Medical hypothesis discovery and innovation in ophthalmology

Abstract

Background: Myopia is becoming more common in many populations worldwide, particularly in East Asia. It is primarily driven by axial elongation, a structural change associated with increased risks of myopic maculopathy, retinal detachment, glaucoma, and cataracts. The expanding range of myopia?control options can make treatment selection and management decisions more challenging in routine pediatric care. This narrative review synthesizes contemporary evidence and guidance for delaying myopia onset and slowing progression in children.
Methods: A targeted, non-systematic search was conducted in PubMed/MEDLINE, Embase, and the Cochrane Library for English-language records published between January 2015 and July 2025, supplemented by the inclusion of seminal pre?2015 trials. Eligible records included randomized or comparative clinical studies, systematic reviews/meta-analyses, and professional consensus/guideline statements in participants < 18 years reporting spherical equivalent refraction and/or axial length (AL). Non-comparative studies were included to provide additional information on safety, including adverse events. Findings were synthesized and presented using a narrative approach.
Results: The evidence reviewed indicated that increased outdoor time consistently reduced incident myopia and modestly slowed progression, supporting the adoption of low-cost prevention strategies. Associations between near work and digital exposure and myopia were less consistent, though moderation in these activities remains advisable. Optical interventions showed consistent efficacy compared to single?vision correction, with strong evidence for defocus incorporated multiple segments (DIMS) lens with highly aspherical lenslet technology spectacles, and dual?focus/high?add soft contact lenses. Safety was generally favorable, although contact lens wear requires infection-risk mitigation. Orthokeratology was effective in slowing AL but requires specialist fitting and structured follow-up, and may be followed by rebound after cessation. Atropine showed a concentration?dependent effect; 0.01% atropine produced inconsistent AL benefit in several non?Asian trials, but longer-term European data suggest a cumulative advantage with continued 0.01% treatment versus placebo. Repeated low?level red?light therapy reduced axial elongation in early trials but was limited by protocol heterogeneity, rebound, and uncertainty regarding long-term safety. Combination regimens (notably orthokeratology plus low?dose atropine and DIMS plus atropine) may provide additional slowing of AL, particularly in children with faster progression.
Conclusions: Evidence supports a risk?stratified pathway integrating outdoor time with effective optical and/or pharmacological therapy. Future research should prioritize head?to?head comparative trials with standardized AL endpoints, longer follow-up, inclusion of more diverse populations, validated treatment cessation strategies, and independent safety and performance standards for light-based devices.