Slowing Myopia Progression in Children: Proven Options

Why does slowing myopia progression matter?

Myopia (nearsightedness) in childhood is not simply a prescription that needs glasses — it is associated with physical changes in the length of the eye. As the eye elongates to become more myopic, the risk of certain serious eye conditions increases, including retinal detachment, glaucoma, and macular changes. These risks are meaningfully higher with high myopia (typically defined as -6.00 diopters or more) [1, 2].

This is the core reason why myopia control has become an area of active clinical interest: slowing how fast myopia progresses during childhood may reduce the final degree of myopia reached in adulthood, and with it, the lifetime risk of those complications. Myopia tends to progress fastest between ages 8 and 14, making early intervention the most impactful 1Ref 1Hutchinson AK, Morse CL, Hercinovic A, Cruz OA, Sprunger DT, Repka MX, Lambert SR, Wallace DK; American Academy of Ophthalmology Preferred Practice Pattern Pediatric Ophthalmology/Strabismus Panel (2023).Pediatric Eye Evaluations Preferred Practice Pattern.Myopia progression risks including retinal detachment and glaucoma from high myopia; evidence for orthokeratology, atropine drops, and outdoor time in slowing childhood myopia progression.

What is orthokeratology (OrthoK)?

Orthokeratology — often called OrthoK or corneal reshaping therapy — uses specially designed rigid gas-permeable contact lenses that the child wears only at night while sleeping. The lenses gently reshape the cornea overnight, so the child has clear vision during the day without needing glasses or daytime contacts.

Beyond correcting daytime vision, orthokeratology has shown consistent evidence of slowing axial eye elongation (the physical growth of the eye that drives increasing myopia) compared to standard glasses or contact lenses [1, 2]. It is typically used for children roughly 8 years and older who have a stable cooperative temperament for contact lens care and whose parents are committed to the required lens hygiene.

Orthokeratology lenses are fitted and monitored by ophthalmologists or optometrists with specific training in the technique.

Low-dose atropine eye drops

Atropine is a medication that has been used in ophthalmology for many years. At very low concentrations (0.01% to 0.05%), applied as a nightly eye drop, atropine has been shown to slow myopia progression in children, with fewer visual side effects (such as light sensitivity and near-vision blur) than higher concentrations used historically 1Ref 1Hutchinson AK, Morse CL, Hercinovic A, Cruz OA, Sprunger DT, Repka MX, Lambert SR, Wallace DK; American Academy of Ophthalmology Preferred Practice Pattern Pediatric Ophthalmology/Strabismus Panel (2023).Pediatric Eye Evaluations Preferred Practice Pattern.Myopia progression risks including retinal detachment and glaucoma from high myopia; evidence for orthokeratology, atropine drops, and outdoor time in slowing childhood myopia progression.

Low-dose atropine is currently off-label in the United States for myopia control, meaning it has not received FDA approval specifically for this use — but ophthalmologists do prescribe it in clinical practice. Families should be aware that it requires compounding (preparation by a compounding pharmacy), and long-term use requires regular monitoring for any effects on the lens or retina.

A Gale pediatrician can discuss the general picture, but the prescription and monitoring for atropine specifically belong with a pediatric ophthalmologist or optometrist experienced in myopia management.

Multifocal soft contact lenses and specialty spectacle lenses

Several soft contact lens designs have been developed and studied for myopia control. These are daytime lenses — not reshaping lenses — that use optical strategies (defocus or multiple zones) to slow eye elongation. Evidence has accumulated over the past decade showing that certain designs reduce myopia progression compared to standard single-vision contact lenses [1, 2].

Specialty spectacle lens designs (not standard glasses) have also been studied. Some commercially available designs have shown promising results in slowing progression. This is an area of ongoing development.

For families who are not ready for contact lenses, specialty glasses may be an accessible starting point. For families comfortable with daytime contacts, soft myopia-control lenses may fit naturally into a child's routine.

Time outdoors: a simple, evidence-linked recommendation

Increased time spent outdoors has been associated with a lower risk of developing myopia and, in some studies, slower progression in children who are already myopic. The mechanism is not fully established — it may relate to exposure to bright light and its effect on retinal signaling [1, 2].

Most recommendations suggest two or more hours of outdoor time per day. This is broadly healthy for children in many ways and carries no downside. It is not a replacement for active myopia control treatment when a child is already progressing rapidly, but it is a reasonable daily habit to encourage alongside treatment.

How to decide which approach is right

Myopia control is not one-size-fits-all. Factors that influence the choice include:

• The child's current degree of myopia and how quickly it has been progressing
• Age and predicted years of remaining progression
• Comfort with contact lenses and family commitment to lens care
• Refractive error pattern (some approaches work best within certain prescription ranges)
• Insurance coverage and cost, since many myopia control options are not covered by standard vision plans

A pediatric ophthalmologist or an optometrist with a practice focus on myopia control is the right specialist to evaluate your child and recommend an approach. A Gale pediatric clinician can also discuss broader eye health and refer your child to the appropriate specialist 2Ref 2Jacobs DS, Afshari NA, Bishop RJ, Keenan JD, Lee J, Shen TT, Vitale S; American Academy of Ophthalmology Preferred Practice Pattern Refractive Management/Intervention Panel (2023).Refractive Errors Preferred Practice Pattern.Clinical framework for myopia management, multifocal soft contact lens designs for myopia control, and specialty spectacle lenses in children and adults.