Stephanie Kearney

Myopia control may involve targeting the peripheral retina to slow eye growth; however, there is no consensus on the optimal lens design, and treatment effects remain variable. This scoping review explored whether a specific retinal region is sensitive to visual manipulation, which could inform more effective treatments. A literature search was conducted in December 2025, with updates in March and June 2026 using PubMed, MEDLINE, and the Cochrane Library. Full manuscripts in English in animals and humans were included and screened by title, abstract, and full text for relevance. A total of 134 studies were identified, with 22 meeting inclusion criteria (13 human, 9 animal studies). Evidence across studies suggests that both the extent and location of defocus influence axial elongation. Increasing the treatment area may enhance myopia control efficacy, although findings are inconsistent regarding whether this relationship is dose-dependent. Several studies indicate that retinal sensitivity to defocus is not uniform, with the horizontal retina, particularly the temporal region, potentially more responsive to defocus than the vertical retina. Notably, converging evidence from human electrophysiological and intervention studies suggests that the near peripheral retina, approximately 6°– 12° eccentricity, may be particularly sensitive to defocus with possible greater sensitivity in the horizontal meridian. While expanding treatment zones may enhance therapeutic effects, the relationship is likely more complex than a simple linear dose-response. Interpretation is limited by variability across studies and heavy reliance on adult and animal studies. Further research in children with progressive myopia is needed to further validate this potential "sweet spot”, investigate inter-individual variability in retinal sensitivity, and determine whether targeting the near peripheral, horizontal retina leads to improved clinical outcomes in myopia control.

Objectives: To evaluate the efficacy and safety of low concentration atropine eye drops for reducing progression of myopia in children in the UK. Design: Multicentre, double masked, superiority, placebo controlled, randomised trial. Setting: National Health Service hospital eye services and academic institutions at five UK centres. Participants: 289 children aged 6-12 years with myopia between −0.50 and −10.0 dioptres (D). Participants were allocated in ratio of 2:1 to atropine or placebo. Interventions: One eye drop of preserved atropine 0.01% or placebo daily for two years. Main outcome measures: The primary outcome was spherical equivalent refractive error of both eyes measured by autorefractor under cycloplegia after two years. Secondary outcomes included change in axial length, best corrected distance and near visual acuity, reading speed, pupil diameter, spectacle correction, adverse event rates, quality of life, and tolerability. Outcomes were collected every six months. An electronic monitoring system was used to assess adherence. Results: 192 participants were included in the atropine group and 97 in the placebo group, with an average age of 9.3 years (standard deviation (SD) 1.7 years). 207 (72%) reported white ethnicity, 161 (56%) were girls, and the mean level of myopia was −2.87 D (SD 1.71 D). A total of 235 (81%) participants completed the study, with primary outcome data available for 230 (80%) participants: 151 (79%) in the atropine group and 79 (81%) in the placebo group. Atropine eye drops were more effective than placebo in reducing myopia progression (mean difference 0.33 D, 95% confidence interval (CI) 0.17 to 0.49 D, P<0.001). Prespecified subgroup analyses did not show differences according to age, ethnicity, sex, or severity of myopia. Changes in central axial length were significantly less in the atropine group versus placebo group: mean difference 0.14 mm (95% CI 0.07 to 0.21, P<0.001). There were no differences in other secondary outcomes, except pupil diameter, which was greater in the atropine group (0.36 mm, 95% CI 0.17, 0.55, P<0.001), and no differences in frequency of adverse events or in tolerability measures. No serious adverse events were related to the trial drugs. Conclusions: Low concentration atropine (0.01%) eye drops significantly reduced progression of myopia and were well tolerated compared with placebo in children in the UK. Trial registration: ISRCTN registry ISRCTN99883695 , ClinicalTrials.gov NCT03690089 .

Aims/Purpose: Myopia arises primarily due to excessive axial elongation and is associated with an increased risk of ocular complications and visual impairment, particularly in high myopia. Although astigmatism may have implications on refractive development, the role of astigmatism in myopic eye growth and the effectiveness of myopia control strategies is unclear. Methods: A scoping review was conducted in March 2025 and updated in August 2025, using MEDLINE and PubMed to explore myopia prevalence and onset, progression and astigmatism (Aim 1) and myopia control and astigmatism (Aim 2). Literature was initially screened by title, abstract and finally by the relevance of the full manuscript. Results: A total of 1004 studies were identified; 26 duplicates were removed; 911 were excluded following title screening and 20 were excluded following abstract screening. A total of 47 studies were included (Aim 1 = 30, Aim 2 = 17), with most conducted in Asia ( n = 31). A higher prevalence of astigmatism was associated with myopia. Myopia progression and astigmatism may be related, although there is limited research on the effects of uncorrected astigmatism on the course of myopia. Additionally, there is limited research regarding the influence of astigmatism on the effectiveness of myopia control strategies, with conflicting findings between studies. Conclusions: Myopia progression and astigmatism may be interdependent. However, a causative role of astigmatism in promoting myopia is unclear. The diverse range of study designs and methodologies impairs the comparability of findings. Prospective research in children of differing ethnicities with a range of astigmatism is required to determine if astigmatism influences the effectiveness of myopia control interventions. This would provide an evidence base to inform clinical decision‐making and management plans for myopic children with astigmatism, particularly in non‐Asian populations where research is limited.

Purpose: This study aims to investigate the feasibility and tolerability of morning bright light therapy (BLT) in children with myopia. Additionally, any potential benefits of morning BLT in reducing myopia progression will be explored. Material and Methods: This was a pilot study exploring the tolerability and feasibility of BLT. A total of 15 children (7 - 13 years) attended two visits, 6 months apart in either the BLT group, myopia management spectacles or contact lenses and BLT (BLT-MMI) group or the control group. Questionnaires collected data on tolerability and feasibility of BLT. A weekly paper diary on compliance was completed. Ocular measures included axial length, vitreous chamber depth, spherical equivalent refraction (SER) and subfoveal choroidal thickness. Results: Children were, on average, 9 years old (SD 1.6 years), baseline SER −1.86 D (0.62 D), baseline axial length 24.67 mm (0.83 mm), 53.3 % female and 53.3 % white. BLT (control n = 4, BLT n = 4, BLT-MMI n = 7) was used on average 84 % (SD 12 %) of the time with compliance poorest over school holidays. There was one report of occasional eyestrain, 91 % of parents reported BLT was easy to use routinely and 91 % of children were happy to use BLT. There was no difference in the change in ocular measures between groups (all p ≥ 0.07). Conclusion: BLT provides a tolerable and feasible intervention with good compliance. Future research should consider closer monitoring of compliance over the school holidays. The current analyses were limited by the small sample size and therefore research is required to explore the efficacy of BLT in myopic children both as a standalone and a combination therapy.

Purpose: General Ophthalmic Services in Scotland (GOS(S)3) vouchers provide children with National Health Service (NHS)‐funded optical correction. This study investigated the financial impact of myopia by reporting current spending on GOS(S)3 vouchers and indicative prevalence of childhood myopia in Scotland. Methods: Data on the number and monetary value of GOS(S)3 vouchers issued for children aged 6–15 years in 2021/22 were obtained from Public Health Scotland. Data were categorised by age, refractive error and voucher value. Refractive error was defined as emmetropia (spherical equivalent refraction (SER) > −0.50D and < +2.00D), hyperopia (SER ≥ + 2.00D) and myopia (SER ≤ −0.50D). Total spending on GOS(S)3 vouchers and spending on additional GOS(S)3 voucher claims (due to spectacle prescription changes within 1 year) were reported. The proportions of additional GOS(S)3 vouchers for myopia and non‐myopic refractive errors (hyperopia and emmetropia combined) were compared with a two‐proportion z ‐test. Indicative prevalence was estimated by dividing the number of GOS(S)3 vouchers (excluding additional vouchers) by the number of children in the population, using data from the National Records of Scotland. Results: Total annual spending on GOS(S)3 vouchers for the correction of emmetropia, hyperopia and myopia was £1.44 million, £1.43 million and £1.91 million, respectively. A greater proportion of GOS(S)3 vouchers was attributed to additional claims for myopia (6.31%) compared to non‐myopic refractive errors (4.10%) ( p < 0.001). The prevalence of myopia as indicated by voucher claims ranged from 2.21% in children aged 6–7 years to 11.95% in 15 year olds. The proportion of children aged 6–15 years requiring spectacles for high myopia (spherical component < −6.00D) was approximately 0.26%, accounting for 3.62% of myopic children. Conclusion: Total spending on GOS(S)3 vouchers for the correction of myopia is lower than the combined spending on GOS(S)3 vouchers for emmetropia and hyperopia. However, children with myopia received more additional GOS(S)3 vouchers than other refractive groups, suggesting these children experienced more short‐term changes to their spectacle prescription.

Myopia management interventions are available across the UK but uptake by eye care practitioners (ECPs) is variable. Research is yet to explore the effectiveness of postgraduate training on clinical practice as perceived by ECPs. This research explores the impact of university-based learning on clinical practice and barriers to practising myopia management in a cohort of ECPs. A survey in REDCap (https://www.project-redcap.org/) was completed by ECPs who had undertaken the Myopia Management Module at Glasgow Caledonian University (https://shorturl.at/4rUXS) between 2022-2023 (n = 48) and 2023-2024 (n = 43). Questions followed a Likert (1-5) scale or binary (yes/no) with free text options. The response rate was 36% (33/91). The primary barrier to practising myopia management before university-based learning was insufficient knowledge (79%) and confidence (67%) despite the majority having undertaken prior training (73%). Following university-based learning, there was a decrease in those not dispensing intervention (30% vs 9%, p = 0.00) and an increase in those measuring axial length (21% vs 52%, p = 0.002). Other aspects of clinical practice which significantly changed were evaluated; these included the frequency that advice was given to pre-myopes (p = 0.00) and progressing myopes (p = 0.00), the frequency that the risk of progression (p = 0.00), and that the success of the intervention (p = 0.02). There was a change to eyecare for a total of 528 paediatric eye appointments/year per ECP educated. Workplace satisfaction increased (54%) and risk of complaints decreased (87%). After university-based learning, the most common barrier to practising myopia management was the lack of a biometer (48%) due to affordability. University-based learning can significantly change clinical practice, increase the dispensing of interventions, increase workplace satisfaction, and decrease perceived risk of patient complaints as perceived by ECPs. After completion, the most common barrier was the lack of a biometer. Employers should consider investing in university-based learning to improve ECP engagement with myopia management.

The risks of developing myopia complications are frequently reported in relative terms, which can be misleading. This study provides absolute risk estimates of visual impairment (VI) from myopia-related diseases. A critical integrative review provided data on frequency of myopic macular degeneration (MMD), primary open-angle glaucoma (POAG), rhegmatogenous retinal detachment (RRD), and associated VI in predominantly White and East Asian populations. The absolute risks of persons over 40 years of age with no myopia, low myopia (-2.00 D), or high myopia (-6.00 D) developing VI from each myopia-related disease were calculated by multiplying the proportion of each refractive group with the disease by the rate of VI. The sum of the risks of VI from MMD, POAG, and RRD provided an estimate of VI risk from any of these three myopia-related diseases in adults over 40 years old. VI from MMD, POAG, or RRD combined is expected in 0.4 in 100, 1.4 in 100, and 6.8 in 100 of White persons with no myopia, low myopia, or high myopia, respectively. The same risks in an East Asian population are 0.5 in 100, 2.4 in 100 and 10.3 in 100 in persons with no myopia, low myopia, or high myopia, respectively. Absolute risks are provided to enable balanced discussions of the future risk that a child may have in developing VI from myopia-related diseases when considering myopia management. These estimates should be put into context using decision tools and balanced statements providing information on the likelihood of both developing VI and not developing VI.

Background/Objectives: Perceptions and barriers to myopia management (MM) in childhood have not been fully explored within some countries, including the UK, where there is minimal public health education on myopia. Methods: The aim of this mixed-methods study was to explore perceptions of myopia and MM interventions using focus groups and a survey to obtain qualitative and quantitative data. Topics included the understanding of myopia, perceptions of MM, considerations when initiating MM, lifestyle risk factors, and barriers to uptake of intervention. Results: Parent awareness and understanding of myopia and MM is limited. Many parents felt that they had not been provided with sufficient explicit advice about their child’s diagnosis or treatment. Despite this, parents were aware of some of the protective lifestyle behaviours which may slow myopia progression. The common belief was that myopia can affect a child’s quality of life. The most common reason that MM had been recommended to parents by practitioners was to reduce disease risk. Conclusions: The cost and lack of public awareness that MM interventions are available were the main barriers to the uptake of MM. There is a need to improve practitioner communication of myopia and its management and, subsequently, improve the standard of children’s eyecare.

Concerns surrounding the global increase in the prevalence of myopia 1 have led to the development of various optical and pharmacological interventions which aim to slow axial elongation within the myopic eye. This is of particular importance when considering that myopia, particularly high myopia, increases the risk of diseases such as maculopathy and subsequent visual impairment.2