IN THE ARENA of myopia management, there can be a sense that it’s all very clear now on the “why,” “who,” and “how” of treatment. Scientists continue to answer questions on the longevity and efficacy of treatments, while industry research provides growing knowledge on existing products and new innovations.
Many colleagues around the world are still in the initial phase of understanding and embracing myopia management, but for those practitioners at the clinical cutting edge, the question begs: What’s next? Here are two trends in which the research is leading toward greater clinical impact for a wider patient base in myopia.
TREND 1: TREATING PRE-MYOPIA
Children who are at risk of developing myopia are termed pre-myopes and typically have a pattern of risk factors including family history, specific binocular vision disorders, and habits of visual environment involving high volumes of near work and less time spent outdoors (Flitcroft et al, 2019). The most predictive risk factor, though, is a child being less hyperopic than age-normal. The well-known Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) study, undertaken with a multiethnic cohort in North America, produced the well-known delineator for pre-myopia of less than +0.75D at age 6 to 7 years (Zadnik et al, 2015).
New research shows this figure may be much higher for children in China, being at least +1.50D to +2.00D for 6 to 7 year olds (Chen et al, 2023; Wang et al, 2024). It is yet to be determined how East Asian ethnicity may influence this figure, recently termed the “hyperopic reserve,” in children living outside of China.
Randomized controlled trials (RCTs) for treatments that can delay myopia onset are growing in number. The results generally show slowed onset by about half, and include atropine 0.01% for older and/or non-Chinese children (Jethani, 2022; Wang et al, 2023), atropine 0.05% for younger Chinese children (Yam et al, 2023), repeated low-level red light (RLRL) therapy (He et al, 2023), and plano spectacle lenses with highly aspherical lenslets (He et al, 2023). Applying these in practice will involve careful communication on suitability, expectations and compliance, but there is strong clinical value in doing so—delaying myopia onset by one year could reduce a patient’s final level of myopia by at least 0.75D, which is equivalent to two to three years of treatment after myopia onset (Bullimore and Brennan, 2023).
TREND 2: LIGHT THERAPIES
RLRL therapy (650nm) has shown impressive efficacy for slowing myopia progression, with new data showing robust results for new populations—those who have high myopia (Xu et al, 2024) and fast progression in orthokeratology wear (Xiong et al, 2024). The potential for combination treatment with other optical devices beckons, although it is not recommended for use with atropine (Eyerising International, 2025).
Clinical questions remain on the potential for significant rebound effect after cessation of treatment (Xiong et al, 2022) and long-term safety in general and with specific devices (Ostrin and Schill, 2024). More reports on clinical experiences and research findings can be expected in the year ahead.
Other novel light therapies including cyan (507nm) light-emitting glasses (Chakraborty et al, 2024) and a “bright light” (full spectrum, 10,000 lux) desktop device (Hon et al, 2024) have also been investigated. One pre-commercial light therapy device, a “digital treatment” that looks like a virtual reality headset, delivers targeted light intensity at the optic nerve head (visual blind spot) to modulate retinal dopamine release. Interim six-month data from the ongoing multisite clinical trial (NCT04967287) showed non-inferiority to myopia control spectacles as separate monotherapies (Flitcroft et al, 2024). The next six months will see this treatment utilized in combination with myopia control spectacles (Dopavision GmbH, 2024).
There are numerous, highly effective and evidence-based treatments available now for slowing myopia progression in children and teens; these new trends point toward the expanding horizon of myopia management.
REFERENCES
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