THE INCREASING number of modalities for myopia control has made it easier than ever to begin implementing this specialty in our practices. Although it is our duty as practitioners to review available treatments so that patients can make informed choices, the variety of options can make the decision difficult. How can we determine the best recommendation for each patient? Let’s look at some commons considerations.

Astigmatism

High astigmatism, such as 2 D or more, limits the available options for myopia control. Orthokeratology (ortho-k) is unlikely to correct high astigmatism, and soft lenses marketed for myopia control are not available with cylinder at this time. Thankfully, most special spectacles for myopia control allow up to 4 D of astigmatism, and low-dose atropine can be used off label, too.

For those interested in contact lenses, high-add, center-distance multifocal soft lenses can have a significant effect on myopia progression: mean differences of 0.46 D and 0.23 mm at 3 years (Walline et al, 2020). Although this doesn’t match the efficacy of ortho-k or special spectacles (Bao et al, 2022; Cho and Cheung, 2012), using the toric version of this center-distance soft multifocal is a reasonable off-label alternative. Due to questions about atropine’s efficacy as monotherapy in the long term and in US populations (Li et al, 2024; Zadnik et al, 2023; Repka et al, 2023; Korenfeld et al, 2026), it may be beneficial to consider optical methods in combination with atropine (Sim et al, 2025; Tsai et al, 2022).

Hobbies

Learning what a child enjoys has utility beyond breaking the ice, as this may help guide treatment. Many activities, including sports and creative pursuits such as music and photography, make specific visual demands. For example, a swimmer would be an excellent candidate for ortho-k because the child would not have to wear lenses in the water.

However, those who play sports requiring fine acuity and contrast, such as baseball, softball, or golf, may not benefit from ortho-k due to the higher-order aberrations they can induce in the periphery (Nti and Berntsen, 2020). These aberrations are increased when optic zone size is reduced to further control axial length growth (Yang et al, 2025).

Multifocal soft contact lenses may also reduce contrast sensitivity (Gong et al, 2017), which is vital in sports performance. Prescribing another pair of sport-specific, single-vision lenses can allow for peak visual performance, and a proven myopia control modality can be used during nonsport activities. A tinted contact lens for sport may improve contrast (Erickson et al, 2009) while also reducing the temptation to skip myopia control and extend wear beyond the field. Any modality will probably be fine for a patient who is engaging in athletics purely for social reasons. However, if a practitioner gauges that a patient is looking to compete at a high level, visual performance must be considered.

Lastly, myopia control spectacles are a great option for patients not yet ready to try contact lenses. But as patients mature, contact lens wear is associated with improved self-esteem and perception of athletic abilities (Walline et al, 2009; Dias et al, 2013). As affordability improves, it may become commonplace to have myopia control contact lenses and a pair of myopia spectacles as backup. Practitioners have the essential task of promoting long-term health through myopia management, while also complementing visual performance and lifestyle through nuanced recommendations.

References

1. 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(6):571-580. doi:10.1001/jama.2020.10834

2. Bao J, Huang Y, Li X, et al. Spectacle lenses with aspherical lenslets for myopia control vs single-vision spectacle lenses: a randomized clinical trial. JAMA Ophthalmol. 2022;140(5):472-478. doi:10.1001/jamaophthalmol.2022.0401

3. Cho P, Cheung SW. Retardation of myopia in orthokeratology (ROMIO) study: a 2-year randomized clinical trial. Invest Ophthalmol Vis Sci. 2012;53(11):7077-7085. doi:10.1167/iovs.12-10565

4. Li Y, Yip M, Ning Y, et al. Topical atropine for childhood myopia control: the atropine treatment long-term assessment study. JAMA Ophthalmol. 2024;142(1):15-23. doi:10.1001/jamaophthalmol.2023.5467

5. Zadnik K, Schulman E, Flitcroft I, et al. Efficacy and safety of 0.01% and 0.02% atropine for the treatment of pediatric myopia progression over 3 years: a randomized clinical trial. JAMA Ophthalmol.2023;141(10):990-999. doi:10.1001/jamaophthalmol.2023.2097

6. Repka MX, Weise KK, Chandler DL, et al. Low-dose 0.01% atropine eye drops vs placebo for myopia control: a randomized clinical trial. JAMA Ophthalmol. 2023;141(8):756-765. doi:10.1001/jamaophthalmol.2023.2855

7. Korenfeld M, Hurcikova M, Tatsuoka K, et al. Study of atropine to reduce (STAR) myopia progression in children: 24-month results of a randomized, double-masked, vehicle-controlled trial of atropine sulfate 0.01% and 0.03. Ophthalmol Ther. 2026;15(5):1685-1703. doi:10.1007/s40123-026-01341-0

8. Sim BX, Loh KL, Htoon HM, et al. Additive effect of highly aspherical lenslet target spectacles to children inadequately controlled by atropine monotherapy. Ophthalmol Sci. 2025;5(4):100753. doi:10.1016/j.xops.2025.100753

9. Tsai HR, Wang JH, Huang HK, Chen TL, Chen PW, Chiu CJ. Efficacy of atropine, orthokeratology, and combined atropine with orthokeratology for childhood myopia: A systematic review and network meta-analysis. J Formos Med Assoc. 2022;121(12):2490-2500. doi:10.1016/j.jfma.2022.05.005

10. Nti AN, Berntsen DA. Optical changes and visual performance with orthokeratology. Clin Exp Optom. 2020;103(1):44-54. doi:10.1111/cxo.12947

11. Yang X, Wen L, Xiao K, Liu Y, Zhou Y. Therapeutic efficacy of orthokeratology lenses with different back optic zone diameters in myopia control: A systematic review and meta-analysis. Cont Lens Anterior Eye. 2025;48(4):102400. doi:10.1016/j.clae.2025.102400

12. Gong CR, Troilo D, Richdale K. Accommodation and phoria in children wearing multifocal contact lenses. Optom Vis Sci. 2017;94(3):353-360. doi:10.1097/OPX.0000000000001044

13. Erickson GB, Horn FC, Barney T, Pexton B, Baird RY. Visual performance with sport-tinted contact lenses in natural sunlight. Optom Vis Sci. 2009;86(5):509-516. doi:10.1097/OPX.0b013e31819f9aa2

14. Walline JJ, Jones LA, Sinnott L, et al. Randomized trial of the effect of contact lens wear on self-perception in children. Optom Vis Sci. 2009;86(3):222-232. doi:10.1097/OPX.0b013e3181971985

15. Dias L, Manny RE, Weissberg E, Fern KD. Myopia, contact lens use and self-esteem. Ophthalmic Physiol Opt. 2013;33(5):573-580. doi:10.1111/opo.12080