Slowing myopia down: drops, lenses and the honest numbers
Three treatments genuinely slow a child's short-sightedness, and none of them reverses it. Here are the figures from the actual trials, including the ones that went the wrong way.
- Low-dose atropine drops, myopia control spectacle lenses and certain contact lenses all slow short-sightedness; none of them reverses it.
- In the only placebo-controlled year of the Hong Kong LAMP trial, one year of change was 0.81 D on placebo, 0.59 D on 0.01% atropine, 0.46 D on 0.025% and 0.27 D on 0.05%.
- Two-year spectacle lens trials in Chinese children aged 8 to 13 slowed progression by roughly half, and the benefit was clearly larger in children who wore them at least 12 hours a day.
- The largest trial run outside Asia missed its main target for 0.02% atropine over three years, so the effect is not identical in every population studied.
- Most of this evidence sits at low or very low certainty, there is much less of it beyond two years, and no trial tells us when treatment can safely be stopped.
Almost every week a parent unfolds an optical shop receipt on my desk and reads the numbers out in order. Power 150 two years ago, 250 last year, 375 now. Then comes the actual question, which is never about the numbers: is this going to keep climbing until she is grown, and is there anything to do about it besides buying stronger lenses every December?
There is. Three families of treatment have real randomised evidence behind them, and all three slow short-sightedness down. None stops it, and none undoes what has already happened. So the useful question is not whether they work. It is how much, in which children, and how sure anyone is. Below are the trial numbers, including the ones that came out the wrong way.
Can anything actually slow my child's short-sightedness?
Yes. Eye drops, certain spectacle lenses and certain contact lenses all reduce how much a short-sighted eye changes over a year. The largest review of the field pooled 104 studies that randomised 17,509 children aged 4 to 18. Two thirds of those studies were done in China and other Asian countries, which is worth knowing when you are sitting in Malaysia.
That review also gives the number everything else should be measured against: the untreated children. In 55 studies covering 4,888 children, the middle child's prescription changed by 0.65 D over one year, and across 58 studies the eye itself grew 0.33 mm longer. That growth is the thing we are actually treating. The prescription is only how we read it. Why short-sightedness is rising and why a very strong prescription matters for life is the background this article deliberately does not repeat.
How much do the atropine drops really do?
In the one trial that compared them against a placebo drop, quite a lot at the stronger end and rather less at the weakest. The Hong Kong LAMP study put 438 children aged 4 to 12 on nightly atropine at 0.05%, 0.025% or 0.01%, or on a dummy drop. Over one year the placebo group's prescription changed by 0.81 D. The 0.01% group changed by 0.59 D, the 0.025% group by 0.46 D, and the 0.05% group by 0.27 D. Eye growth followed the same ladder, 0.41 mm on placebo down to 0.20 mm on 0.05%.
The stronger drops cost something in comfort. In that trial 0.05% enlarged the pupil in daylight by about 1 mm and weakened the focusing muscle by about 2 D, against about 0.3 D on placebo, which is why some children on the higher concentrations need help with glare or near work. All three concentrations were tolerated without a measured effect on quality of life.
Now the counterweight, and it is a real one. The largest trial run outside Asia, across 26 North American sites and five European countries, tested 0.02% and 0.01% over three years. At three years the 0.02% drop missed its main target and did not significantly slow the prescription. The 0.01% drop in the same trial did, by 0.24 D. A two year European trial of 0.01% in children aged 6 to 16 found no significant effect on the prescription overall, a small effect on eye growth, and a measurable benefit in its White children with none at all in its non-White children. So the drops work, the concentration matters, and the effect is not identical in every population studied.
Are the myopia control spectacle lenses worth it?
On the trial evidence, yes, and they ask least of a child, because they are a pair of glasses. In a two year trial of 183 Chinese children aged 8 to 13, lenses with many small defocus segments slowed the prescription by 52% and eye growth by 62% against ordinary single vision lenses. Put plainly, the ordinary lens group changed by 0.85 D over two years and the defocus lens group by 0.41 D. In the same trial 21.5% of the children wearing them had no measurable progression at all, against 7.4% in ordinary lenses.
A separate two year trial in Wenzhou, China, in children aged 8 to 13, tested lenses using tiny aspherical lenslets and found the prescription slowed by 0.80 D against single vision lenses. The number I care about most is a different one. Among the children who actually wore the lenses at least 12 hours every day, the slowing was 0.99 D, and the authors say outright that longer wearing hours gave better control. A myopia control lens in a school bag is an ordinary lens. This is the same argument I have with parents about any first prescription and the part time wearing that undermines it, and it applies with more force here.
What about contact lenses, or the overnight ones?
Both have trial evidence, and both add a hygiene responsibility a spectacle lens does not. Daily disposable soft lenses designed for myopia control were tested over three years in children aged 8 to 12 across four countries: the prescription changed 59% less and the eye grew 52% less than in the control group. There were no serious eye complications, and four symptomless corneal events, one in the treated group and three in the control group.
Overnight lenses that reshape the cornea while a child sleeps were tested in 102 Hong Kong children aged 6 to 10 over two years. Eye growth was 0.36 mm in the lens group against 0.63 mm in the spectacle group, about 43% slower. Note what is being measured there. Ortho-k trials report eye length rather than prescription, because the lens itself changes the prescription overnight, so there is no comparable prescription figure to quote. Five children in that trial stopped treatment because of adverse events, which is the honest counterpart to the headline. The large review also found that overnight lenses combined with low dose atropine probably slow eye growth a little more than the lenses alone.
How certain is any of this?
Less certain than the numbers above look, and I would rather you heard that from me. The review that pooled everything rates its own evidence from moderate down to very low depending on the treatment. Overnight lenses sit at moderate certainty for slowing eye growth. The low dose atropine concentrations above, and the newer spectacle designs, sit at low or very low certainty. Very low certainty does not mean the treatment fails. It means the size of the benefit could move quite a bit as better trials arrive.
Three other cautions travel with those figures. The network of trials is poorly connected, so the estimates rest on direct head to head comparisons, which makes any league table ranking one treatment above another shakier than each treatment's own comparison against nothing. Results differed a good deal between studies. And there is much less evidence beyond two years, while adverse effects and how faithfully children used the treatment were not consistently reported. Every percentage here belongs to one trial, one age band and mostly East Asian children, so none of it is a prediction for the particular child in front of me. That is why I measure and re-measure rather than promise.
If we start, can we ever stop?
I cannot give you an age, and anyone who gives you one is going beyond the evidence. The same large review says plainly that there is limited evidence on whether stopping myopia control increases progression beyond what age alone would produce. That is an unsatisfying sentence and it is the true one.
There is a related trap worth naming, because the number circulates. The Hong Kong drop trial switched its placebo children onto 0.05% atropine at the start of the second year, so every two year figure from it compares one concentration against another, never against nothing. Those children did progress more slowly after switching, which says something useful about starting late and nothing at all about stopping.
Will any of this give my child normal eyesight back?
No. Not one of these treatments reverses short-sightedness, and every trial above enrolled children who were already short-sighted, so none of it prevents myopia in a child who does not yet have it. What treatment buys is a slower rate, and a smaller number at the end of growing. That is worth having, and it is not a cure.
If your child is not yet short-sighted, the habit with evidence for delaying the start is a different one, and the outdoor time evidence, sized honestly, covers what it can and cannot promise. If your child already wears glasses, bring the old prescriptions to the next appointment. Two dated numbers on a receipt tell me more than any single reading taken today, and they begin every one of these conversations.
- Your child is under about seven and already short-sighted, or the prescription has jumped sharply in under a year.
- One eye is much more short-sighted than the other, or vision in one eye will not sharpen with glasses.
- An eye starts to turn in or out, having been straight before.
- A strongly short-sighted child reports new floaters, flashes of light, or a shadow or curtain across part of the vision.
- A child using prescribed eye drops or contact lenses develops a red, painful or light-sensitive eye.
Common questions
Her power goes up every single year. Can anything actually slow it?
How much do the atropine drops really do?
Are the special spectacle lenses worth it?
What about the overnight lenses?
Is it safe to put atropine in a child's eyes for years?
If we stop the treatment, does it all come back?
Will any of this make her eyesight normal again?
Do these treatments stop my younger child becoming short-sighted at all?
- Cochrane Database of Systematic Reviews 2025 · Interventions for myopia control in children: a living systematic review and network meta-analysis · pubmed.ncbi.nlm.nih.gov
- Ophthalmology 2019 · Low-Concentration Atropine for Myopia Progression (LAMP) Study, phase 1 randomised placebo-controlled trial · pubmed.ncbi.nlm.nih.gov
- Ophthalmology 2020 · Two-Year Clinical Trial of the Low-Concentration Atropine for Myopia Progression (LAMP) Study, phase 2 report · pubmed.ncbi.nlm.nih.gov
- JAMA Ophthalmology 2023 · Efficacy and Safety of 0.01% and 0.02% Atropine for Pediatric Myopia Progression Over 3 Years (CHAMP) · pubmed.ncbi.nlm.nih.gov
- Acta Ophthalmologica 2024 · Myopia Outcome Study of Atropine in Children (MOSAIC), two-year result in a European population · pubmed.ncbi.nlm.nih.gov
- British Journal of Ophthalmology 2020 · Defocus Incorporated Multiple Segments spectacle lenses slow myopia progression, two-year randomised trial · pubmed.ncbi.nlm.nih.gov
- JAMA Ophthalmology 2022 · Spectacle Lenses With Aspherical Lenslets for Myopia Control vs Single-Vision Spectacle Lenses · pubmed.ncbi.nlm.nih.gov
- Optometry and Vision Science 2019 · A 3-year Randomized Clinical Trial of MiSight Lenses for Myopia Control · pubmed.ncbi.nlm.nih.gov
- Investigative Ophthalmology and Visual Science 2012 · Retardation of Myopia in Orthokeratology (ROMIO) study, two-year randomised trial · pubmed.ncbi.nlm.nih.gov