Key messages

• Medicines, such as atropine, given as eye drops, can slow the progression of short- or near-sightedness (myopia) in children, and also reduce elongation of the eyeball due to myopia. Higher doses of atropine are most effective. We are uncertain about the effects of lower doses of atropine.

• Several treatments, including special types of lenses in eyeglasses, contact lenses, and a new therapy using low intensity red light, may slow the progression of short-sightedness, but their effect is still uncertain. There is insufficient information on the risk of unwanted side effects associated with strategies to control myopia.

• It is also unclear whether the reported benefit of treatments to slow the progression of myopia is maintained over the years.

What is short-sightedness?

Short-sightedness (or near-sightedness, or myopia) means people struggle to see objects clearly that are far away, while objects that are near remain clear. It is very common worldwide, and affects more than half of the children in China and South-East Asia. Short-sightedness may impair many aspects of life, including educational and occupational activities. Short-sighted people have longer eyes, which means that the retina is stretched. This puts the eye at greater risk of eye diseases, such as glaucoma, maculopathy, and retinal detachment, later in life.

How is short-sightedness treated?

Although conventional eyeglasses or contact lenses can correct short-sightedness, they do not slow its progression. A number of optical treatments (glasses and contact lenses) and medications are available that aim to slow the progression of short-sightedness. But they need to be given in childhood, when short-sightedness progresses most quickly. Medicines, such as atropine eye drops, may be effective, but can increase light sensitivity and cause problems when reading, especially the higher doses. Special eyeglasses are also available that include more than one focus power within the lens (multifocal or peripheral-plus lenses). These can also be provided as soft contact lenses. Other contact lenses, called orthokeratology, aim to temporarily change the shape of the eye surface. They are worn during sleep and removed during the day. Both soft contact lenses and orthokeratology may increase the risk of infections to the eye surface. An emerging treatment involves repeated short-duration exposure to low intensity red light.

What did we want to find out?

We aimed to find out whether medicines used as eye drops, light therapy, and special lenses in eyeglasses or contact lenses, can slow the progression of myopia, and the elongation of the eyeball. We also documented the risk of unwanted effects when using them.

What did we do?

We searched for studies that tested medicines, lenses, and light therapy that aimed to slow the progression of short-sightedness in children, and compared them with a control group, or with other medicines and lenses. Most of the control groups received a placebo (sham) treatment or single vision eyeglasses or contact lenses.

What did we find?

We included 104 studies (40 new for this update) that randomised 17,509 children with myopia.

• Higher doses of atropine may reduce the progression of short-sightedness, but the effect of low-dose atropine could be small and is uncertain.

• Based on short-term studies, orthokeratology is the most effective optical treatment for slowing elongation of the eyeball. However, these lenses were often poorly tolerated, and in some studies, more than half of the children did not complete the treatment.

• Other types of contact lenses, known as multifocal soft contact lenses and myopia-control eyeglasses, may also reduce the progression of short-sightedness, but, again, we remain uncertain about their benefits.

• Although short-term studies in Chinese children suggest that red light therapy may reduce myopia progression, we are very uncertain about these findings.

• Unwanted effects associated with treatments to control myopia were not consistently reported. Eye discomfort in bright light and blurred vision for near objects were the most common treatment-related unwanted effects in studies using atropine. Lower doses of atropine appear to have fewer unwanted effects.

• Although studies that tested contact lenses did not report any serious unwanted effects, there is limited information on the true rate of unwanted effects in children outside the context of a research study, or when wearing contact lenses for longer periods.

What are the limitations of the evidence?

Most of the evidence came from studies conducted in ways that may have introduced errors into their results, and potential unwanted effects were not well reported. The majority of the studies followed participants for two years or less. Therefore, there is insufficient evidence on whether benefits increase over the years, and whether the effects are sustained.

How up-to-date is the evidence?

This review is up-to-date to February 2024.