Controversies in Myopia Control Treatment: What Does it Mean for Future Research?

Purpose: Treatment of myopia has been informed by more than 3 decades of clinical trials and other observations. However, controversies regarding myopia control remain, such as when to stop treatment and what is the long-term efficacy of treatment. This perspective aims to describe clinically relevant and current controversies regarding myopia treatment.

Design: Perspective.

Methods: We reviewed clinical trial data and other studies regarding myopia control therapies.

Results: Controversies in myopia treatment are related to the efficacy of low dose atropine eyedrops and new lens design spectacles to substantially reduce progression of myopia. In addition to efficacy, safety of therapies including soft contact lenses, orthokeratology and low-level red light remains a concern. The therapeutic role of outdoor time in reducing myopia progression also requires further investigation. More research is necessary to confirm treatment effectiveness, duration of required treatment, tapering schedules and when to begin and stop treatment.

Conclusions: Myopia management is evolving and maintaining competency in the multiple approaches poses a challenge. Key challenges include identifying high-risk children who would benefit most from treatment, limited evidence supporting the effectiveness of myopia progression control treatments in certain populations, and concerns regarding availability and cost of treatment, which may create socioeconomic barriers to access. The limitations of current methods to slow or stop myopia progression highlight the need for continuing rigorous investigation of new and improved strategies to reduce the burden of myopia.