Choosing the right patients for soft lenses, orthokeratology, and spectacle lenses has long-lasting effects on the vision health of those with myopia.
Myopia has evolved beyond being a simple refractive complaint. It is now recognized as a progressive ocular condition with significant long-term implications for vision, ocular health, and quality of life. With the global surge in myopia prevalence, especially among children and adolescents,1 optometrists are increasingly obligated to not only correct refractive error but also manage myopia progression to protect future vision, eye health, and quality of life.
Current evidence underscores that proactive myopia management in childhood is a crucial preventive public health strategy, shifting clinical care toward preservation of ocular structure and function rather than just visual acuity correction.1-3
The primary pathophysiologic change in myopia is axial elongation of the eye, which increases the chances for structural complications. A comprehensive review of the risks associated with myopia reveals that even each diopter increase in refractive error significantly elevates the lifetime risk of sight-threatening conditions, including myopic maculopathy, glaucoma, lens changes, and retinal detachment.4
As myopic eyes elongate, the retina and choroid thin, predisposing individuals to peripheral retinal degeneration, lattice changes, and higher rates of retinal tears and detachments. Observational analyses show that higher degrees of myopia correlate with a several-fold greater risk of retinal detachment and cataract compared with emmetropic eyes.5
Myopic eyes often exhibit optic nerve head changes, including peripapillary atrophy and tilted discs. These structural and biomechanical vulnerabilities make the optic nerve head more susceptible to damage from IOP. Such changes can also complicate glaucoma diagnosis, emphasizing the need for careful monitoring in patients with high myopia. Epidemiological studies support an elevated prevalence of open-angle glaucoma in myopic populations, highlighting the importance of vigilant optic nerve assessment and long-term follow-up.6
Myopia has been linked to an earlier onset of nuclear cataract compared with nonmyopic eyes. Although cataract surgery usually restores vision, axial elongation can complicate intraocular lens calculations and raise the risk of postoperative complications, such as macular degeneration and retinal tears. Slowing myopia progression can therefore help reduce the lifetime risk of visual impairment.7
Because myopia progression increases structural risks, management strategies focus on slowing axial elongation and reducing long-term complications. A systematic review of multiple randomized trials confirmed that optical, pharmacologic, or combined therapies are more effective than single-vision spectacles at slowing both refractive change and axial growth.8,9
Contact lenses have become a cornerstone of early myopia management, expanding clinicians’ treatment options. In recent years, their use has enabled even very young patients to benefit from effective myopia control strategies.
FDA-approved peripheral defocus soft contact lenses for myopia control are designed to induce peripheral myopic defocus and help slow axial elongation of the eye. Clinical evidence shows that these lenses significantly reduce axial length progression in children. With standardized base curves and diameters, they offer straightforward clinical fit for practitioners and convenient daily wear for patients. These lenses deliver a consistent treatment effect, are safe, and offer an effective option for myopia management. Although they are easy to use, successful outcomes depend on proper hygiene and patient adherence.9-11
Other daily disposable designs incorporating extended depth-of-focus optics are currently under regulatory review. Although not FDA approved for myopia control, they are commonly used off-label, particularly in patients with moderate to high myopia. Additionally, cross-sectional and longitudinal studies suggest that multifocal soft contact lenses with higher add powers (eg, +2.50 diopter), typically available in monthly replacement modalities, can slow axial elongation. Although generally less effective than lenses specifically designed for myopia control, they may offer a more accessible and cost-effective alternative for some patients.12-15
Ideal candidates for soft contact lenses include:
Orthokeratology (ortho-K) lenses reshape the cornea overnight, providing unaided vision during waking hours while inducing peripheral myopic defocus. Systematic reviews and meta-analyses confirm that ortho-K slows axial elongation compared with single-vision controls.28
Recent data also suggest that lens design variations that use a smaller treatment zone may optimize myopia control by increasing peripheral defocus. Ortho-K fitting is highly customizable, requires clinical expertise, and is more time intensive than soft contact lens fitting for myopia control.9,16,17
Ortho-K is suitable for:
In the United States, new designs such as highly aspherical lenslet spectacles are now available and FDA approved, and other technologies such as the defocus incorporated multiple segments (DIMS) lens are under regulatory consideration. These lenses aim to reduce peripheral hyperopic defocus by introducing a myopic defocus signal across the retina, thereby slowing axial eye growth and myopia progression.14,15
Large, randomized trials show that these lenses slow myopia progression and reduce axial length elongation more effectively than single-vision spectacles. A major meta-analysis found statistically significant treatment effects with defocus-incorporated spectacle lenses compared with single-vision spectacle lenses.18-20
These innovations expand treatment options for the following children:
Routine measurement of axial length is a valuable tool in myopia management, although changes in refractive error alone remain an important indicator of disease progression.21,22 Although not mandatory to initiate or practice myopia control, tracking axial length allows clinicians to:
Emerging evidence suggests that combining optical and pharmacologic therapies can provide additive benefits in slowing myopia progression. A recent study in Chinese children demonstrated that adding low-dose atropine (0.01%) to either ortho-k or DIMS lenses significantly reduced axial elongation compared with either treatment alone.23,24
This supports a personalized approach that considers age, baseline progression rates, and lifestyle factors when managing myopia. Myopia management is a dynamic and personalized approach that optimizes long-term outcomes.
Although optical and pharmacologic interventions dominate clinical practice, evidence also highlights the contributions of the visual environment to myopia onset and progression. Increased near work without breaks and reduced outdoor time are associated with higher myopia incidence and progression rates. Encouraging balanced visual habits such as frequent breaks during near work and increased time outdoors is critical and complements clinical therapies.25,26
Educating families about myopia as a chronic condition with lifelong implications is essential. Use evidence-based data to discuss risks, realistic expectations, and the benefits of early intervention.27
The landscape of myopia management continues to evolve. As new lens designs, pharmacologic treatment, and diagnostic tools come into practice, optometrists are uniquely positioned to integrate these innovations into personalized care plans.
In addition, by viewing myopia management as preventive eye care, clinicians can shift from reactive correction to proactive strategies that preserve ocular health over the long term and ultimately protect vision across a lifetime.
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