Childhood Myopia: How to Slow Its Progression Based on Scientific Evidence

Myopia, or difficulty seeing at a distance, is one of childhood’s most common vision problems. Its prevalence has risen significantly worldwide, becoming a significant public health concern. Beyond its impact on daily life, progressive myopia can lead to serious long-term complications, such as retinal detachment, early-onset cataract, glaucoma, and myopic maculopathy.

This article explains what myopia is, why it progresses, and what the most recent international expert guidelines (WSPOS 2023 and UK/Ireland 2024) recommend to slow its progression.

What is myopia, and why does it progress?

Myopia usually results from excessive eyeball elongation (called axial lengthening). As the eye grows too long, images are focused in front of the retina rather than on it, leading to blurred distance vision.

Myopia is typically classified by severity based on cycloplegic refraction:

• Low myopia: -0.50 to less than -3.00 diopters (D)
• Moderate myopia: -3.00 to less than -6.00 D
• High myopia: -6.00 D or more

Both genetic and environmental factors play a role. Children with myopic parents are at higher risk. Still, lifestyle factors, such as reduced outdoor time and excessive near work (reading, screen use at short distances), are strongly associated with myopia onset and progression.

Evidence-based strategies to slow myopia progression

According to current scientific consensus, the best approach combines behavioural changes with optical and pharmacological interventions.

1. Behaviour: more daylight, less screen time

Substantial evidence supports that increasing time outdoors — ideally at least 2 hours per day — helps prevent myopia and may slow its progression. Natural light stimulates dopamine release in the retina, which helps regulate eye growth.
Excessive use of digital devices and prolonged reading at distances under 20 cm are associated with faster progression. Encouraging breaks, maintaining appropriate reading distance, and reducing screen exposure outside of schoolwork are essential.

2. Spectacle lenses with peripheral defocus (DIMS, HALT, C.A.R.E. technologies)

Innovative spectacle lenses have been developed beyond correcting central vision in recent years. These lenses introduce peripheral myopic defocus, which helps slow eye growth (axial elongation). The most studied technologies include:

DIMS (Defocus Incorporated Multiple Segments): uses hundreds of small positive-powered lenslets (+3.50 D) around a central clear zone to induce peripheral defocus. Studies show up to a 50% reduction in myopia progression.

HALT (Highly Aspherical Lenslets Technology): features scattered aspherical lenslets that create a specific light profile to generate peripheral myopic defocus.

C.A.R.E. (Cylindrical Annular Refractive Elements): Developed by Zeiss, this technology uses cylindrical annular lens elements arranged concentrically around the central optical zone. These structures provide targeted peripheral defocus to inhibit axial growth in an effective and visually comfortable way.

These principles are used in several lenses currently available:

• Hoya MiYOSMART™ (DIMS)
• Essilor Stellest™ (HALT)
• Zeiss MyoCare™ (C.A.R.E.)
• Shamir Spark Mi™ (HALT)

These lenses are particularly beneficial for children aged 6 to 13 with progressive myopia and have demonstrated safety and effectiveness in clinical trials.

3. Contact lenses with therapeutic effect

There are two main approaches:
Daily soft multifocal contact lenses: combine central correction with peripheral defocus and have been shown to reduce progression by about 40%.

Orthokeratology (Ortho-K) involves wearing rigid contact lenses overnight to temporarily reshape the cornea, allowing clear vision during the day. While globally used with reported efficacy, the effect is reversible once stopped, and strict hygiene and clinical follow-up are essential. In my clinical practice, I generally do not recommend Ortho-K as a first-line option for children under 11–12 years, as I consider the risk of infectious complications a relevant concern in younger patients who may struggle with lens care routines.

4. Low-dose atropine eye drops: a pharmacological study.

Atropine, used in low concentrations (0.01% to 0.05%), has been shown to reduce myopia progression by acting on the retina and sclera to slow down eye growth. Current studies suggest that 0.05% offers the best balance between effectiveness and minimal side effects (mild pupil dilation and slight near vision blur). Combining atropine with optical interventions (e.g., DIMS/HALT lenses) appears to have an additive effect, making this a particularly promising strategy in children with fast progression.

What can parents do?

Encourage daily outdoor activity, ideally at least 2 hours.
Limit screen time and close-up work, especially at very short distances.
Schedule regular eye exams, even if your child does not have complaints.
Discuss treatment options with the child’s ophthalmologist, including glasses, contact lenses, or atropine.

Ensure good treatment adherence, as consistent use is key to success.

Childhood myopia can be managed. We can protect today’s vision and our children’s long-term eye health with timely follow-up and evidence-based interventions.