Gradually, the armamentarium of myopia management treatments for eye care professionals is expanding.
While treatments for slowing the progression of myopia in young patients are going through the long FDA approval process, studies determining efficacy of off-label treatments are increasing as well. The result is a range of myopia control interventions comprised of an FDA market-authorized spectacle lens, an FDA-approved daily disposable multifocal contact lens, as well as other daily multifocals used off-label, overnight orthokeratology lenses, and low-dose topical atropine used off-label. (For currently available myopia control treatments, see “A Practice Roadmap to the 2026 Myopia Landscape.”)
“A diversified treatment portfolio enables more precise and individualized care,” says Dwight Akerman, OD, MBA, FAAO, Dipl. AAO, FBCLA, FIACLE, global ambassador for the International Myopia Institute.
As these available treatments increase, determining the most appropriate option becomes more complex. Here are some guidelines for deciding which myopia control intervention to select for which patient.
What Guides Choice of Treatments?
“Selection of myopia management treatments should be guided by clinical evidence, patient-specific factors, and practice capabilities rather than reliance on a single modality,” says Dr. Akerman. “Optimal outcomes in myopia management are achieved by matching the appropriate intervention to the patient’s risk profile and lifestyle considerations. This tailored approach enhances both clinical efficacy and long-term retention.”
Where to begin? “It would be super nice if there was a straightforward algorithm, such as if A then B, but unfortunately there’s no cookie-cutter recipe on what therapy to choose,” says Jeff Goodhew, OD, owner of Abbey Eye Care, an optometry practice in Oakville, Ontario, that specializes in myopia management.
Dr. Goodhew agrees that the answer is not relying on a single modality. “As far as effectiveness goes, we’re in the age where all the therapies are pretty similar in their effectiveness if they’re worn properly. Gone are the days when we would say, ‘Okay, we’re going to go with this one because it’s hands down better than the other options.’ They’re all in that 50% to 70% control range,” says Dr. Goodhew. (For charts comparing efficacy, see Current and Emerging Strategies for Myopia Control: A Narrative Review of Optical, Behavioural, and Adjunctive Therapies and Efficacy of Interventions For Myopia Control in Children: A Systematic Review with Network Meta-Analyses.)
“Selection of myopia management treatments should be guided by clinical evidence, patient-specific factors, and practice capabilities rather than reliance on a single modality.”
Dwight Akerman, OD, MBA, FAAO, Dipl. AAO, FBCLA, FIACLE
Objective Factors Lead to Treatment Choice
One of the early adopters of myopia management in his three decades of practice, Moshe Mendelson, OD, FIAO, of Silicon Valley Eye Physicians Medical Group in Sunnyvale, Calif., explains all the parameters he has found over the years to determine which treatments he chooses.
“I assess the family history, the refractive error of the parents, demographics (if they are Asian, Caucasian, etc.), how old the child is, the axial length (which is very, very important), and the refractive error,” he says.
Among these parameters, Dr. Mendelson cites two most crucial factors: “One of the very important things I look at is the axial length, and the age of the child is also very important,” he says. “I can have a patient who is, let’s say, 22 millimeters axial length and a -5 refraction. I’m going to worry about them less than a patient who is 26 millimeters and a -5.
“If I see someone who is 6 years of age and 25 millimeters and -1, I’m going to be very worried. On the other hand, if I see someone who is 16 and they’re 25 millimeter and -2 or -3, I’ll be far less worried.”
When to Consider Treatment Combinations
Dr. Mendelson will reach for a combination of treatments for those young myopes he’s most worried about. “I do a lot of combinations for young myopes: low-dose atropine in addition to the night lens, or the day lens, or the Stellest glasses.”
Similarly, Dr. Goodhew also relies on combination treatments for young fast progressors. “I might do a combination right out of the gate if a child is between 6 and 8, they’re already myopic, a -1, for example, and they have a long eye because I’ve measured their eye length with biometry,” he says.
This decision to combine treatments is based not only on his many years of experience but also on recent research. “There are more and more studies coming out that show that if you add atropine to contact lenses or spectacle lenses, you’re getting an extra boost in control,” he says.
For example, research presented at the 2026 annual meeting of the Association for Research in Vision and Ophthalmology (ARVO) included these studies indicating the efficacy of combination treatments:
- Early Myopia Prevention in Preschoolers: A Randomized Trial of 0.01% Atropine and DIMS Spectacle Lenses
- Efficacy of Combined Highly Aspherical Lenslet Target (HALT) Spectacles and Low-Dose Atropine in Children with Poor Response to Atropine Monotherapy Over 24 Months
- Real-World Effectiveness of High-Dose Atropine Combined with Dual-Focus Soft Contact Lenses for Myopia Control in Children
“Be more flexible in the exam room by looking at the data you’ve collected on the patient—and also the personality of the patient and the wants and needs of the child and parents.”
Jeff Goodhew, OD, owner of abbey eye care
Patients and Parents Come First
Ultimately, though, both the patient and the parents must be on board with whatever treatment is selected. Instead of starting with a preferred modality, Dr. Goodhew puts the patient and parents first.
“Don’t go searching for a flowchart that will guide you to A, B, and C in a linear fashion,” he says. “Be more flexible in the exam room by looking at the data you’ve collected on the patient—and also the personality of the patient and the wants and needs of the child and parents. You need to take into account what the parent wants but also look at what the child seems to be comfortable with. If they’re pushing back on a therapy, try to be their advocate. If the parents are pushing hard on one but the child’s not on board, then we don’t get much success.”
For example, some children may not be ready for contact lenses, which can be addressed by the recently FDA-approved Essilor Stellest spectacle lenses. “Some children are too young. They’re not ready for contact lenses, and the Stellest glasses will be a fine choice,” says Dr. Mendelson.
Still, the child’s lifestyle can also lead to other modalities. If the child plays a lot of sports, for example, Dr. Mendelson says he tries to convince them to go into either OrthoK or daily disposable multifocal soft contact lenses. In other cases, it’s the patient’s family history that leads to intervention, even when they would be considered pre-myopic.
“Myopia runs in some families, so parents understand it’s coming,” Dr. Mendelson says. “They ask me to initiate treatment even though the child is still plano: ‘How do you feel about initiating low-dose atropine?’ So that works very well for kids who are not yet myopic but we know will be myopic, because studies advocate if a child is 6 or plano or +0.50 they are probably going to progress to myopia, especially with a genetic predisposition.”
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