Author: Claude (AI), from PubMed abstracts · Reviewed by: Dr Mina Abdelmseih · Reviewed: 2026-11-15 · Review due: 2027-11-15

Educational content only. Not personalised medical advice. Clinical decisions remain the responsibility of the treating clinician.

Optical myopia control: spectacle lenses, contact lenses and orthokeratology

Optical myopia control uses spectacle lenses, soft multifocal contact lenses or orthokeratology (ortho-K) to slow refractive progression and axial elongation in children [S8]. Randomised trials show meaningful effects for several designs, but the 2025 Cochrane review rates much of the evidence as low or very low certainty [S8]. Spectacles are the least invasive option and have the lowest dropout [S9] [S11].

Key points - Myopia control spectacle lenses reduced axial elongation by 0.15 mm and refractive progression by 0.31 D versus single-vision lenses in a 2026 meta-analysis of 23 RCTs [S9]. - Highly aspherical lenslet (HAL) and DIMS spectacle lenses had the largest effects among spectacle designs [S9]; longer daily wear improved HAL efficacy [S4]. - Daily disposable dual-focus and high-add (+2.50 D) multifocal soft contact lenses slowed progression over 3 years [S2] [S3]. - Ortho-K reduces axial elongation (moderate-certainty evidence) [S8] but carried a higher adverse event risk than conventional contact lenses in one meta-analysis [S5]. - Dropout ranged from 6% to 21% per year, lowest for spectacles and highest for soft contact lenses [S11].

Evidence last checked: 2026-10-17 (PubMed abstracts).

Red flags

• Painful red eye in a contact lens or ortho-K wearer. Ortho-K wearers were up to 3.79 times more likely to have an adverse event than conventional contact lens wearers [S5]. Corneal infiltrative events were seen in a soft lens trial [S2].
• Progression above guideline thresholds on treatment. More than 0.50 D per year, or axial elongation above 0.3 mm (until age 10) or 0.2 mm (above 11) [S6].
• Stopping ortho-K. Axial elongation rebounded after discontinuation (MD 0.10 mm) [S5].

Recognise it: who may benefit

• Trials enrolled children aged about 7 to 13 years with low to moderate myopia, for example -1.00 to -5.00 D (DIMS) [S1], -0.75 to -4.75 D (HAL) [S4] and -0.75 to -4.00 D (MiSight) [S2].
• Most trials were done in China or other Asian countries (66.3%) [S8]; a Polish RCT found DIMS effective in European children [S10].

Confirm it: baseline and monitoring

• The Brazilian guideline recommends corneal topography, cycloplegic refraction every 6 months and annual optical biometry, more often for fast progressors [S6].
• Trials measured outcomes by cycloplegic autorefraction and axial length [S1] [S3].

Manage it

Before acting on this section, check the national and local guidelines, product information and regulatory approvals that apply where you practise. See the medical disclaimer.

Tier A (primary care / no specialist)

• Correct myopia and refer a child with myopia for assessment of myopia control where it is available [S6].
• Where only single-vision spectacles are available, these remain the control comparator in all the trials, not an active treatment [S9].

Tier B (general eye clinic)

1. Spectacle lenses (first-line where available and affordable). - DIMS (+3.50 D myopic defocus segments): over 2 years, progression -0.41 D vs -0.85 D with single vision; axial elongation 0.21 vs 0.55 mm [S1]. - HAL: over 2 years, refractive progression slowed by 0.80 D and axial elongation by 0.35 mm vs single vision; in children wearing HAL at least 12 hours a day, by 0.99 D and 0.41 mm [S4]. - Pooled: HAL -0.28 mm and -0.52 D; DIMS -0.45 D, with only one RCT reporting axial length; other lens types had modest or variable effects [S9]. - In Polish children, DIMS gave less axial elongation than 0.01% atropine at 12 months (0.11 vs 0.19 mm), mainly in 6 to 11 year olds [S10].
2. Encourage full-time wear. Efficacy depended on wearing time for HAL [S4].
3. Duration. The guideline advises sustained treatment for at least 2 years [S6].

Tier C (specialist centre)

1. Soft multifocal contact lenses. - MiSight 1-day (dual-focus daily disposable): over 3 years, -0.51 vs -1.24 D and 0.30 vs 0.62 mm compared with a single-vision daily lens; no serious ocular adverse events [S2]. - BLINK: high add (+2.50 D) slowed 3-year progression by 0.46 D vs single vision; medium add (+1.50 D) did not differ significantly [S3]. - After stopping high-add lenses in older teenagers, growth returned to age-expected rates without loss of the earlier effect [S7].
2. Orthokeratology. Cochrane: MD -0.18 mm axial elongation at 1 year, moderate certainty [S8]. A meta-analysis found 1-year axial elongation 0.16 mm lower than other modalities, but noted selection bias favouring ortho-K and an underdeveloped safety evidence base [S5].
3. Combinations. Ortho-K plus low-dose atropine probably reduces axial elongation more than ortho-K alone (MD -0.12 mm, moderate certainty) [S8]. The guideline lists combinations for uncontrolled cases [S6].
4. Retention. Discuss handling and follow-up burden; reasons for dropout differ by modality [S11].

Refer when

Pitfalls

• Treating all "myopia control" lenses as equal: effects vary by design [S9] and add power [S3].
• Ignoring wearing time [S4].
• Underestimating ortho-K risks and rebound on stopping [S5].
• Generalising Asian trial data without caution, although European data are emerging [S8] [S10].

Evidence notes

• Cochrane certainty for optical interventions ranges from very low to moderate, with heterogeneous results and limited data beyond 2 years [S8].
• The Polish trial is an interim 1-year report of an ongoing study [S10].
• The ortho-K meta-analysis searched only to 2021 [S5].
• The authors of BLINK state that the clinical importance of the observed differences needs further research [S3].
• Not covered by these sources: cost and availability in low-income settings, lens hygiene protocols and ortho-K fitting technique.

Related articles

• Low-dose atropine for myopia control
• Contact lens complications and safe wear
• Outdoor time and the prevention of myopia

References

See the numbered source list below. Each marker [S#] links to its PubMed and DOI record.