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As the concerns of worldwide myopia increase, myopia management has become an important part of clinical practice; however, clinicians should be aware of rebound effects upon the discontinuation of treatment. Discontinuation is preferably initiated by the practitioner but may also be initiated by the patient without the practitioner’s knowledge.

As further research is presented on rebound, practitioners will receive more guidance around how to discontinue patients safely and effectively. This article will provide advice on how to discontinue patients from therapy in clinical practice based on current research.

Soft Lenses

Studies have shown minimal to no rebound effects with dual focus and extended depth of focus contact lenses.^1,2 Ruiz-Pomeda and colleagues showed that after two years of wearing MiSight contact lenses, followed by a one-year cessation period, no rebound effect was observed,¹ although the mean age of the MiSight wearers was older than the control group.

Clinically, these findings imply that patients should continue in myopia control soft lenses for at least two years. Also, the age of cessation is important. Ideally, children should be at least 13 years old when lenses are removed. In my practice, we also continue treatment until axial length and myopic progression is stable.

Orthokeratology

Many studies have demonstrated rebound after discontinuation of orthokeratology.^3-7 For this reason, counseling and careful monitoring is highly necessary for this group. Recommendations to discontinue orthokeratology after the age of 14 have been provided.⁴ Similar to soft lens therapy, stability of axial length over a period of time is necessary to discontinue treatment.

Atropine

Rebound effects of atropine have been highly studied with higher-dose atropine showing more rebound than low-dose atropine.^8-10 Younger children also tend to show more rebound than older children.9 As a stand-alone treatment, 0.05% atropine is currently the most common recommendation. Tapering atropine concentrations is a popular method of discontinuing atropine treatment as suggested by the World Health Organization (WHO).¹¹ To my knowledge, however, there is no data to show that this is the best method of discontinuing treatment.

Clinicians often opt to reduce concentrations from 0.05% to 0.025%, 0.01%, or even lower concentrations (or other variations of concentrations) over a period of time to limit rebound. Careful monitoring of myopia progression and axial length is necessary during this period and after discontinuation.

Spectacles

No rebound was observed when defocus incorporated multiple segments (DIMS) lenses were discontinued after 3.5 years of wear.¹² Minimal rebound was observed with highly aspherical lenslets (HAL) lenses in a shorter-term cross-over study.¹³These findings further substantiate the guidance that spectacle lenses are safe and effective, and a treatment time of at least two years may result in less rebound.

Red Light Therapy

Repeated low-level red light (RLRL) therapy is highly effective in reducing myopic progression, but rebound is a significant concern.^14,15 The mechanism of action is not fully understood.

Further research is required to provide proper guidance for the treatment of myopia. In countries where RLRL therapy is being offered, careful monitoring and education for the patients prior to the initiation of treatment is required.

Contact lenses and spectacles offer a safe and effective method of treatment while demonstrating less rebound when discontinuing therapy. High efficacy of treatment, age of the patient, and length of treatment may contribute to rebound.¹⁶These are important considerations when practitioners evaluate discontinuing their patients from myopia control therapy.

1. Ruiz-Pomeda A, Prieto-Garrido FL, Hernandez Verdejo JL, Villa-Collar C. Rebound Effect in the Misight Assessment Study Spain (Mass). Curr Eye Res. 2021 Aug;46:1223-1226.
2. Weng R, Lan W, Bakaraju R, et al. Efficacy of contact lenses for myopia control: Insights from a randomised, contralateral study design. Ophthalmic Physiol Opt. 2022 Nov;42:1253-1263.
3. Swarbrick HA, Alharbi A, Watt K, Lum E, Kang P. Myopia control during orthokeratology lens wear in children using a novel study design. Ophthalmology. 2015 Mar;122:620-630.
4. Cho P, Cheung SW. Discontinuation of orthokeratology on eyeball elongation (DOEE). Cont Lens Anterior Eye. 2017 Apr;40:82-87.
5. Li Z, Hu Y, Cui D, Long W, He M, Yang X. Change in subfoveal choroidal thickness secondary to orthokeratology and its cessation: a predictor for the change in axial length. Acta Ophthalmol. 2019 May;97:e454-e459.
6. Wang A, Yang C, Shen L, Wang J, Zhang Z, Yang W. Axial length shortening after orthokeratology and its relationship with myopic control. BMC Ophthalmol. 2022 Jun 3;22:243.
7. Zhu Q, Yin J, Li X, et al. Effects of Long-Term Wear and Discontinuation of Orthokeratology Lenses on the Eyeball Parameters in Children with Myopia. Int J Med Sci. 2023 Jan 1;20:50-56.
8. Chia A, Chua WH, Wen L, et al. Atropine for the treatment of childhood myopia: changes after stopping atropine 0.01%, 0.1% and 0.5%. Am J Ophthalmol. 2014 Feb;157:451-457.e1.
9. Yam JC, Zhang XJ, Zhang Y, et al. Three-Year Clinical Trial of Low-Concentration Atropine for Myopia Progression (LAMP) Study: Continued Versus Washout: Phase 3 Report. Ophthalmology. 2022 Mar;129:308-321.
10. Wei S, Li SM, An W, et al. Myopia progression after cessation of low-dose atropine eyedrops treatment: A two-year randomized, double-masked, placebo-controlled, cross-over trial. Acta Ophthalmol. 2023 Mar;101:e177-e184.
11. The impact of myopia and high myopia: report of the Joint World Health Organization–Brien Holden Vision Institute Global Scientific Meeting on Myopia. In Sydney, Australia: University of New South Wales.
12. Lam CSY, Tang WC, Zhang HY, et al. Long-term myopia control effect and safety in children wearing DIMS spectacle lenses for 6 years. Sci Rep. 2023 Apr 4;13:5475.
13. Sankaridurg P, Weng R, Tran H, et al. Spectacle Lenses With Highly Aspherical Lenslets for Slowing Myopia: A Randomized, Double-Blind, Cross-Over Clinical Trial: Parts of these data were presented as a poster at the Annual Research in Vision and Ophthalmology meeting, 2022. Am J Ophthalmol. 2023 Mar;247:18-24.
14. Chen H, Wang W, Liao Y, et al. Low-intensity red-light therapy in slowing myopic progression and the rebound effect after its cessation in Chinese children: a randomized controlled trial. Graefes Arch Clin Exp Ophthalmol. 2023 Feb;261:575-584.
15. Xiong R, Zhu Z, Jiang Y, et al. Sustained and rebound effect of repeated low-level red-light therapy on myopia control: A 2-year post-trial follow-up study. Clin Exp Ophthalmol. 2022 Dec;50:1013-1024.
16. Chiu YC, Tsai PC, Lee SH, Wang JH, Chiu CJ. Systematic Review of Myopia Progression after Cessation of Optical Interventions for Myopia Control. J Clin Med. 2023 Dec 21;13:53.