The quest for the most effective myopia control strategy is a subject of considerable interest among ECPs, patients, and their families. While it may be tempting to pick a control option based on control efficacy alone, this can be insufficient and overlooks the multi-dimensional nature of myopia prevention and management (for more information on how myopia control defines “efficacy,” see sidebar). While no single method has emerged as the unequivocal leader in myopia control, each offers distinct characteristics that will be discussed in this article.

Low-dose atropine 
Low-concentration atropine eye drops have gained attention for their tolerability and efficacy.¹ Preparing low-dose atropine (LDA) requires meticulous formulation to balance efficacy and safety, with an established dose-response relationship in a range of low to moderate myopia.² Because LDA focuses on myopia control, patients undergoing the treatment require refractive correction. Additionally, the exact mechanism and the target site of action for its use in myopia control remains unclear, and the factors impacting on the productive absorption of LDA through topical route, such as ocular surface inflammation or iris pigmentation, have not been thoroughly assessed (for more information on research into LDA, see my previous columns at bit.ly/OMmyopia0523 and bit.ly/OMmyopia1023). 

Multifocal contact lenses
Daytime wear multifocal contact lenses (MFCL) are becoming prominent in myopia control, boasting similar efficacy to OrthoK. They offer a simpler fitting process, a variety of replacement schedules, and fewer restrictions regarding myopia levels. However, daytime wear necessitates wearers independently manage their lenses.

Novel spectacles
Emerging lenslet technology in novel spectacles, particularly prevalent in Asia, have demonstrated efficacy and a straightforward fitting process. However, the long-term efficacy across diverse populations remains to be further evaluated (for more information on novel spectacles and myopia management, see my March 2024 column at bit.ly/OMmyopia0324).

Overnight orthokeratology
Overnight orthokeratology (OrthoK) involves the use of specially crafted gas-permeable contact lenses worn during sleep, which is designed to help clear the vision of the wearer after the lenses are removed in the morning.  Beyond its FDA-approved purpose for temporary myopia correction, OrthoK has been observed to slow myopia progression in children, a finding corroborated by multiple clinical studies. Efficacy rates can vary, though, based on several factors: the individual risk of rapid myopia progression, variations in corneal reshaping effectiveness, and the requirement for clear daytime vision post-lens removal. OrthoK is best for patients who don’t mind that it requires precise fitting and regular lens replacement.

Tailoring treatment
Ultimately, the decision for which myopia control option to use is influenced by the professional judgment of medical practitioners, patient lifestyles, personal preferences, and cultural factors. A comprehensive approach to myopia management, integrating optical, pharmaceutical, and behavioral strategies, and tailored to the individual, holds the key to future advancements in this field. OM

References

1. Lawrenson, J.G., et al., Interventions for myopia control in children: a living systematic review and network meta-analysis. Cochrane Database Syst Rev, 2023. 2(2): p. CD014758.

2. Kaiti, R., R. Shyangbo, and I.P. Sharma, Role of Atropine in the control of Myopia Progression- A Review. Beyoglu Eye J, 2022. 7(3): p. 157-166.