New Frontiers in Myopia

At Myopia Profile, we make it our mission to seek out the latest science at international conferences, and in the published science, and make it accessible to colleagues right across the world. In that pursuit, this article brings together the latest learnings from two major conferences – the biennial International Myopia Conference (IMC), which took place in September 2024 in Sanya, China; and the annual Association for Research in Vision and Ophthalmology (ARVO) meeting, which ran in May 2025 in Salt Lake City, in the United States.

Going back 15 years, our only evidence available for myopia control treatments with reasonable efficacy was orthokeratology (OK)1 and 1% atropine.2 Going back five years, the MiSight three-year study,3 defocus incorporated multiple segments (DIMS) twoyear spectacle lens study,4 and LAMP one-year data on 0.01%, 0.025%, and 0.05% atropine5 were all newly published. Fast forward to today and the data on new spectacle and contact lens designs; atropine concentrations and combinations; and emerging treatments like repeated low-level red-light (RLRL) therapy have all materialised since.

The early randomised controlled trials mentioned here are now presenting data on outcomes over seven-plus years and beyond. Seven-year data on the MiSight 1 day study has recently been published, showing no rebound effect (loss of accrued treatment) after cessation in children with a mean age of just over 16 years, who had worn myopia control soft contact lenses for either three or six years.6 Long-term ocular health data also affirms confidence, with no changes to corneal endothelium or other biomicroscopy signs after 10 years of full-time daily disposable contact lens wear.7

At ARVO, seven-year data on the LAMP study and eight-year data on DIMS spectacle lenses were presented. The LAMP study continued after five years of treatment – in the past two years all participants used 0.05% atropine – to investigate how to cease treatment with two methods: stop or taper. Children using 0.05% atropine were randomised to either continue for 12 months (stop), or use 0.05% for six months then taper to 0.025% for another six months (taper), followed by one year of observation. Both groups progressed similarly in year six (pre-cessation), but in year seven (cessation), the taper group had less progression (-0.26D and 0.14 mm) than the stop group (-0.36D and 0.17 mm). Tapering treatment, instead of stopping, was concluded to minimise rebound effects.8

RLRL therapy (650 nm) has grown in awareness and evidence in the past year or two, showing impressive efficacy for slowing myopia progression in a two-year clinical trial.10 More recent data is demonstrating robust results for new populations – those with high myopia11 and fast progression (>0.50 mm/year) in OK wear.12 The potential for combination treatment with other optical devices beckons, although it is not recommended for use with atropine.13 Clinical questions remain on the potential for significant rebound effect after cessation of treatment,14 and long-term safety in general and with specific devices,15 which was a topic of much discussion at the IMC.

At ARVO, new research on RLRL explored correlates with stronger outcomes and animal models. A new real-world study evaluated 896 children aged 6–18 years in China who received RLRL therapy, administered at home twice daily for three minutes over two years. Complete myopia control (defined as axial elongation <0.10 mm/year or refraction change <0.25D/year) was achieved in 65% and 68% of participants, respectively, with better outcomes linked to older age, longer baseline axial length (AL), and higher baseline myopia. Best corrected visual acuity remained stable in 95% of cases, with no serious adverse events reported.16

Other novel light therapies have been explored at IMC and ARVO, including cyan (507 nm) light-emitting glasses16 and a ‘bright light’ (full spectrum, 10,000 lux) desktop device.17 One pre-commercial light therapy device, a ‘digital treatment’, which looks like a virtual-reality headset, delivers targeted light intensity at the optic nerve head (visual blind spot) to modulate retinal dopamine release. Called MyopiaX, sixmonth data at IMC was followed with reporting of 12-month data at ARVO, evaluating safety and efficacy in European children aged 6–12 years (n=81) over 12 months. Children were randomly assigned to MyopiaX for six months followed by combination with DIMS for another six months, or DIMS alone for 12 months (active control). The MyopiaX treated group showed 0.14 mm axial elongation compared to 0.08 mm for active (DIMS wearing) controls in the first six months, but similar growth in the second six-month period. Refraction change over 12 months was similar between groups. No adverse events were reported, but adherence was low and declined over time. This non-inferiority trial shows promising results, although compliance with the treatment presents a challenge for future clinical use.

The strongest data set supporting atropine combined with optical treatments is for 0.01% atropine with OK, which has seen enough studies to possess meta-analysis support17 although the ‘boost’ effect is only significant in the first six months.18 Early clinical studies, which are not randomised controlled trials, show likely benefits of combining other concentrations and optical treatments, such as 0.01% atropine with DIMS spectacle lenses (HOYA MiyoSmart).19 There are single retrospective studies on combining 0.05% atropine with OK20 and MiSight 1 day21 contact lenses.

At ARVO, combination treatment research continued its progress, with positive outcomes for DIMS and 0.025% atropine, along with atropine monotherapy studies exploring various concentrations, patient groups including premyopia and European data, retinal impacts, formulations, and delivery systems. One study found no impact of photochromic spectacle lens use on the myopia controlling efficacy of atropine treatment, where around half of patients (mean age 8.4 ± 2.4 years) wore these lenses by choice. Various concentrations of atropine were prescribed, from 0.01% to 0.1% in this cohort.22

Researchers at the University of Canberra presented a fascinating study at ARVO, asking whether commonly prescribed psychotropic medications could influence ocular growth or the anti-myopic effects of atropine. Using a chick model of form-deprivation myopia, five psychotropic agents (Ritalin, fluoxetine, sertraline, atomoxetine, diazepam) were administered with or without daily 1% atropine drops over seven days. Ritalin alone inhibited the development of experimental myopia, but did not affect atropine efficacy when administered together. None of the other agents showed any effects on myopia development or interaction with atropine.23 There’s a way to go before this translates into clinical advice, but it does highlight the potential for atropine’s side effects to be potentiated by systemic medications, which also have anti-cholinergic effects.24

A new HALT Max design with increased lenslet power and asphericity, compared to HALT (Essilor Stellest), was examined in 50 Singaporean children (mean age 8.6 years) who wore one lens design in each eye (contralateral cross-over study design). Eyes wearing HALT Max lenses showed slower axial length growth over six months compared to those wearing HALT lenses (0.043 mm vs 0.105 mm), indicating improved treatment efficacy. In a separate short-term visual performance study, high and low contrast visual acuity showed no significant differences between designs. These short-term findings suggest that the HALT Max design may improve myopia control efficacy without compromising short-term visual performance.26,27

Finally, testing treatments in various ethnicities is also expanding our understanding of candidates and outcome expectations. Diffusion optics technology (DOT) spectacle lenses and MiSight 1 day soft contact lenses, first examined in multisite but primarily White patient groups, are now showing impressive efficacy in Chinese children. Those wearing DOT spectacle lenses for 12 months showed only AL 0.09 mm and -0.17D myopic change over 12 months, compared to 0.35 mm and -0.64D in the control group.28 Similarly, MiSight 1 day demonstrated slower axial length growth and myopia progression compared to controls (mean treatment difference 0.25 mm/0.53D).29

In myopia management, AI has the potential to support multi-factor inputs and analysis for myopia risk, through evaluation of population data and verification against individuals. One recent paper reported a novel AI algorithm called DeepMyopia, which was trained on over 1.6 million fundus images and tested on additional Chinese multi-site data sets to successfully predict myopia onset within one, two, or three years. Using multifactorial data, it was able to accurately stratify children into low and high risk. These two groups then underwent intervention of less (<120 min/ day) or more (≥120 min/day) outdoor time, with those identified by DeepMyopia showing less myopia onset overall compared to those with risks isolated through non-cycloplegic metadata. The authors cited that AI can support early detection, effective intervention, and best use of health resources.30

Myopia detection through retinal imaging analysis has the potential to augment screening processes, reaching larger populations with more accessibility. It could even circumvent the training and/or cycloplegia needed for accurate refraction screening.30 To that end, a handful of ARVO abstracts explored use of smartphones for acuity and refraction screening, some optimised for analysis using AI. One study evaluated the accuracy and performance of smartphone photorefraction as a novel myopia screening tool in more than 800 myopic participants aged 6–43 years. For verification, cycloplegic and non-cycloplegic smartphone photorefraction outputs were compared with open-field autorefraction at one and three metres. After factoring in accommodation, the mean absolute error (MAE) between the two methods was 0.79D to 0.99D, with highest accuracy for myopia between -2.00D and -4.00D. Non-cycloplegic photorefraction showed better sensitivity (93%) and specificity (81%) for detecting myopia greater than -2.00D. While arguably not suitable for a basis of prescribing, these sorts of tools have potential for application in expanding the reach of myopia detection and targeting for follow-up care.31

AI could also be used to support treatment decisions, enabling personalised strategies through analysis of multiple inputs. There is undoubtedly a challenge in determining myopia control efficacy – comparing patients to average outcomes in clinical trials when the individual patient could be anything but ‘average’. Centile curves for axial length can be helpful but recent analysis indicates these still need further development.32 AI could even be used in combination with virtual reality to simulate outdoor environments as an adjunct treatment option.33

Use of AI seems a golden new age, and indeed adoption is increasing rapidly, but this is not without risks. Inherent randomness in AI – important for diversity in responses – can lead to outputs and errors that cannot be explained by the AI. In the health care setting, this may present unacceptable risks, along with concerns about data safety and privacy. Models may be trained on data sets not representative or generalisable to other populations. There are also significant direct and indirect costs in utilising AI.32 Overall, the enormous potential must be matched with careful exploration and implementation.

If you’ve been involved in myopia management for a while, and keeping an eye on the latest science, it can be tempting to think that most of the big questions have been figured out. It’s true that our treatment options and knowledge base have grown enormously in recent years, but there is still much to learn about how to ensure the best possible outcomes for individual patients, through investigations of success factors and impacts in wider populations. The use of AI adds another dimension to the potential for truly personalised care. Watch this space – we’ve learnt so much but there’s still more to come.