Optical Interventions for Myopia Control

Abstract

Pediatric myopia is a major public health challenge driven primarily by progressive axial elongation, which substantially increases the lifetime risk of vision-threatening complications, such as myopic macular degeneration. Accordingly, contemporary management emphasizes myopia control rather than simple refractive correction. Current strategies include behavioral modification, low-dose atropine, and — most critically — optical interventions. These interventions encompass a variety of myopia-control spectacle lenses, such as Defocus Incorporated Multiple Segments (DIMS), Highly Aspherical Lenslet (HAL), and newer designs such as Cylindrical Annular Refractive Elements (CARE) and Lenslet-ARray-Integrated (LARI), which use lenslet arrays to project a plane or volume of myopic defocus in front of the peripheral retina. In contrast, Diffusion Optics Technology (DOT) employs microscopic light-scattering elements to reduce retinal image contrast without forming a secondary focal plane. Beyond spectacles, additional modalities, including multifocal soft contact lenses, dual-focus designs, and orthokeratology, rely on the same underlying principle of myopic defocus. All these optical strategies operate by manipulating the peripheral visual profile to suppress pro-elongation signals in the growing eye. Existing evidence demonstrates a 30%–60% reduction in axial elongation, depending on the technology employed. Combination therapy, particularly the integration of optical devices with low-dose atropine, offers superior efficacy compared with monotherapy, especially in children with rapid progression. Standard monitoring includes axial length measurement every six months and cycloplegic refraction one to two times per year. General practitioners play a pivotal role in identifying high-risk children — such as those with early-onset myopia, rapid refractive shifts, or a strong family history of high myopia — and in facilitating timely referral to ophthalmologists for definitive evaluation and evidence-based intervention.