Literature review: myopia and its current treatment
Article Sidebar
Main Article Content
Abstract
Myopia is currently a highly prevalent condition with a rising incidence worldwide. Patients typically present with reduced visual acuity due to the focal point of light being in front of the retina, resulting in blurred distance vision. Associated symptoms may include eyestrain and headaches, which can further affect daily activities and academic performance. In cases of high myopia, several sight-threatening complications have been reported, such as retinal tears, retinal detachment, and pathologic changes in the macula, including choroidal neovascularization. The pathogenesis of myopia is multifactorial, involving both genetic predisposition and environmental influences. Current management strategies aim not only to improve visual acuity and relieve symptoms to enhance quality of life, but also to slow the progression of myopia. Approaches include lifestyle modification, optical correction with spectacles, and pharmacological interventions such as low-dose atropine eye drops.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Morgan IG, French AN, Ashby RS, Guo X, Ding X, He M, et al. The epidemics of myopia: Aetiology and prevention. Prog Retin Eye Res. 2018;62:134–49.
Holden BA, Fricke TR, Wilson DA, Jong M, Naidoo KS, Sankaridurg P, et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036–42.
Morgan I, Rose K. How genetic is school myopia? Prog Retin Eye Res. 2005;24(1):1–38.
Dolgin E. The myopia boom. Nature. 2015; 519(7543):276–8.
Nearsightedness (Myopia) | National Eye Institute [Internet]. [cited 2025 Sep 20]. Available from: https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/nearsightedness-myopia
Morgan IG, Ohno-Matsui K, Saw SM. Myopia. The Lancet. 2012;379(9827):1739–48.
Tideman JWL, Polling JR, Vingerling JR, Jaddoe VWV, Williams C, Guggenheim JA, et al. Axial length growth and the risk of developing myopia in European children. Acta Ophthalmol (Copenh). 2018; 96 (3): 301–9.
Friedman NJ, Kaiser PK. Essentials of ophthalmology. 1st ed. Philadelphia: Elsevier, Saunders; 2007. 294 p.
Williams K, Hammond C. High myopia and its risks. Community Eye Health. 2019; 32 (105):5–6.
Ohno-Matsui K, Kawasaki R, Jonas JB, Cheung CMG, Saw SM, Verhoeven VJM, et al. International Photographic Classification and Grading System for Myopic Maculopathy. Am J Ophthalmol. 2015; 159(5): 877-883.e7.
Wong TY, Ferreira A, Hughes R, Carter G, Mitchell P. Epidemiology and Disease Burden of Pathologic Myopia and Myopic Choroidal Neovascularization: An Evidence-Based Systematic Review. Am J Ophthalmol. 2014;157(1):9-25.e12.
Yam JC, Jiang Y, Tang SM, Law AKP, Chan JJ, Wong E, et al. Low-Concentration Atropine for Myopia Progression (LAMP) Study. Ophthalmology. 2019;126(1):113–24.
Bao J, Huang Y, Li X, Yang A, Zhou F, Wu J, et al. Spectacle Lenses With Aspherical Lenslets for Myopia Control vs Single-Vision Spectacle Lenses: A Randomized Clinical Trial. JAMA Ophthalmol. 2022; 40(5):472.
Low W, Dirani M, Gazzard G, Chan YH, Zhou HJ, Selvaraj P, et al. Family history, near work, outdoor activity, and myopia in Singapore Chinese preschool children. Br J Ophthalmol. 2010;94(8):1012–6.
Rose KA, Morgan IG, Ip J, Kifley A, Huynh S, Smith W, et al. Outdoor Activity Reduces the Prevalence of Myopia in Children. Ophthalmology. 2008;115(8):1279–85.
Saw SM, Chua WH, Hong CY, Wu HM, Chan WY, Chia KS, et al. Nearwork in early-onset myopia. Invest Ophthalmol Vis Sci. 2002 43(2):332–9.
Mutti DO, Mitchell GL, Moeschberger ML, Jones LA, Zadnik K. Parental myopia, near work, school achievement, and children’s refractive error. Invest Ophthalmol Vis Sci. 2002;43(12):3633–40.
Dirani M, Tong L, Gazzard G, Zhang X, Chia A, Young TL, et al. Outdoor activity and myopia in Singapore teenage children. Br J Ophthalmol. 2009;93(8):997–1000.
Gwiazda JE, Hyman L, Norton TT, Hussein MEM, Marsh-Tootle W, Manny R, et al. Accommodation and Related Risk Factors Associated with Myopia Progression and Their Interaction with Treatment in COMET Children. Investig Opthalmology Vis Sci. 2004;45(7):2143.
Mutti DO, Mitchell GL, Hayes JR, Jones LA, Moeschberger ML, Cotter SA, et al. Accommodative Lag before and after the Onset of Myopia. Investig Opthalmology Vis Sci. 2006;47(3):837.
Saw SM, Tan SB, Fung D, Chia KS, Koh D, Tan DTH, et al. IQ and the Association with Myopia in Children. Investig Opthalmology Vis Sci. 2004;45(9):2943.
Williams C, Miller LL, Gazzard G, Saw SM. A comparison of measures of reading and intelligence as risk factors for the development of myopia in a UK cohort of children. Br J Ophthalmol. 2008;92(8):1117–21.
Czepita D, Mojsa A, Zejmo M. Prevalence of myopia and hyperopia among urban and rural schoolchildren in Poland. Ann Acad Med Stetin. 2008;54(1):17–21.
Guggenheim JA. Myopia, genetics, and ambient lighting at night in a UK sample. Br J Ophthalmol. 2003;87(5):580–2.
Campbell FW, Green DG. Optical and retinal factors affecting visual resolution. J Physiol. 1965;181(3):576–93.
Hutchinson AK, Morse CL, Hercinovic A, Cruz OA, Sprunger DT, Repka MX, et al. Pediatric Eye Evaluations Preferred Practice Pattern. Ophthalmology. 2023; 130(3): P222–70.
Li T, Zhou X, Zhu J, Tang X, Gu X. Effect of cycloplegia on the measurement of refractive error in Chinese children. Clin Exp Optom. 2019;102(2):160–5.
Amblyopia PPP 2022 - Updated 2024 - American Academy of Ophthalmology [Internet]. [cited 2025 Sep 20]. Available from: https://www.aao.org/education/preferred-practice-pattern/amblyopia-ppp-2022
Daoud YJ, Hutchinson A, Wallace DK, Song J, Kim T. Refractive Surgery in Children: Treatment Options, Outcomes, and Controversies. Am J Ophthalmol. 2009; 147(4):573-582.e2.
Jacobs DS, Lee JK, Shen TT, Afshari NA, Bishop RJ, Keenan JD, et al. Refractive Surgery Preferred Practice Pattern®. Ophthalmology. 2023;130(3):P61–135.
Goss DA. Nearwork and myopia. The Lancet. 2000;356(9240):1456–7.
Hepsen IF, Evereklioglu C, Bayramlar H. The effect of reading and near-work on the development of myopia in emmetropic boys: a prospective, controlled, three-year follow-up study. Vision Res. 2001; 41(19):2511–20.
Wallman J, Gottlieb MD, Rajaram V, Fugate-Wentzek LA. Local Retinal Regions Control Local Eye Growth and Myopia. Science. 1987;237(4810):73–7.
Diether S, Schaeffel F. Local Changes in Eye Growth induced by Imposed Local Refractive Error despite Active Accommodation. Vision Res. 1997; 37(6): 659–68.
Wallman J, Winawer J. Homeostasis of Eye Growth and the Question of Myopia. Neuron. 2004;43(4):447–68.
Smith EL, Hung LF, Huang J. Relative peripheral hyperopic defocus alters central refractive development in infant monkeys. Vision Res. 2009;49(19):2386–92.
Chia A, Tay SA. Clinical Management and Control of Myopia in Children. In: Ang M, Wong TY, editors. Updates on Myopia: A Clinical Perspective [Internet]. Singapore: Springer; 2020 [cited 2025 Sep 20]. p. 187–200. Available from: https://doi.org/10.1007/978-981-13-8491-2_8
Chung K, Mohidin N, O’Leary DJ. Undercorrection of myopia enhances rather than inhibits myopia progression. Vision Res. 2002;42(22):2555–9.
Walline JJ, Lindsley K, Vedula SS, Cotter SA, Mutti DO, Twelker JD. Interventions to slow progression of myopia in children. Cochrane Eyes and Vision Group, editor. Cochrane Database Syst Rev [Internet]. 2011 Dec 7 [cited 2025 Sep 20]; Available from: https://doi.wiley.com/10.1002/14651858.CD004916.pub3
Gwiazda JE, Hyman L, Everett D, Norton T, Kurtz D, Manny R, et al. Five–Year Results From the Correction of Myopia Evaluation Trial (COMET). Invest Ophthalmol Vis Sci. 2006;47(13):1166.
Hasebe S, Ohtsuki H, Nonaka T, Nakatsuka C, Miyata M, Hamasaki I, et al. Effect of Progressive Addition Lenses on Myopia Progression in Japanese Children: A Prospective, Randomized, Double-Masked, Crossover Trial. Investig Opthalmology Vis Sci. 2008;49(7):2781.
Cheng D, Woo GC, Drobe B, Schmid KL. Effect of Bifocal and Prismatic Bifocal Spectacles on Myopia Progression in Children: Three-Year Results of a Randomized Clinical Trial. JAMA Ophthalmol. 2014;132(3):258.
Sankaridurg P, Donovan L, Varnas S, Ho A, Chen X, Martinez A, et al. Spectacle Lenses Designed to Reduce Progression of Myopia: 12-Month Results. Optom Vis Sci. 2010;87(9):631–41.
Lam CSY, Tang WC, Tse DY yin, Lee RPK, Chun RKM, Hasegawa K, et al. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol. 2020;104(3):363–8.
Bao J, Yang A, Huang Y, Li X, Pan Y, Ding C, et al. One-year myopia control efficacy of spectacle lenses with aspherical lenslets. Br J Ophthalmol. 2021;bjophthalmol-2020-318367.
Alvarez‐Peregrina C, Sanchez‐Tena MA, Villa‐Collar C, Martinez‐Perez C, De Corcuera‐Terrero B, Liu N, et al. Clinical evaluation of MyoCare in Europe (CEME) for myopia management: One-year results. Ophthalmic Physiol Opt. 2025; 45(4):1025–35.
Laughton D, Hill JS, McParland M, Tasso V, Woods J, Zhu X, et al. Control of myopia using diffusion optics spectacle lenses: 4-year results of a multicentre randomised controlled, efficacy and safety study (CYPRESS). BMJ Open Ophthalmol. 2024;9(1):e001790.
Aller TA, Liu M, Wildsoet CF. Myopia Control with Bifocal Contact Lenses: A Randomized Clinical Trial. Optom Vis Sci. 2016;93(4):344–52.
Li S, Kang M, Wu S, Meng B, Sun Y, Wei S, et al. Studies using concentric ring bifocal and peripheral add multifocal contact lenses to slow myopia progression in school-aged children: a meta-analysis. Ophthalmic Physiol Opt. 2017;37(1):51–9.
Lam CSY, Tang WC, Tse DYY, Tang YY, To CH. Defocus Incorporated Soft Contact (DISC) lens slows myopia progression in Hong Kong Chinese schoolchildren: a 2-year randomised clinical trial. Br J Ophthalmol. 2014;98(1):40–5.
Pauné J, Morales H, Armengol J, Quevedo L, Faria-Ribeiro M, González-Méijome JM. Myopia Control with a Novel Peripheral Gradient Soft Lens and Orthokeratology: A 2-Year Clinical Trial. BioMed Res Int. 2015;2015:1–10.
Sun Y, Xu F, Zhang T, Liu M, Wang D, Chen Y, et al. Orthokeratology to Control Myopia Progression: A Meta-Analysis. Al-Ghoul KJ, editor. PLOS ONE. 2015;10(4):e0124535.
Li SM, Kang MT, Wu SS, Liu LR, Li H, Chen Z, et al. Efficacy, Safety and Acceptability of Orthokeratology on Slowing Axial Elongation in Myopic Children by Meta-Analysis. Curr Eye Res. 2016;41(5):600–8.
Huang J, Wen D, Wang Q, McAlinden C, Flitcroft I, Chen H, et al. Efficacy Comparison of 16 Interventions for Myopia Control in Children. Ophthalmology. 2016;123(4):697–708.
Lee YC, Wang JH, Chiu CJ. Effect of Orthokeratology on myopia progression: twelve-year results of a retrospective cohort study. BMC Ophthalmol. 2017;17(1):243.
Santodomingo-Rubido J, Villa-Collar C, Gilmartin B, Gutiérrez-Ortega R, Sugimoto K. Long-term Efficacy of Orthokeratology Contact Lens Wear in Controlling the Progression of Childhood Myopia. Curr Eye Res. 2017;42(5):713–20.
Cho P, Cheung SW. Discontinuation of orthokeratology on eyeball elongation (DOEE). Contact Lens Anterior Eye. 2017;40(2):82–7.
Ashby R, Ohlendorf A, Schaeffel F. The Effect of Ambient Illuminance on the Development of Deprivation Myopia in Chicks. Investig Opthalmology Vis Sci. 2009;50(11):5348.
Rucker FJ, Wallman J. Chick eyes compensate for chromatic simulations of hyperopic and myopic defocus: Evidence that the eye uses longitudinal chromatic aberration to guide eye-growth. Vision Res. 2009;49(14):1775–83.
Flitcroft DI. The complex interactions of retinal, optical and environmental factors in myopia aetiology. Prog Retin Eye Res. 2012;31(6):622–60.
Stone RA, Lin T, Laties AM, Iuvone PM. Retinal dopamine and form-deprivation myopia. Proc Natl Acad Sci. 1989;86(2):704–6.
Chua WH, Balakrishnan V, Chan YH, Tong L, Ling Y, Quah BL, et al. Atropine for the Treatment of Childhood Myopia. Ophthalmology. 2006;113(12):2285–91.
Yam JC, Li FF, Zhang X, Tang SM, Yip BHK, Kam KW, et al. Two-Year Clinical Trial of the Low-Concentration Atropine for Myopia Progression (LAMP) Study. Ophthalmology. 2020;127(7):910–9.
Yam JC, Zhang XJ, Zhang Y, Wang YM, Tang SM, Li FF, et al. Three-Year Clinical Trial of Low-Concentration Atropine for Myopia Progression (LAMP) Study: Continued Versus Washout. Ophthalmology. 2022;129(3):308–21.
Chia A, Lu QS, Tan D. Five-Year Clinical Trial on Atropine for the Treatment of Myopia 2. Ophthalmology. 2016;123(2):391–9.
Pineles SL, Kraker RT, VanderVeen DK, Hutchinson AK, Galvin JA, Wilson LB, et al. Atropine for the Prevention of Myopia Progression in Children. Ophthalmology. 2017;124(12):1857–66.
Tan D, Lam D, Chua W, Shuping D, Crockett R. One-year multicenter, double-masked, placebo-controlled, parallel safety and efficacy study of 2% pirenzepine ophthalmic gel in children with myopia. Ophthalmology. 2005;112(1):84–91.
Siatkowski RM, Cotter SA, Crockett RS, Miller JM, Novack GD, Zadnik K. Two-year multicenter, randomized, double-masked, placebo-controlled, parallel safety and efficacy study of 2% pirenzepine ophthalmic gel in children with myopia. J Am Assoc Pediatr Ophthalmol Strabismus. 2008;12(4):332–9.
Jiang Y, Zhu Z, Tan X, Kong X, Zhong H, Zhang J, et al. Effect of Repeated Low-Level Red-Light Therapy for Myopia Control in Children. Ophthalmology. 2022;129(5):509–19.
Liu G, Rong H, Liu Y, Wang B, Du B, Song D, et al. Effectiveness of repeated low-level red light in myopia prevention and myopia control. Br J Ophthalmol. 2024;108(9):1299–305.
Xu Y, Cui L, Kong M, Li Q, Feng X, Feng K, et al. Repeated Low-Level Red Light Therapy for Myopia Control in High Myopia Children and Adolescents. Ophthalmology. 2024;131(11):1314–23.
