Myopia Control in 2026: Atropine, Lenslet Spectacles, Ortho-K and Red Light
Last updated: October 2026
About half the world's population is projected to be myopic by 2050, and the proportion with high myopia is rising fastest. Myopia control is now a routine paediatric consultation. The evidence has moved quickly in the last three years, especially for atropine, which turned out more modest at 0.01% than many hoped.
Why we chase axial length, not just dioptres
- The risks of myopic maculopathy, retinal detachment, glaucoma and cataract rise with axial length and degree of myopia.
- Each dioptre of myopia prevented is estimated to cut the risk of myopic maculopathy by about 40%.
- Measure axial length with optical biometry at baseline and every 6 months. Use cycloplegic refraction in children.
The options and the evidence
| Intervention | What the evidence shows | Practical notes |
|---|---|---|
| Outdoor time | Delays onset; about 40–80 extra minutes a day is associated with lower incidence. A weaker effect once myopia has started. | Free, safe, and advised for every child. |
| Low-dose atropine | LAMP (Hong Kong): 0.05% was the most effective of 0.05%, 0.025% and 0.01%. LAMP2: 0.05% reduced new-onset myopia in pre-myopic children. CHAMP, PEDIG and MOSAIC: modest effect of 0.01% alone in more diverse populations. | Many clinicians now prefer 0.025–0.05%. Effect depends on formulation. Taper rather than stop abruptly to limit rebound. |
| Lenslet (defocus) spectacles | DIMS (MiyoSmart) and HAL (Stellest) slow axial elongation by roughly 30–50%. Stellest received FDA authorisation in September 2025 for children aged 6–12 at the start of treatment. | Good first option for younger children. Requires full-time wear and good centration. Long-term data now extend to 6–8 years. |
| Dual-focus soft contact lenses | MiSight 1 day (FDA 2019): 0.67 D less progression and 0.28 mm less axial growth over 3 years, with benefit through 6 years and no rebound reported. | Daily disposable. Suits motivated children from about age 8. |
| Orthokeratology | Reduces axial elongation by about 0.2–0.3 mm over 2 years. | Overnight wear carries a risk of microbial keratitis (including Acanthamoeba), so hygiene teaching is essential. |
| Repeated low-level red light (RLRL) | Large short-term effects in Chinese trials, including combined with ortho-k. | Safety is uncertain: retinal injury has been reported, some devices may exceed exposure limits, and rebound after stopping is a concern. Devices are not FDA-cleared. Do not combine with atropine (larger pupil). |
Regulatory snapshot
- United States: MiSight (2019) and Stellest (2025) are authorised. A low-dose atropine product (SYD-101) received a complete response letter from the FDA in October 2025, so atropine is still used off-label or compounded there.
- India: low-dose atropine eye drops and myopia-control spectacle lenses are commercially available. Check the concentration and whether the formulation is preserved.
A practical approach
- Identify children at risk: early onset, both parents myopic, little outdoor time, or progression of 0.5 D a year or more.
- Record a baseline cycloplegic refraction and axial length, and compare against age-based growth charts.
- Start with outdoor time plus one optical treatment (lenslet spectacles or dual-focus contact lenses), or low-dose atropine, depending on age, family preference and cost.
- Review every 6 months. If axial growth remains fast, combine treatments (for example atropine with ortho-k or lenslet spectacles).
- Continue at least into the mid-teens, then taper and monitor for rebound.
Viva pearls
- Peripheral myopic defocus is the shared principle behind DIMS, HAL, MiSight and ortho-k.
- Know LAMP well: a concentration-dependent effect, with 0.05% the most effective and still well tolerated.
- Atropine 0.05% enlarges the photopic pupil by about 1 mm and reduces accommodation by about 2 D, usually without affecting quality of life.
- Ortho-k's main danger is microbial keratitis.
Related: atropine 0.01% eye drops in myopia, understanding myopia and amblyopia treatment updates.
Key sources
- Ophthalmology Times: treating myopia today (October 2025)
- Review of Myopia Management: low-dose atropine, where are we now?
- Myopia Profile: three key myopia questions for 2026
- Sydnexis: complete response letter for SYD-101 (October 2025)
- Holden BA et al. Global prevalence of myopia and high myopia, 2000 through 2050. Ophthalmology 2016;123:1036–42
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