Which myopia control treatment works best?

Current evidence suggests that many myopia control treatments achieve comparable efficacy, with no single treatment being clearly superior. However, some treatments are notably less effective than others.1,2

Whether myopia control efficacy is best expressed as an absolute change or a percentage effect also remains debated.2

Before comparing treatment options, it helps to clarify how myopia control efficacy is assessed. 

1. Randomized controlled trials (RCTs) are the gold standard. RCTs are studies which directly compare a treatment group, against an age- and refraction-matched control group receiving no treatment – which typically involves single vision lenses or a placebo eye drop.3
2. Efficacy applies within a study. Within a single study, how effectively the treatment worked compared to the control is often expressed as a percentage. While valuable for that specific study, these percentages cannot be directly compared to other studies, as different studies have different characteristics that can influence outcomes.1
3. Axial length is the preferred measure. Compared with refraction, axial length is more sensitive at detecting changes in myopia progression, making it a more precise gauge of treatment efficacy.3 As a result, the axial length efficacy (%) often appears slightly lower than refractive efficacy (%).

Directly comparing percentage efficacy can create misleading assumptions about which treatment is best. So how can we identify the most effective treatments? 

A clearer approach is to group treatments by effect size – those shown to slow axial elongation by at least 50%, or those by roughly 33%. In practice, broad percentage categories provide a simple way to communicate efficacy with parents and patients.

For example, if three myopia control studies report axial elongation reductions of 75%, 52%, and 66%, compared with their respective control groups, all three would fall into the ‘at least 50%’ category. 

This approach offers some advantages: 

• Clear for patients and parents. Percentages such as 50% ("slows myopia by about half") and 33% ("slow it by about a third") are intuitive, while also making it clear that no myopia control strategy achieves 100% efficacy.
• Clear for clinicians. It provides an evidence-based, easy to communicate framework that helps practitioners present multiple treatment options at once.

Myopia Profile’s Managing Myopia Guidelines infographic uses a simplified format to explain treatment options to parents. These free, multilingual resources are designed to support clinical decision making and communication in practice.

Panel 2 of the infographic groups similarly effective treatments, according to axial length outcomes from RCTs with at least 12 months of published data. Note that availability may vary by country.

Because current shows that many treatments achieve similar efficacy, with no single option clearly superior, broad efficacy categories are used: at least 50% and around 33%. These make it easy to communicate average expected outcomes and set treatment goals. For example, explaining that a treatment can slow myopia progression by "at least half", or that a treatment slows it by "about a third".

Numerous treatment options may be suitable for your patient, since many have similar efficacy. Choose the ideal treatment based on what you have available, and what best suits their ocular, lifestyle and family factors.

A simple approach is to ask yourself the following questions:

1. What is the most effective treatment that you have available to you? Try to select from the ‘best’ (gold category) treatments where possible.
2. Glasses or contact lenses? Child with myopia need vision correction, so start with optical treatments that can provide both myopia correction and effective myopia control. 
3. Which treatment will achieve the best compliance? Compliance is crucial to myopia control success, so treatments should be worn full-time and/or every day. A general guideline is at least 12 hours per day – every day for glasses, and 6 to 7 days per week for contact lenses.5,8