Midyear 2026 recap: Major clinical findings in optometry

New spectacle lens data, red light safety concerns, and atropine tapering findings

The first half of 2026 delivered a wave of research relevant to myopia management, spanning spectacle lens design, treatment tapering strategies, and mechanistic questions about why myopia progresses. A safety evaluation of red light therapy devices and a case report linking semaglutide to rapid diabetic retinopathy (DR) progression round out a busy 6 months for ODs managing both pediatric and adult patients. Below is a summary of the major findings optometrists should know heading into the second half of the year.

MiYOSMART iQ spectacle lenses show no average progression at 6 and 12 months

HOYA Vision Care presented interim 6-month data on its MiYOSMART iQ spectacle lenses at the 41st Asia-Pacific Academy of Ophthalmology Congress in February, evaluating the Defocus Incorporated Multiple Segments Triple Enhanced Design (DIMS TED) lenses in children aged 4 to 12 years with progressive myopia.¹ At 6 months, the lenses showed no myopia progression on average with minimal eye growth, and performed twice as effectively as the original MiYOSMART lenses at controlling axial elongation.¹

Twelve-month data presented at the ARVO 2026 Annual Meeting reinforced these results in 196 schoolchildren in Hong Kong. Nine of 10 children wearing the lenses showed no clinically relevant progression over the first year, with mean spherical equivalent refractive error changing by +0.046 D in the treatment group compared with −0.534 D in the single-vision control group. MiYOSMART iQ is currently rolling out across major eye hospitals in China, with broader availability planned through 2026.

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Red light therapy devices may exceed retinal safety limits

A Brief Report published in JAMA Ophthalmology raised concerns about the safety of commercially available red light therapy devices used for myopia control.² Researchers Lisa A. Ostrin, OD, PhD, and Alexander W. Schill, PhD, of the University of Houston College of Optometry, evaluated 4 devices against American National Standards Institute (ANSI) guidelines. The Sky-n1201 and EyeRising devices reached ANSI group 1 safety limits within 2.8 and 1.4 seconds, respectively, well under the 180-second recommended treatment duration.

The Future Vision device remained within Class 1 laser limits but only under extended exposure conditions, while the LED-based AirDoc device stayed safe well beyond the recommended duration. The authors called for rigorous, independent safety validation before widespread pediatric use, citing prior reports of retinal structural changes and reduced cone photoreceptor density with repeated red light exposure. Red light therapy remains unavailable in the US, but ODs should be prepared to counsel patients and families who may be considering devices obtained internationally.

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A proposed mechanism links near work, dim light, and myopia progression

Researchers at SUNY College of Optometry proposed a unifying hypothesis for why several disparate risk factors, including near work, dim indoor lighting, and treatments like atropine and multifocal lenses, all appear to influence myopia progression.³ Senior author Jose-Manuel Alonso, MD, PhD, and doctoral student Urusha Maharjan suggested pupil constriction during near work may reduce retinal illumination enough to affect the neural pathways involved in visual processing.

The theory holds that outdoor light allows the pupil to constrict while still delivering ample retinal stimulation, while near work indoors under dim lighting produces the same pupillary response without sufficient light reaching the retina. The authors were careful to note the hypothesis is not a final answer and does not diminish the roles of genetics or screen-associated near work. Still, it offers ODs a physiological framework for counseling families on lighting and near-work habits alongside established interventions.

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Tapering low-dose atropine outperforms abrupt discontinuation

An 8-year follow-up of the Low-Concentration Atropine for Myopia Progression (LAMP) study found children tapered off 0.05% atropine before full discontinuation had significantly less myopia progression over 3 years than those who stopped abruptly.⁴ Investigators from the Chinese University of Hong Kong and 6 other institutions randomized 246 children who had completed 5 years of atropine treatment to either a taper group, receiving 6 months of 0.05% atropine followed by 6 months of 0.025%, or a stop group, continuing 0.05% atropine for a full year before discontinuation.

Over the following 3 years, spherical equivalent progression and axial elongation were significantly slower in the taper group, and 65.1% of tapered patients had a good response to discontinuation compared with 42.6% in the stop group (P = .003). Younger age and higher baseline myopia were associated with a larger benefit from tapering. The findings give ODs prescribing compounded low-dose atropine off-label a more evidence-based approach to eventual discontinuation.

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Epi-on CXL shows efficacy in pediatric keratoconus

A phase 3 subgroup analysis presented at the American Association for Pediatric Ophthalmology and Strabismus meeting in March found epithelium-on, oxygen-enriched corneal crosslinking (CXL) improved outcomes in pediatric patients with keratoconus.⁵ Michael B. Raizman, MD, of Ophthalmic Consultants of Boston, evaluated 30 eyes of 22 patients aged 13 to 17 years randomized 2:1 to epithelium-on CXL or sham treatment.

At 6 months, mean maximal corneal curvature improved by 0.5 D in treated eyes and worsened by 1.5 D in sham eyes, a between-group difference of 2.0 D. Best spectacle-corrected visual acuity improved by 7.9 Early Treatment Diabetic Retinopathy Study letters in the treatment group and worsened by 2.4 letters in the sham group. Given the more aggressive disease course typical in pediatric keratoconus, a noninvasive option with a favorable safety profile may support earlier referral and intervention for ODs monitoring young patients with progressive disease.

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Case report links semaglutide initiation to rapid DR progression

A poster presented at the AOA's Optometry's Meeting in June described a patient who developed rapid proliferative DR progression 6 months after starting semaglutide, ultimately requiring bilateral intravitreal anti-VEGF injections.⁶ Author Hannah E. Grimes, OD, of the Southern College of Optometry and the Ralph H. Johnson VA Medical Center, presented the case as part of a growing body of evidence linking GLP-1 receptor agonist initiation to accelerated DR in patients with preexisting retinal disease and poor glycemic histories.

The mechanism is thought to involve rapid glucose normalization temporarily worsening retinal perfusion in vulnerable eyes, consistent with earlier findings from the SUSTAIN-6 trial. As GLP-1 medications continue to be prescribed at rising rates, ODs are increasingly positioned as the first eye care providers to catch retinal sequelae. AOA guidance recommends a comprehensive dilated exam at or shortly after GLP-1 initiation for patients with preexisting DR, elevated HbA1c, or a history of poor glycemic control.

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References:

1. HOYA Vision Care presents breakthrough 6-month MiYOSMART iQ clinical evidence at Asia-Pacific Academy of Ophthalmology Congress 2026. News release. HOYA Vision Care. February 8, 2026. Accessed February 9, 2026. No myopia progression reported on average in 6-month trial assessing MiYOSMART iQ spectacle lenses. Optometry Times. February 10, 2026.

2. Ostrin LA, Schill AW. Safety evaluation of 4 red light therapy devices for myopia. JAMA Ophthalmol. 2026; published online February 5. doi:10.1001/jamaophthalmol.2025.5660

3. New research suggests myopia could be caused by how we use our eyes indoors. News release. State University of New York College of Optometry. Accessed February 19, 2026.

4. Zhang Y, Zhang XJ, Zaabaar E, et al. Discontinuation approach and follow-up of low-concentration atropine for myopia progression: eight-year results of the LAMP Randomized Clinical Trial. JAMA Ophthalmol. 2026; published online March 26. doi:10.1001/jamaophthalmol.2026.0436

5. Raizman MB, et al. Epithelium-on oxygen-enriched corneal crosslinking in pediatric keratoconus: phase 3 subgroup analysis. Presented at the 51st Annual Meeting of the American Association for Pediatric Ophthalmology and Strabismus; March 18-22, 2026; Boston, MA.

6. Grimes HE. Semaglutide initiation and rapid diabetic retinopathy progression: a case report. Presented at Optometry's Meeting, American Optometric Association; June 17-20, 2026; Phoenix, AZ.