Short-sightedness

Before you pay for myopia control: ten questions to ask any provider

A quote is easy to compare by its figure and hard to compare by what it includes. Ten questions to put to any provider, with the evidence behind each, and no prices or names on this page.

by Dr Chan Li Yen · MBBS, MOphth (UM), Fellowship in Paediatric Ophthalmology & Strabismus

Dr Chan Li Yen, consultant paediatric ophthalmologist, MMC 43128, NSR 132980 · Eagle Eye Centre Kuala Lumpur, Petaling Jaya

12 min read · 2,114 words

Key takeaways

Cochrane's 2025 review (104 trials, 17,509 children) found low-dose atropine, defocus spectacle lenses and multifocal soft contact lenses slowed change over one year, but rated the certainty very low. Untreated children worsened by a median 0.65 dioptres.
The International Myopia Institute guideline says anyone on myopia control should be reviewed at least every 6 months, with the same measuring method each time and axial length where the clinic has the instrument.
A sound plan says how you will know it is working, what happens if it is not, and when and how treatment will stop. Cochrane calls the evidence on rebound after stopping limited.
In March 2025 the Medical Device Authority announced a ban on online sales of optical devices and contact lenses, which must be dispensed by registered opticians or optometrists.
Put price last, and ask for the whole-course cost in writing. Nobody can promise where a child's number will stop.

A quote for myopia control (treatment meant to slow a child's short-sightedness, rabun jauh) lands in your hands, and the first instinct is to compare the figure. Compare what each quote includes instead. This page is a neutral checklist of ten questions you can put to any provider, so the answers decide it, not the brochure.

I do not quote prices here, and I do not compare clinics or products.

Is myopia control worth paying for?

For some children it may be, and the answer depends on how fast the eyes are changing and how sure the evidence is. Nobody can promise where your child's number will stop.

The biggest review we have is a 2025 Cochrane review of 104 trials and 17,509 children. Children given no treatment worsened by a median of 0.65 dioptres (the unit of lens strength, written D) in a year. Against that, low-dose atropine drops slowed the change by about 0.25 D, defocus-type spectacle lenses by about 0.45 D and multifocal soft contact lenses by about 0.27 D, all rated very low certainty by Cochrane. The review also says there is less evidence beyond two years, and that side effects were not consistently reported.

So the question to carry into the room is not "does it work" but "how much, for how long, and how sure are we". The detail on each option is in slowing myopia down: drops, lenses and the honest numbers and what the atropine numbers say.

Who should prescribe and monitor myopia control? (questions 1 and 2)

A registered eye care professional who examines your child before anything is sold, and who stays responsible afterwards. Eye doctors and optometrists are both legitimate routes. What matters is that someone named is accountable for the follow-up, not only the first fitting.

Question 1: who will examine my child and prescribe, and what is their registration? Atropine is a medicine, so a doctor writes that prescription. Lenses are fitted by registered opticians or optometrists, which is what Malaysia's Optical Act 1991 expects, as the Medical Device Authority (MDA) restated in 2025.

Question 2: who sees my child at each visit, and who do I call if something goes wrong? The International Myopia Institute guideline (an international specialist panel) asks for full disclosure to parents of the options, the likely benefit, the risks and, where it applies, that a treatment is off-label, meaning used for a purpose it was not formally approved for. That conversation should happen before you pay.

What should be measured, and how often? (questions 3 and 4)

Your child's glasses power and, where the clinic has the instrument, the length of the eyeball, repeated at least every 6 months. The International Myopia Institute guideline says anyone on myopia control should be reviewed at least that often for safety and for whether it is working.

Question 3: what will you measure at the start and at each review? Power can be measured with or without drops that relax the eye's focusing (cycloplegic drops), which the guideline accepts where indicated. Axial length is the front-to-back length of the eye, measured with a quick scan that does not touch the eye. The guideline puts healthy growth at about 0.1 mm a year and 0.2 to 0.3 mm a year with increasing myopia. Axial length is not yet widespread in clinics, so a clinic without the instrument is not automatically wrong. What matters is that the same method is used each time, so the numbers can be compared.

Question 4: how often will my child be reviewed, and are those visits part of what I am paying for? Ask for the schedule in writing.

What should the plan say about stopping, and about safety? (questions 5 to 7)

It should say how you will know the treatment is working, what happens if it is not, when it will stop, and what to do if the eye turns red or painful. A plan with a start and no end or exit is incomplete.

Question 5: how will we know if it is working, and what is the next step if it is not? In one six-year trial of dual-focus soft contact lenses (85 children completed the second half), about 10 percent of eyes did not respond. A good provider says in advance that response varies.

Question 6: what is the plan for stopping or stepping down? The guideline says treatment should be reviewed regularly to decide whether to continue, change, add to or halt it, and that parents should be told the expected "life span" of the option. Stopping matters because progression can speed up afterwards. In the third year of the LAMP trial, children whose atropine was stopped progressed faster than those who continued, for instance 0.68 D against 0.28 D at the 0.05 percent strength, though the rebound was judged small. Cochrane calls the evidence on rebound limited, so be wary of a firm promise either way.

Question 7: what are the side effects, and what are the safety checks? Atropine drops can sting, blur near vision and make light uncomfortable, more so at higher strengths. Contact lenses, including overnight lenses that reshape the cornea (ortho-k), carry a small risk of infection. One retrospective study of 677 children (1,435 patient-years of wear) found 13.9 cases of serious corneal infection per 10,000 patient-years, from only two cases, so the range is very wide (1.7 to 50.4), and neither child lost sight. Red-light devices are the newest. A 2026 laboratory study of four commercial devices found that two laser-based ones reached the published safety limit within 1.4 and 2.8 seconds, when the recommended session is 180 seconds, and its authors asked for independent safety testing before wide use in children. Our article on red-light therapy for short-sightedness covers that in full, and contact lenses for children and teens covers lens care.

Is the product or device allowed to be sold, and where? (question 8)

It should be registered for use in Malaysia and supplied through a registered professional, so ask where it is registered and who is selling it. In March 2025 the MDA announced a ban on selling optical devices and contact lenses on online platforms, because they must be prescribed and dispensed by registered opticians or optometrists under the Optical Act 1991.

Question 8: is this product registered for use in Malaysia, and can you show me the registration? As reported by The Star, the MDA said it would not approve online advertisements or sales of these products and that penalties can reach RM200,000 or two years in jail. I could not verify the registration status of any specific myopia control product or device for this article, so I will not say that any of them is or is not registered. The answer has to come from the provider, in writing, and you are entitled to ask.

What else should I ask before I pay? (questions 9 and 10)

Ask what the evidence says for the exact product being offered, in children like yours, and what the whole course will cost over its full length.

Question 9: what does the evidence say for this product, and how sure is it? A good answer names a trial or guideline, gives a comparison and says how certain it is. A percentage with no comparison, or an "up to" figure, is a weak answer.

Question 10: what is the cost over the whole course, and what is included? Include follow-up visits, replacement lenses or drops, and any extra if the plan changes.

One more thing sits outside any quote. Time outdoors is free and has its own evidence. Two hours outside explains what it can and cannot do.

How do I use these ten questions without turning the visit into a quarrel?

Bring them on paper and ask them calmly, because a good provider will be glad you asked. You are not testing anyone. You are making sure the plan is written down, measurable and has an end.

The ten in one list:

Who will examine and prescribe, and what is their registration?
Who sees my child at every visit, and who do I call if there is a problem?
What is measured at the start and at each review?
How often are reviews, and are they included?
How will we know if it is working, and what happens if it is not?
What is the plan for stopping or stepping down?
What are the side effects and the safety checks?
Is the product registered for use in Malaysia, and is it supplied through a registered professional?
What does the evidence say for this exact product, and how sure is it?
What will the whole course cost, and what is included?

If the answers are vague, take the quote home and ask a second professional. A child's eyes do not change overnight, and a week spent asking is not a week lost. When short-sightedness stops getting worse sets out what the growth years look like.

See an eye doctor promptly if…

A child wearing contact lenses or overnight lenses has a red, painful or watery eye, or light hurts: take the lenses out and be seen the same day.
Vision suddenly blurs, or one eye is clearly worse than the other.
After starting drops, your child has a lasting sore, swollen or very light-sensitive eye.
The provider has not seen your child for the agreed review, and the glasses now seem weaker.
Your child sees flashes of light, a shower of new floaters or a curtain over part of the vision: same-day care.

Common questions

Is myopia control worth the money?

It depends on how fast your child's eyes are changing and how sure the evidence is for the option offered. Cochrane's 2025 review found several treatments slowed change over a year, but rated the certainty very low for low-dose atropine, defocus spectacle lenses and multifocal soft contact lenses. Nobody can promise where a number will stop, so ask for the reasoning, not a guarantee.

What should a myopia control plan include?

A named person responsible, a measured starting point, a review at least every 6 months, a way to tell if it is working, a stopping or step-down plan, and a safety plan. The International Myopia Institute guideline sets out these points, and asks for informed consent that covers benefits, risks and off-label use. Ask for the plan in writing.

Is axial length measurement necessary?

It is useful, but it is not yet standard in every clinic. Axial length is the front-to-back length of the eye. The guideline puts normal growth at about 0.1 mm a year and 0.2 to 0.3 mm a year with increasing myopia, and says to measure it at least every 6 months where the instrument is available. Consistent methods matter more than any one number.

Can I buy myopia lenses or contact lenses online in Malaysia?

No. The Medical Device Authority announced in March 2025 that online sale of optical devices and contact lenses is banned, because they must be prescribed and dispensed by registered opticians or optometrists. The Star reported penalties of up to RM200,000 or two years in jail. Ask any provider to show you the registration of the product they supply.

What happens when myopia control stops?

Progression can speed up for a while. In the LAMP trial's third year, children who stopped atropine progressed faster than those who continued, for example 0.68 dioptres against 0.28 at the 0.05 percent strength, although the rebound was judged small. Cochrane calls the evidence on rebound limited, so ask the provider for a stopping or step-down plan in advance.

Is red-light therapy safe?

The long-term safety is not yet known. A 2026 laboratory study of four commercial devices found two laser-based ones reached the published safety limit within 1.4 and 2.8 seconds, against a recommended 180-second session, and called for independent testing before wide use in children. Ask what device is used, how it is registered, and who checks the eye afterwards.

Can I get a second opinion on a myopia control quote?

Yes, and it is reasonable to do so before paying. A child's eyes change over months, so a week spent asking is not a week lost. Take the written plan, the latest measurements and the quote, and ask a second eye doctor or optometrist the same ten questions.

References

Cochrane · Interventions for myopia control in children: a living systematic review and network meta-analysis (2025) · pubmed.ncbi.nlm.nih.gov
Investigative Ophthalmology & Visual Science · IMI Clinical Management Guidelines Report (2019) · pubmed.ncbi.nlm.nih.gov
JAMA Ophthalmology · Safety Evaluation of 4 Red Light Therapy Devices for Myopia (2026) · pubmed.ncbi.nlm.nih.gov
The Star · MDA bans online sale of optical devices, contact lenses (25 March 2025) · www.thestar.com.my
Ophthalmology · LAMP study continued versus washout, phase 3 report (2022) · pubmed.ncbi.nlm.nih.gov
Optometry and Vision Science · The risk of microbial keratitis with overnight corneal reshaping lenses (2013) · pubmed.ncbi.nlm.nih.gov
Optometry and Vision Science · Long-term effect of dual-focus contact lenses on myopia progression in children: a 6-year multicenter clinical trial (2022) · pubmed.ncbi.nlm.nih.gov

By Dr Chan Li Yen. General information only. It does not replace a consultation. If you are worried about your child's eyes or vision, please see an eye doctor.