Managing Myopia: Effective Strategies for Slowing Progression

14
Apr

The increasing global prevalence of myopia has prompted significant attention towards developing effective management strategies to mitigate its progression and associated risks. Myopia, particularly when it manifests in childhood, can lead to serious ocular complications, including retinal detachment, glaucoma, and macular degeneration in adulthood. Current research has demonstrated that a range of evidence-based interventions can effectively slow myopia progression and reduce axial elongation. These interventions include optical measures, such as multifocal spectacle lenses, orthokeratology, and multifocal contact lenses, as well as pharmacological treatments like low-concentration atropine. This article provides a thorough examination of the most promising management strategies, supported by clinical studies, to guide practitioners in optimizing myopia control for their patients and improving long-term visual health outcomes.

 Evidence-Based Myopia Control Measures:

Optical treatments:

  1.       Multifocal Spectacle Lenses:

Defocus Incorporated Multiple Segments (DIMS) spectacle lenses have been shown to effectively slow myopia progression and axial elongation in children while maintaining good visual comfort. These lenses feature a central optical zone for distance vision correction and an annular zone with multiple +3.50 diopter segments that induce myopic defocus on the peripheral retina.

A two-year double-masked randomized trial demonstrated that children wearing DIMS lenses experienced significantly lower myopia progression (−0.41 ± 0.06 D) compared to those wearing single-vision lenses (−0.85 ± 0.08 D). Similarly, axial elongation was reduced in the DIMS group (0.21 ± 0.02 mm) versus the single-vision lens group (0.55 ± 0.02 mm) 1.

  1.       Dual-Focus and Multifocal Contact Lenses:

Extensive research supports the effectiveness of soft multifocal contact lenses in slowing myopia progression. These lenses, designed with center-distance correction and concentric or gradient plus-power zones, create controlled myopic defocus.

The FDA-approved MiSight® daily disposable contact lens (CooperVision) demonstrated a 59% reduction in spherical equivalent refractive error progression over three years (−0.51 ± 0.64 D vs. −1.24 ± 0.61 D in controls) and a 52% reduction in axial elongation (0.30 ± 0.27 mm vs. 0.62 ± 0.30 mm) 2.  

Additionally, the BLINK study found that high-add (+2.50 D) multifocal lenses significantly reduced myopia progression (−0.60 D) compared to medium-add (+1.50 D) lenses (−0.89 D) and single-vision lenses (−1.05 D), highlighting their efficacy in slowing eye elongation 3.

  1.       Orthokeratology (Ortho-K) Lenses:

Ortho-K lenses are gas-permeable contact lenses worn overnight to temporarily reshape the cornea, providing clear daytime vision without corrective lenses.

Clinical trials such as ROMIO 4 and HM-PRO 5 reported that Ortho-K lenses reduced the axial elongation by 43% to 63%. The reduction was more pronounced in younger, more rapidly progressing myopic children with an age of 7–8 years than in older children with an age of 9–10 years. Another study found that children with myopic anisometropia using Ortho-K in the myopic eye exhibited significantly lower axial elongation (0.07 ± 0.21 mm) than the emmetropic untreated eye (0.36 ± 0.23 mm)6.

Combination therapies, such as Ortho-K with low-concentration atropine (0.01%) or soft bifocal contact lenses, appear to enhance myopia control outcomes 1& 7.

Pharmacological Measure:

Atropine has been widely studied for its ability to slow myopia progression by inhibiting scleral proliferation. While its exact mechanism remains unclear, theories suggest involvement of dopamine signaling and increased UV exposure leading to scleral collagen cross-linking 7.

The ATOM 2 study evaluated the efficacy of low doses (0.5%, 0.1%, and 0.01%) of atropine on myopia progression. The study demonstrated a dose-dependent effect, with higher atropine concentrations providing greater myopia control. However, higher concentrations were associated with a stronger rebound effect after discontinuation, whereas 0.01% atropine exhibited minimal rebound and fewer side effects, making it the preferred option 8.

The LAMP 9 study further compared 0.05%, 0.025%, and 0.01% atropine, finding that 0.05% was the most effective, reducing both spherical equivalent changes and axial elongation. After two years, 0.05% atropine demonstrated double the efficacy of 0.01% atropine10.

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  4.       Cho, P., & Cheung, S.-W. (2012). Retardation of Myopia in Orthokeratology (ROMIO) Study: A 2-Year Randomized Clinical Trial. Investigative Ophthalmology & Visual Science, 53(11), 7077–7085. https://doi.org/10.1167/iovs.12-10565
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  6.       Na, M., & Yoo, A. (2018). The effect of orthokeratology on axial length elongation in children with myopia: Contralateral comparison study. Japanese Journal of Ophthalmology, 62(3), 327–334. https://doi.org/10.1007/s10384-018-0573-x
  7.       Russo, A., Boldini, A., Romano, D., Mazza, G., Bignotti, S., Morescalchi, F., & Semeraro, F. (2022). Myopia: Mechanisms and Strategies to Slow Down Its Progression. Journal of Ophthalmology, 2022, 1004977. https://doi.org/10.1155/2022/1004977
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