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Mastering Myopia: Premyopia and Cycloplegic Considerations

I have learned more about low hyperopia in children as the concept of premyopia has expanded.

By: Aaron Salzano, OD
Contact Lens Spectrum March 2, 2026 Vol 41, Issue March-April 2026 Page(s): 8

Clinical Report: Mastering Myopia: Premyopia and Cycloplegic Considerations

Overview

This report discusses the significance of premyopia in children, emphasizing the role of cycloplegic refraction in identifying at-risk patients. It highlights effective interventions such as outdoor time and low-concentration atropine to manage myopia progression.

Background

Myopia is a growing global concern, particularly among children, necessitating early identification and intervention strategies. The concept of premyopia, defined by low hyperopia, serves as a critical marker for potential future myopia. Understanding the implications of cycloplegic refraction is essential for accurate diagnosis and management.

Data Highlights

StudyFindings
LAMP2 Trial0.05% atropine reduced myopia incidence from 53.0% to 28.4% compared to placebo.
Guo et al. (2022)Significant hyperopia detected post-cycloplegia in children initially classified as low hyperopes.
Wu et al. (2025)Atropine showed less myopia than cyclopentolate in refraction outcomes.

Key Findings

  • Premyopia is defined as a refractive error of +0.75 D or less.
  • Cycloplegic refraction is crucial for accurate diagnosis of premyopia.
  • Outdoor time of 2 hours daily is beneficial in delaying myopia onset.
  • 0.05% atropine effectively slows myopia progression in children.
  • Noncycloplegic refraction may underestimate hyperopia in children.

Clinical Implications

Practitioners should prioritize cycloplegic refraction to accurately identify premyopia and educate families on the importance of outdoor activities. Implementing low-concentration atropine as a preventive measure can significantly reduce the incidence of myopia in at-risk children.

Conclusion

Accurate identification and management of premyopia are essential in preventing future myopia. Continued research and adherence to established guidelines will enhance outcomes for pediatric patients.

References

  1. Flitcroft DI, He M, Jonas JB, et al., Invest Ophthalmol Vis Sci, 2019 -- IMI - Defining and Classifying Myopia: A Proposed Set of Standards for Clinical and Epidemiologic Studies
  2. Zadnik K, Sinnott LT, Cotter SA, et al., JAMA Ophthalmol, 2015 -- Prediction of Juvenile-Onset Myopia
  3. Jonas JB, Ang M, Cho P, et al., Invest Ophthalmol Vis Sci, 2021 -- IMI Prevention of Myopia and Its Progression
  4. Yam JC, Zhang XJ, Zhang Y, et al., JAMA, 2023 -- Effect of Low-Concentration Atropine Eyedrops vs Placebo on Myopia Incidence in Children: The LAMP2 Randomized Clinical Trial
  5. Guo X, Shakarchi AF, Block SS, et al., Ophthalmology, 2022 -- Noncycloplegic Compared with Cycloplegic Refraction in a Chicago School-Aged Population
  6. Contact Lens Spectrum — MASTERING MYOPIA
  7. contact lens spectrum — Mastering Myopia: Innovations and Future Directions
  8. Contact Lens Spectrum — Mastering Myopia: Starting Strong: Managing Myopia from the Onset
  9. Contact Lens Spectrum — MASTERING MYOPIA
  10. Contact Lens Spectrum — MASTERING MYOPIA
  11. IMI 2025 Digest - Myopia Institute
  12. Effect of Low-Concentration Atropine Eyedrops vs Placebo on Myopia Incidence in Children: The LAMP2 Randomized Clinical Trial | Ophthalmology | JAMA | JAMA Network
  13. Efficacy of spectacle lenses for myopia control: a meta-analysis of randomised controlled trials | British Journal of Ophthalmology