This article was originally published in a sponsored newsletter.

Researchers have shown that “future myopia can be predicted in a nonmyopic child using a simple, single measure of refractive error.”¹ Of course, prediction without prevention is of limited value. Fortunately, proven options for prevention are expanding.

In a recent column, a comprehensive clinical trial was discussed that showed low-concentration atropine delays myopia onset.² The two-year placebo-controlled, double-masked trial conducted in Hong Kong randomized 474 children, aged 4 to 9 years, to receive 0.05% atropine, 0.01% atropine, or placebo, with the eyedrops applied once nightly in both eyes. The two-year cumulative incidence of myopia was 53% in the placebo group. Remarkably, 0.05% atropine almost halved the incidence to 28%.

More recently, a smaller trial provided further support for low-concentration atropine delaying onset.³ Sixty pre-myopic children aged 6 to 12 years were randomized to receive one drop of 0.01% atropine or placebo once nightly for six months. Myopia onset was significantly lower in the 0.01% atropine group than in the placebo group: 12% versus 36%, respectively.

Last month in another clinical trial on myopia prevention, 287 children who had pre-myopia (defined as cycloplegic spherical equivalent between –0.50D and +0.50D in the more myopic eye) were randomized to repeated low-level red-light (RLRL) therapy twice per day, five days per week, with each session lasting three minutes or no treatment.⁴ The 12-month incidence of myopia was 40.8% (49 of 120) in the intervention group and 61.3% (68 of 111) in the control group, a relative 33.4% reduction in incidence.

Earlier onset of myopia is associated with an increased likelihood of higher levels of myopia and thus a heightened risk of visual impairment.⁵ A patient’s final level of myopia may be lowered by myopia control after onset, but delaying onset by one year has the potential to lower the final level myopia by 0.75D or more—that’s equivalent to two to three years of myopia control with existing modalities.⁵

All readers should consider adding myopia prevention to their myopia management practice.

1. Zadnik K, Sinnott LT, Cotter SA, et al. Prediction of Juvenile-Onset Myopia. JAMA Ophthalmol. 2015 Jun;133:683-689.

2. Yam JC, Zhang XJ, Zhang Y, et al. Effect of Low-Concentration Atropine Eyedrops vs Placebo on Myopia Incidence in Children: The LAMP2 Randomized Clinical Trial. JAMA. 2023 Feb 14;329:472-481.

3. Wang W, Zhang F, Yu S, et al. Prevention of myopia shift and myopia onset using 0.01% atropine in premyopic children - a prospective, randomized, double-masked, and crossover trial. Eur J Pediatr. 2023 Mar 22. [Online ahead of print]

4. He X, Wang J, Zhu Z, et al. Effect of Repeated Low-level Red Light on Myopia Prevention Among Children in China With Premyopia: A Randomized Clinical Trial. JAMA Netw Open. 2023 Apr 3;6:e239612.

5. Bullimore MA, Brennan NA. Myopia: An ounce of prevention is worth a pound of cure. Ophthalmic Physiol Opt. 2023 Jan;43:116-121.