Every recommendation we make is grounded in published clinical trial evidence. This page explains what that evidence actually shows, and how we translate it into a plan for your child.
Myopia management has grown quickly, and with that growth has come a genuinely large number of products, devices and claims, not all of them equally well supported. Our approach starts from the published research, not the other way around: we look at what the trial evidence actually shows for a treatment, then decide where it fits in a child's care, rather than choosing a product first and looking for evidence to justify it after.
This matters because myopia control isn't cosmetic. It's treatment aimed at reducing lifetime risk of sight-threatening eye disease, covered in detail on our Myopia-Related Eye Diseases page. Every dioptre and every millimetre of axial length genuinely matters, so the treatments used to influence them deserve real scrutiny.
The strongest myopia control trials are randomised controlled trials that track axial length, not just prescription, over one to three years, comparing a treatment group against children wearing standard single-vision correction. Axial length is used because it's the more direct, objective marker of how much the eye is actually growing, less easily confounded than a prescription reading.
Results are usually reported as a percentage reduction in axial elongation compared with the control group. This gives us a genuinely useful basis for comparison between studies of the same treatment, though, as covered below, comparing percentages across different treatments and different trials needs care.
Rather than ranking treatments by exact percentages, which aren't reliably comparable across different trials, we group them into broad tiers based on the overall weight of published evidence, an approach also used by respected clinical education resources such as Myopia Profile.
OrthoK, MiSight contact lenses, MiyoSMART and Stellest spectacle lenses, 0.05% atropine, and repeated low-level red-light therapy (RLRL) each show around 50% or more reduction in axial elongation across multiple studies, with no single option shown to be clearly superior to the others in this tier. RLRL's evidence base has grown substantially: a 2022 multicentre randomised trial first established its efficacy, and a real-world cohort study of nearly 2,900 children followed for up to five years has since shown effective axial length control sustained across every year of follow-up, which is why we no longer consider it an early-stage option.
Treatments such as 0.025% atropine and certain other soft multifocal contact lens designs show meaningful but somewhat smaller average effects in trials.
Very low-dose atropine (0.01%) and standard progressive addition spectacle lenses show only modest effects in most trials, and are generally not our first recommendation where a more effective option is suitable.
Pre-myopia intervention, such as plano or low-plus peripheral defocus lenses and low-dose atropine for at-risk, not-yet-myopic children, remains a newer area with promising early trial results and a smaller but rapidly growing evidence base than the more established treatments above.
Percentage efficacy figures are not directly comparable between different trials, since study populations, ethnicities, follow-up periods and control groups all differ. A 60% result in one study doesn't necessarily mean greater real-world effectiveness than a 50% result in another. This is exactly why we use broad evidence tiers, and clinical judgement, rather than treating percentages as a precise ranking. See our Myopia Control Treatments page for how each option compares in more detail.
Strong trial evidence tells us how a treatment performs on average across a study population. Turning that into the right recommendation for one specific child takes clinical reasoning as well.
We start from the most effective evidence tier where possible, then narrow based on age, prescription and eye health.
Lifestyle, sport, and a child's comfort with lens handling or overnight wear all narrow the realistic options further.
Compliance is one of the biggest real-world drivers of outcome. A slightly less “top-tier” treatment worn reliably often outperforms a higher-evidence option worn inconsistently.
Myopia management remains one of the more active areas of eye health research. Bodies such as the International Myopia Institute (IMI) publish regularly updated white papers summarising the global evidence base and clinical management guidelines, which we follow closely alongside the published literature itself and clinician-focused summaries such as Myopia Profile.
Current areas of active research include combination therapy, pairing a lens-based treatment with atropine for children who need more than a single treatment offers; intervening even earlier, in at-risk children before myopia technically begins, covered on our Preventing Myopia page; and further optimising red-light therapy protocols for younger children and those who need extra support with adherence. We treat this as a living evidence base, and our recommendations evolve as it does, not as a fixed set of products we default to indefinitely. RLRL is a good example of that evolution in practice: it moved from a promising early-stage treatment to one backed by real-world, five-year outcome data in the space of only a few years, and we update our own recommendations as the evidence itself matures.
Book a comprehensive myopia assessment and we'll explain exactly what the evidence supports for your child's specific situation, not a one-size-fits-all recommendation.