childhood myopia.
2. Treated inflammatory group: Children with chronic inflammatory conditions, most commonly juvenile idiopathic arthritis (JIA) or related systemic diseases, who had been on systemic anti-inflammatory or immunomodulatory drugs since childhood. These children did not show the same early myopic shift. Instead, they generally remained hyperopic and only drifted toward mild myopia around age 17, and even then not to the degree seen in the control group.
3. Untreated inflammatory group: A smaller subgroup of children with systemic inflammatory diseases who were not treated with systemic anti-inflammatory drugs. These children demonstrated worse and earlier-onset myopia than both the control group and the treated inflammatory group, and their myopia continued to progress.

Together, these findings support the hypothesis that systemic anti-inflammatory therapy during childhood can slow or modify the progression of myopia. However, the speakers emphasized several important limitations and unanswered questions:

• The study is retrospective and observational, not a randomized clinical trial.
• The children were on many different anti-inflammatory agents, so the study cannot pinpoint which specific drug(s) are effective.
• In animal models, only dexamethasone clearly worked, but it is a broad immunosuppressant with a complex mechanism and potential side effects, making it less ideal for widespread pediatric use.
• It is unknown whether starting anti-inflammatory treatment after myopia has already begun would effectively slow further progression.
• It is also unknown what happens if treatment is stopped—whether myopia would then accelerate or “catch up.”

Looking ahead, Siatkowski suggested that if researchers can identify a well-tolerated anti-inflammatory with a strong safety profile, potentially delivered topically or via sustained-release (ie, a contact lens), it could be a “game changer” for managing the current myopia epidemic. Summers added that a more practical drug—possibly as simple as something in the class of ibuprofen or similar agents, though this remains speculative—could be much easier to give to children over long periods. Both underscore that more targeted, prospective studies are needed to clarify mechanisms, optimal agents, timing, and long-term outcomes, but the preliminary human data align intriguingly with decades of animal work and strengthen the concept of myopia as, at least in part, an inflammation-mediated process.