Current status on the development and treatment of myopia.

This is a review of the current literature describing the effect of atropine, bifocals, and/or contact lenses on slowing the progression of myopia. Cumulative data from a number of studies have demonstrated atropine instilled once a day in myopic eyes resulted in a 90% average reduction of myopia progression, as compared to untreated eyes, i.e., from 0.50 D/year to 0.05 D/year. Pirenzepine, a muscarinic pharmacological agent, has a minimal effect on pupil size and accommodation, and it has been shown to slow myopia by 44%. Bifocals and progressive lenses, which have been used for years to slow the progression of myopia, have recently been shown to produce, on average, only small, clinically insignificant treatment effects. However, their effectiveness is increased in children who are esophoric and have a large lag of accommodation, reducing myopia progression to between 0.25 and 0.40 D/year. Traditional correcting soft and gas permeable contact lenses, as well as novel spectacle lens designs, have not been shown to be effective in reducing myopic progression. Under-correction of the refractive error has been shown not only to be ineffective in slowing myopia, but has also been associated with an increased rate of myopia progression. Orthokeratology, using reverse geometry designed lenses, has been shown to be moderately effective in decreasing the progression of myopia by between 30 to 50% in a number of short-term, well-controlled studies, reducing myopia progression to between -0.25 and -0.35 D/year. Recently, there have been pilot studies using novel peripherally correcting soft contact lenses to slow the progression of myopia. Two of those lens designs have been shown to be moderately effective in slowing the progression of myopia, both of which had a 30% efficacy, reducing myopia progression to 0.35 D/year. In summary, myopia control is entering a new era with the use of contact lenses and pharmaceutical agents to effectively slow its progression with minimal side effects.