At the completion of this article, the reader should be able to…
• Compare optical, pharmacological, and emerging myopia control interventions.
• Describe the role of contact
lens–based myopia management
(soft lenses and orthokeratology).
• Assess quality-of-life implications
of different myopia control modalities.
• Formulate individualised, evidence-based myopia management plans for patients.
Andrew Kotsos
B.Optom (Melb), PGCertOcTher
Founder/managing director of
eyedea Consulting
Professional education & development consultant for Johnson & Johnson Vision
Kerry Ho
B.Optom (Hons)/Sci (Vis Sci)
Clinical optometrist at
Eyecare Plus Chullora
Professional education & development consultant for Johnson & Johnson Vision
Andrew Kotsos and Kerry Ho review the growing range of myopia treatment options and show why choosing the approach that addresses patients’ clinical as well as lifestyle needs may be the best way to support long-term success.
Myopia is now widely recognised as a significant global public health challenge. In a landmark analysis, Brien A. Holden and colleagues projected that by 2050, nearly half of the world’s population would be myopic, including close to one billion people with high myopia.¹ This forecast reframed myopia from a routine refractive condition to a disease with serious long-term ocular health implications.
Even more startling, recent data suggest that this trajectory may be accelerating.
A large systematic review and meta analysis focusing on children and adolescents projected that by 2050, approximately 40% of young people worldwide will be myopic.²
The increasing prevalence of myopia in younger age groups is particularly concerning, as earlier onset of myopia has been consistently associated with longer periods of progression and higher levels of myopia later in life.³
At the same time, our understanding of myopia itself has evolved. Myopia is no longer viewed as a static refractive outcome, but as a progressive ocular condition driven primarily by axial elongation.4
Longitudinal evidence shows that axial length growth often accelerates before myopia is clinically evident, while refraction may still fall within the emmetropic range.5 Together, these findings underscore the limitations of relying on refraction alone to guide management decisions.
As myopia becomes more common, begins earlier, and progresses over longer periods, passive observation and uniform treatment are no longer sufficient – especially given the expanding range of effective and safe myopia control interventions.
Today, effective care now requires early identification, proactive intervention, and strategies tailored to each individual child.
From correction to control
Historically, myopia management focused almost exclusively on optical correction using single vision spectacles or contact lenses.
Progression was largely viewed as inevitable, and clinical care centred on monitoring refractive change, while ensuring that optimal visual clarity was provided to the patient.
Over the past two decades, this paradigm has shifted.
A growing body of research has demonstrated that myopia progression can be slowed through targeted interventions, resulting in the development of spectacle based, contact lens based, and pharmacological strategies – as well as light based approaches, which emerged more recently.6,7
As these options matured, myopia care transitioned toward active disease modification.
Myopia not a single condition
Myopia shows substantial variation in age of onset, rate of progression, and long term risk, shaped by factors including genetics, ethnicity, educational demands, visual behaviours, and environmental exposure.
Earlier onset and faster progression are linked to higher levels of adult myopia and a greater lifetime risk of myopia-related ocular complications.
Increasing severity is associated with a higher likelihood of myopic macular degeneration (MMD), retinal detachment, glaucoma, and cataract.8
This risk is further amplified with age, as prolonged axial elongation and cumulative structural change place increasing stress on ocular tissues.9
As a result, individuals who develop myopia early and continue to progress face a greater risk of sight-threatening complications later in life.
Myopia should therefore be viewed as a spectrum rather than a single diagnosis, as refractive status alone does not fully capture future ocular health risk.
Same refraction, different risk
Refractive error alone is an incomplete indicator of myopia risk. Longitudinal data show that children with identical baseline refractions can have markedly different outcomes.
Data from the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study demonstrate the influence of demographic factors such as ethnicity and sex.10
For example, among children with a baseline refractive error of +0.50 D at age seven, the probability of becoming myopic by age 14 was estimated at 55% for a female Asian American child, compared with 9% for a male White American child.10 This supports the concept of pre myopia as a clinically meaningful state preceding refractive onset.
Biometric studies further reinforce this distinction. Axial length growth has been shown to accelerate prior to myopia onset, while refraction may remain relatively stable.5
Where available, axial length measurements provide valuable additional insight to risk assessment.
Looking beyond efficacy
As the range of validated myopia control options has expanded, efficacy alone is no longer sufficient to guide treatment selection.
When multiple modalities offer clinically meaningful benefits, additional considerations become increasingly important.¹¹
These include quality of vision, quality of life and safety, all of which influence tolerance and long term use.¹¹,¹²
Safety profiles also vary between approaches and must be considered in the context of ocular health and family preferences.8 In practice, decisions are shaped by everyday realities – cost, appearance, routines, and the level of parental involvement required. Taking these into account supports care that is more likely to be followed and effective over time.
Suitability matters
The success of myopia management depends not only on biological efficacy, but on how well an intervention fits into everyday life.
Across modalities, treatment outcomes are dependent on sustained use. Contemporary guidance emphasises selecting treatments that function effectively in real world settings beyond controlled trial conditions.¹¹
School demands, sport participation, travel routines and family dynamics all influence acceptance and sustainability.
While these factors do not alter intrinsic efficacy, they strongly affect whether treatment benefits are realised and support the notion that the best treatment is the one that the patient will actually use or comply with.
Quality of life research supports this view. Studies consistently show higher vision related quality of life scores for contact lens based myopia management (whether soft disposable lenses or orthokeratology) compared with single vision spectacles, particularly for activities, appearance and overall satisfaction.¹²,¹³
These findings reinforce that patient experience is integral to therapeutic success.
Expanding the therapeutic toolkit
Modern myopia management encompasses optical, pharmacological and emerging strategies.
Optical approaches include peripheral defocus spectacle lenses, soft contact lenses designed for myopia management and overnight orthokeratology.
Pharmacological treatments, most notably low dose atropine, remain appropriate for some patients, while light based therapies have emerged more recently and continue to be evaluated as the evidence base continues to develop.6,7
Optical strategies aim to influence ocular growth by modifying retinal image quality. Introducing peripheral or simultaneous myopic defocus via spectacle lenslets, soft contact lenses or corneal reshaping has been shown to reduce axial elongation relative to single vision correction.14,15
It is also important to recognise that myopia management modalities continue to evolve across both spectacle and contact lens based approaches.
Advances in optical design increasingly focus on refining how therapeutic plus defocus is delivered, with newer designs reporting improved axial length control while maintaining functional vision.16,17
These developments reflect a broader trend toward next generation solutions that seek to enhance efficacy without compromising visual performance.
Within contact lens–based myopia management, ACUVUE Abiliti 1-Day – a disposable soft contact lens specifically designed for myopia management in children – forms part of this evolution. Its optical design is intended to deliver higher levels of therapeutic defocus while preserving visual quality, aligning contact lens innovation with principles demonstrated across modern optical myopia control strategies.18
An important distinction between treatment categories relates to rebound effects after treatment cessation.
Optical interventions show little evidence of clinically meaningful rebound once withdrawn, whereas rebound has been reported following cessation of atropine and some light based therapies.19
Regardless of modality, however, the extent to which any intervention achieves its intended benefit ultimately depends on consistent real world use.
Real-world adherence
Clinical trials assume ideal adherence, which often differs from everyday practice. Reduced wearing time or early discontinuation can significantly diminish treatment benefits, while sustained use supports long term myopia control.11
Myopia management often continues for years, so treatments must support long-term adherence to deliver real-world results.
If adherence drives outcomes in practice, product design becomes a key factor in treatment selection.
Clinicians therefore favour options that combine proven efficacy with ease-of-use in a child’s everyday life.
From a design perspective, ACUVUE Abiliti 1-Day sits within such a category, incorporating paediatric specific parameters, including a 13.8mm diameter and 7.9mm base curve, intended to support centration, comfort and ease of handling (both insertion and removal) in younger wearers. These features aim to reduce barriers during fitting and ongoing wear.20
Optically, the RingBoost Technology within ACUVUE Abiliti 1-Day is designed to deliver higher levels of therapeutic plus defocus while preserving central visual quality, addressing the long standing challenge of balancing efficacy and vision.18
Three year data demonstrate an average reduction of 0.72 D in myopia progression, with 55.2% of children showing no clinically meaningful progression.
Axial length outcomes show an average reduction of 0.31 mm, with more than one quarter of children showing no axial elongation over the same period.21
This data is indicative of the advantages of next-gen innovations such as ACUVUE Abiliti 1-Day in comparison to the more traditional dual focus soft myopia management contact lens options on the market.
Importantly, these outcomes fall within the range reported for other contemporary optical myopia control modalities evaluated over similar durations, reinforcing that ACUVUE Abiliti 1-Day delivers clinically meaningful efficacy consistent with modern evidence based approaches.7,14,15
Conclusion
Myopia management has evolved beyond uniform refractive correction.
With improved understanding of progression risk, earlier detection and an expanding range of validated interventions, care must now be individualised.
However, even the most effective intervention only works if patients actually use it.
By integrating clinical risk assessment, lifestyle considerations, adherence and evolving optical design, clinicians can deliver myopia management strategies that are designed for adherence and ease-of-use, and better protect their patients’ long term ocular health.
References
1.Holden BA, Fricke TR, Wilson DA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016;123:1036–42.
2. Liang J, Pu Y, Chen J, et al. Global prevalence, trend and projection of myopia in children and adolescents from 1990 to 2050. Br J Ophthalmol. 2024.
3. Mutti DO, Sinnott LT, Mitchell GL, et al. Prediction of myopia onset and progression using refractive error and demographic factors. Optom Vis Sci. 2024;101:179–87.
4. Brennan NA, Cheng X, Jong M, Bullimore MA. Commonly held beliefs about myopia that lack a robust evidence base: 2025 update. Eye Contact Lens. 2025.
5. Mutti DO, Hayes JR, Mitchell GL, et al. Refractive error, axial length, and relative peripheral refractive error before and after the onset of myopia. Invest Ophthalmol Vis Sci. 2007;48:2510–19.
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8. Bullimore MA, Ritchey ER, Shah S, et al. The risks and benefits of myopia control. Ophthalmology. 2021;128:1561–79.
9. Tideman JWL, et al. Association of axial length with risk of visual impairment. JAMA Ophthalmol. 2016;134:1355–63.
10. Mutti DO, Sinnott LT, Mitchell GL, et al. Prediction of myopia onset and progression using refractive error and demographic factors. Optom Vis Sci. 2024.
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12. Walline JJ, Gaume A, Jones LA, et al. Benefits of contact lens wear for children and teens. Eye Contact Lens. 2007;33:317–21.
13. Santodomingo‑Rubido J, Villa‑Collar C, Gilmartin B, et al. Myopia control with orthokeratology contact lenses in Spain. Eye Contact Lens. 2013;39:153–7.
14. Lam CSY, Tang WC, Tse DY, et al. Defocus Incorporated Multiple Segments spectacle lenses slow myopia progression. Br J Ophthalmol. 2020;104:363–8.
15. Walline JJ, Walker MK, Mutti DO, et al. Effect of high add power, medium add power, or single‑vision contact lenses on myopia progression in children. JAMA. 2020;324:571–80.
16. Raveendran RN, Ong WS, Wong YL, et al. Effect of increased power and asphericity of highly aspherical lenslets on myopia control efficacy. Transl Vis Sci Technol. 2025;14(11):9.
17. Tse DYY, et al. Myopia control efficacy of defocus incorporated multiple segments triple enhanced design spectacle lenses. 41st Asia‑Pacific Academy of Ophthalmology Congress; 2026. Abstract 205567.
18 Johnson & Johnson Vision. Development of Optical Design of ACUVUE Abiliti® 1‑Day Soft Therapeutic Lenses for Myopia Management. Data on file. 2021.
19. Bullimore MA, Brennan NA. Efficacy in myopia control – the impact of rebound. Ophthalmic Physiol Opt. 2025.
20. Johnson & Johnson Vision. Data on File 2021. Mechanical Design of ACUVUE Abiliti 1-Day Soft Therapeutic Lenses for Myopia Management – Effect on Fit and Handling.
21. Johnson & Johnson Vision. Data on File.
22. Bullimore MA, Saunders KJ, Baraas RC, et al. IMI – Interventions for controlling myopia onset and progression 2025. Invest Ophthalmol Vis Sci. 2025;Sep 2;66(12):39.
