EJO

ISSN 1120-6721
Eur J Ophthalmol 2015; 25 (4): 280-285
DOI: 10.5301/ejo.5000571

REVIEW

How can we prevent myopia progression?

Thomas Chassine1, Max Villain1, Christian P. Hamel1-5, Vincent Daien1,4,6
1
Department of Ophthalmology, Gui De Chauliac Hospital, Montpellier - France
2
Genetics of Sensory Diseases, Gui De Chauliac Hospital, Montpellier - France
3
INSERM U1051, Institute for Neurosciences of Montpellier, Hôpital Saint Eloi, Montpellier - France
4
Université Montpellier 1, Montpellier - France
5
Université Montpellier 2, Montpellier - France
6
INSERM U1061, Epidemiology, Montpellier - France

ABSTRACT
Purpose: Myopia has increased worldwide during recent years and is becoming a serious public health problem.
In East Asia, the prevalence can reach 80% of the population. The focus for screening and interventions should be
on early life during childhood when myopia progression is faster.
Methods: Review and discussion of the recent literature on potential interventions for preventing the develop-
ment of myopia or slowing its progression.
Results: Increased time spent outdoors is a protective factor for myopia progression. Undercorrection increased
myopia progression and optimal correction is mandatory. The use of progressive or bifocal lenses (spectacles or
contact lenses) may yield a slowing of myopia by limiting eye accommodation. Rigid gas permeable contact lenses
were found to have few effects on myopic eye growth. A marked slowing of myopia was observed with orthokera-
tology by temporarily changing the curvature radius of the cornea. The largest positive effects for slowing myopia
progression were observed with atropine eyedrops with an interesting dose effect. The benefit of surgical scleral
reinforcement is reserved for severe and progressive myopia.
Conclusions: In this review, we discuss optical and pharmacologic interventions that can be used in myopia
management.
Keywords: Atropine, Contact lenses, Myopia, Orthokeratology, Prevention, Scleral reinforcement

Introduction equivalent -0.5 D, but other studies use ≤-0.25 or ≤-0.75 D.

Myopia is a serious public health problem. Indeed, the prev-
alence of myopia has increased significantly in many industrial-
ized countries (1). In particular, myopia has increased in many
Asian countries. In Singapore, the myopia prevalence was 26%,
43%, 66%, and 83% in 1970, 1980, the mid-1990s, and the late
1990s, respectively (2). In the United States, the prevalence
of myopia in individuals aged 12 to 54 years increased from
25% to 41.6% between 1971 and 2004 (p<0.001), more among
Caucasians (26.3% to 43%, respectively, p<0.001) than African
Americans (13% to 33.5%, respectively, p<0.001) (3).
Importantly, there is a lack of general consensus in the cri-
teria to define myopia. Many studies are based on a spherical
Accepted: January 11, 2015
Published online: February 3, 2015
Corresponding author:
Vincent Daien
Service d’Ophtalmologie
Hôpital Gui de Chauliac
CHU de Montpellier
80, Avenue Augustin Fliche
34295 Montpellier cedex 5, France
vincent.daien@gmail.com
High-grade myopia has been defined as <-6 D (4).
The increased prevalence of higher myopia is associated
with comorbidities such as retinal detachment, subretinal neo-
vascularization, early cataract, and glaucoma. These patholo-
gies are major causes of visual impairment and blindness. As
the population ages in Western countries, myopia could de-
crease disability-free life expectancy in later life. Furthermore,
this could lead to important cost burdens to our societies.
The past decade has seen a greater understanding of the mo-
lecular biological mechanisms that determine refractive error,
giving further support to the belief that myopia is the result
of a complex interaction between genetic predisposition and
environmental exposures (5). The focus for screening and pre-
vention should be at early life during childhood when myopia
progression is faster.
In this review, we discuss all potential interventions for
preventing the development of myopia or slowing its progres-
sion, including time spent outdoors, atropine, bifocal lenses
(eyeglasses or contact lenses), orthokeratology, and surgical
scleral reinforcement.
Methods
We performed a literature search of Medline and Google
scholar databases for articles published in English or French

© 2015 Wichtig Publishing

Chassine et al
from 1966 to December 2014 using the search terms myopia,
epidemiology, time outdoors, atropine, lenses, glasses, con-
tact lenses, orthokeratology, and surgery. We also included
articles found from references in previous articles. We exclud-
ed articles with inadequate documentation of the method-
ology, treatment, or clinical course. We identified 36 articles
with sufficient relevance to improve knowledge for slowing
myopia progression.
Results
Spending more time outdoors protects against myopia
development and progression
Time spent outdoors and reduced need for close vision
work may be important in myopia. In a cohort of 863 Australian
children (6 years old, on average), myopic children spent 16.3
hours per week outdoors versus 21.0 hours for nonmyopic chil-
dren (p<0.0001) (6).
In a 2013 study of 681 children conducted in China, more
time spent outside was associated with a lower prevalence
of myopia (odds ratio [OR] 0.32, 95% confidence interval
[CI] 0.21-0.48) (7). Indeed, a comparison of 124 Australian
children and 628 children from Singapore showed that the
myopia prevalence was less for Australian than Singapore
children even though the former children spent more time
reading and enjoying activities involving near vision (3.3%
vs 29.1%, p<0.001). The only major difference was the time
spent outdoors: Australian children spent more time out-
doors than Singapore children (13.8 vs 3.1 hours per week)
(8). A 2006 study of 1209 adolescents in Singapore showed
that physical activity outside appears to be a protective
factor for myopia development in disease progression (p =
0.008) but not sports practiced indoors (p = 0.16) (9). In a
meta-analysis from 7 studies, the pooled OR for myopia in-
dicated a 2% reduced odds of myopia per additional hour of
time spent outdoors per week (10) (Tab. I).
Atropine
Atropine could slow myopia progression possibly by pre-
venting the eye's accommodation. However, other factors are
probably involved. Atropine is a muscarinic receptor antago-
nist acting on receptors localized in the sclera, thus inhibit-
ing the elongation of the eye. Furthermore, atropine causes
mydriasis, which allows more ultraviolet light to reach the
retina.
In the Atropine in the Treatment of Myopia (ATOM) 1 study,
conducted in Singapore and including 346 children (mean age
9.2 years), the use of 1% atropine for 2 years in one eye re-
duced the progression of myopia. In the control group treated
with placebo, myopia evolved -1.20 ± 0.69 D and axial length
increased 0.38 ± 0.38 mm, whereas in the group treated with
1% atropine, the increase in myopia was -0.28 ± 0.92 D and
the axial length was stable: -0.02 ± 0.35 mm (11).
In the ATOM 2 study, lower doses of atropine were used:
0.5%, 0.1%, and 0.01%. The progression of myopia was -0.30
± 0.60 D (0.27 ± 0.25 axial length), -0.38 ± 0.60 D (0.28 ± 0.28
axial length), and -0.49 ± 0.63 D (0.41 ± 0.32 for axial length),
respectively. Hence, atropine has a dose effect. Atropine has
© 2015 Wichtig Publishing
281
some side effects: allergic conjunctivitis, dermatitis, and pupil
dilation. In the ATOM 2 study, allergic conjunctivitis occurred
in none of the 0.01% atropine group, 4% of the 0.1% atropine
group, and 4% of the 0.5% atropine group (12); dermatitis in-
volving eyelids occurred in none of the 0.01% atropine group,
1% of the 0.1% atropine group, and 2% of the 0.5% atropine
group (12); the loss of distance best-corrected visual acuity
>1 line occurred in 13% of the 0.01% atropine group, 13% of
the 0.1% atropine group, and 8% of the 0.5% atropine group
(12). Near visual acuity was not significantly impaired in the
0.01% group, whereas deficiencies were noted in the 0.1%
and 0.5% groups (p<0.001). Atropine at 0.01% seems to be
the best compromise, with a significant reduction in progres-
sion of myopia and few side effects (12).
The ATOM 1 and 2 studies were followed by the ATOM
3 study, which allowed for studying the reaction of the eye
after atropine was stopped. A rebound effect occurred and
myopia progressed. In the 12 months after atropine treat-
ment 0.5%, 0.1%, and 0.01% was stopped, myopia increased
by -0.87 ± 0.52 D (0.35 ± 0.20 axial length), -0.68 ± 0.45 D
(0.33 ± 0.18 axial length), and -0.28 ± 0.33 D (0.19 ± 0.13 axial
length), respectively. The rebound effect was substantial with
0.5% and 0.1% but moderate with 0.01% treatment (13). The
use of 0.01% atropine seemed to be the best option.
In a meta-analysis of 4 randomized controlled studies
and 7 cohorts, the overall population was 1850 children 5 to
15 years old with myopia from -0.5 to -9.75 D for 22 months
(range 12-36 months). Progression of myopia differed for
children receiving and not receiving atropine. For the 4 ran-
domized studies, the use of atropine was effective in reduc-
ing myopia progression as compared with placebo (OR 6.73,
95% CI 2.45-18.50; p<0.001). The cohort studies had similar
results (OR 22.10, 95% CI 7.09-68.81; p<0.001). The results
did not differ by concentration of atropine (14) (Tab. I).
Optimal spectacles correction vs undercorrection prevents
myopia progression
An undercorrection of myopia could lead to myopia
progression. Patients from 11 to 33 years old were followed
for 6 to 8 years: 125 underwent full correction and 22 un-
dercorrection of -0.12 D, 63 undercorrection of -0.25 D,
21 undercorrection of -0.37 D, and 44 undercorrection of
-0.5 D. The degree of undercorrection was associated with
progression of myopia: -0.20 D for the optimal correction,
-0.28 D for -0.12 D correction, -0.29 D for -0.25 D correc-
tion, -0.29 D for -0.37 D correction, and -0.49 D for -0.50 D
correction (p = 0.006) (15). A 2002 study of 94 patients in
Malaysia included a control group (fully corrected) and
patients with undercorrected myopia of -0.75 D. Myopia
progression was higher in the undercorrected group; after
2 years, the disease progression was -1.00 D and -0.77 D for
the control group (p<0.01) (16) (Tab. I).
Bifocal or bifocal and prismatic spectacles
Bifocal or bifocal and prismatic spectacles appear to af-
fect the progression of myopia. Bifocal spectacles are de-
signed to reduce eye accommodation with near vision and
prismatic lenses to reduce convergence in near vision. This
282 Slowing myopia progression

TABLE I - Review of studies

Potential protective Myopia progression or prevalence during the study period No. of participants/ Study Ref
factor setting duration, y

Time spent outside 16.3 h/wk for myopic children 863/Australia 5 6

21.0 h/wk for nonmyopic children
Australian, prevalence myopia: 3.3%, 13.8 h/wk outside 124/Australia - 8
Singaporian, prevalence myopia: 29.1%, 3.1 h/wk outside 628/Singapore
Lower prevalence of myopia associated with time spent outside, 681/China - 7
odds ratio = 0.32
The total outdoor activity (h/day) was significantly associated with 1209/Singapore 1 9
myopia, odds ratio = 0.90
In a meta-analysis, pooled odds ratio for myopia indicated a 2% - 10
reduced odds of myopia per additional hour of time spent
outdoors per week
Atropine Placebo, myopia progression: -1.20 D 346/Singapore 2 11
1% Atropine, myopia progression: -0.28 D
0.5% Atropine, myopia progression: -0.30 ± 0.60 D 400/Singapore 2 12
0.1% Atropine, myopia progression: -0.38 ± 0.60 D
0.01% Atropine, myopia progression: -0.49 ± 0.63 D
Myopic rebound after atropine stopped
In a meta-analysis, the use of atropine was effective in reducing - 14
myopia progression as compared with placebo: odds ratio 6.73
Optimal correction vs. Full correction: progression : -0.20 D 275/USA 1 15
undercorrection
Undercorrection of -0.25 D, progression: -0.29 D
Undercorrection of -0.5D, progression: -0.49 D
Full correction, myopia progression: -1.00 D 141/Malaysia 2 16
Undercorrection of 0.75 D, myopia progression: -0.77 D
Bifocal or bifocal and Monofocal spectacles, myopia progression: -2.06 D 135/Canada 3 17
prismatic spectacles
Bifocal spectacles, myopia progression: -1.25 D
Both bifocal and prismatic spectacles, progression: -1.01 D
Monofocal spectacles, myopia progression: -1.23 D 90/China 2 18
Progressive spectacle +1.50, myopia progression: -0.76 D
Progressive spectacle +2.00 D, myopia progression: -0.66 D
Monofocal spectacles, myopia progression: -1.48 D 469/USA 3 19
Progressive spectacle +1.50, myopia progression: -1.28 D
Contact lens materials Hydrogel, myopia progression: +0.02 D 284/USA 3 22
Silicone hydrogel, myopia progression : -0.41 D
Rigid contact lenses, myopia progression: -1.56 D 116/USA 3 23
Soft contact lenses, myopia progression: -2.19 D
Multifocal soft contact Monofocal lenses, myopia progression: -0.40 D 221/China 2 25
lenses
Multifocal soft contact lenses, myopia progression: -0.30 D
Monofocal lens in one eye, myopia progression: -0.69 D 40/New Zealand 1 26
Multifocal lens in the other eye, myopia progression: -0.44 D
To be Continued

© 2015 Wichtig Publishing

Chassine et al 283

TABLE I - Continued

Potential protective Myopia progression or prevalence during the study period No. of participants/ Study Ref
factor setting duration, y

Orthokeratology Orthokeratology, myopia progression: -0.28 D 210/China 3 27

Atropine 0.125%, myopia progression: -0.34 D
Orthokeratology, myopia progression: 0.31 mm 57/China 2 28
Spectacles, myopia progression: 0.64 mm
Orthokeratology, myopia progression: 0.04 mm 26/Australia 1 29
Rigid contact lenses, myopia progression: 0.09 mm
Surgical methods Sub-Tenon injection, myopia stabilization: 52.9% 182/Russia 9 33
Control group (spectacles), myopia stabilization: 11.1%
Scleral reinforcement surgery, myopia progression: 0.75 mm 30/China 3 34
Contralateral eye, myopia progression: 0.94 mm
Scleral reinforcement surgery, myopia progression: -1.5 D 41/China 5 35
Control group (spectacles), myopia progression: -3.02 D

correction could have a beneficial effect for children practic-
ing an activity such as reading for a long time. In one study,
control children wore monofocal lenses and other children
wore bifocal spectacles or both bifocal and prismatic spec-
tacles: progression of myopia was -2.06, -1.25, and -1.01 D,
respectively (p<0.001). The axial length increased by 0.82,
0.57, and 0.54 mm, respectively. Wearing bifocal and pris-
matic spectacles may thus reduce eye accommodation and
myopia progression (17).
A 1999 study in Hong Kong found similar results. The use
of progressive lenses with +1.50 or +2.00 D may reduce the
progression of myopia. Children aged 9 to 12 years and fol-
lowed for 2 years were divided into 3 groups: wearing mono-
focal or progressive spectacles with +1.5 D or +2.00 D. The
progression of myopia was -1.23, -0.76, and -0.66 D, respec-
tively. The progression of myopia may be reduced by the use
of progressive lenses. The addition of +2.00 D seems to give
the best results and suggests a dose effect (18).
A study of data from the Correction of Myopia Evaluation
Trial (COMET) of 469 children with a follow-up of 3 years found
the same results. Children from 9 to 12 years old were divided
into 2 groups, wearing monofocal glasses or progressive lens-
es. The progression of myopia was -1.28 ± 0.06 and -1.48 ±
0.06 D, respectively. Wearing bifocals may reduce the progres-
sion of myopia by reducing eye accommodation (19) (Tab. I).
Wearing hydrogel soft contact lens may not be effective for
preventing progression of myopia
A 3-year study found no significant difference between
wearing contact lenses and glasses on myopia progression.
The increase was -1.07 ± 0.10 and -0.91 ± 0.10 D in the lens-
and glass-wearing groups, respectively (20). Moreover, a
change from wearing glasses to contact lenses may result in
progression of myopia. In a 1998 study for the use of bifocal
lenses in the development of myopia, patients could contin-
ue to wear glasses or change to monofocal or multifocal soft
contact lenses. Wearing soft contact lenses was associated
with a greater progression of myopia than wearing glasses:
-0.74 and -0.25 D for the contact and bifocal lens groups, re-
spectively. However, some patients switched from progres-
sive glasses to monofocal lenses, which could have influenced
the results (21) (Tab. I).
Silicone hydrogel and rigid contact lens materials may affect
the progression of myopia
Silicone hydrogel appears to stabilize myopia more than
hydrogel materials. A 3-year study in the United States of 54
patients wearing hydrogel lenses and 230 wearing silicone hy-
drogel lenses showed less progression of myopia with the use
of silicone hydrogel lenses than hydrogel +0.02 and -0.41, re-
spectively (p<0.001) (22). Wearing rigid contact lenses seems
to reduce myopia progression as compared with soft lenses.
A 3-year study of 116 patients found less progression of myo-
pia in patients wearing rigid contact lenses as compared with
soft contact lenses: the change was -1.56 ± 0.95 and -2.19
± 0.89 D, respectively (p<0.001). However, the difference in
axial length was not significant (p = 0.57) (23).
Adverse effects of contact lens wear on the cornea have
been documented by several studies. The incidence rates for
bacterial microbial keratitis range from approximately 2/10,000
per year for rigid contact lens to 2.2 to 4.1/10,000 per year for
daily-wear soft contact lens and 13.3 to 20.9/10,000 per year
for extended-wear soft contact lenses. The most significant risk
factors are overnight wear, smoking, male sex, and socioeco-
nomic status (24) (Tab. I).
Multifocal soft contact lenses may be more effective for pre-
venting myopia progression than monofocal soft contact
lenses
A 2-year randomized controlled trial of 221 children from
8 to 13 years old conducted in China showed that wearing

© 2015 Wichtig Publishing

284
multifocal soft contact lenses with a +2.5 D addition reduced
myopia progression. The progression was 25% slower with
multifocal contact lenses than simple lenses (-0.30 vs -0.40 D
per year, p = 0.03). Moreover, the progression in axial length
was reduced (0.13 vs 0.18 mm/year, p = 0.009 (25). In an-
other study conducted for 1 year, children from 11 to 14 years
old wore a conventional soft contact lens in one eye and a
multifocal contact lens in the other. Progression was -0.69 ±
0.38 and -0.44 ± 0.33 D (p<0.001) with the monofocal and
multifocal lenses, respectively (26) (Tab. I).
Orthokeratology
Orthokeratology allows for temporarily changing the cur-
vature radius of the cornea by applying a rigid lens with a
particular geometry worn at night. The aim is to apply slight
compression on the cornea through the meniscus tears. In the
morning, the lens is removed and the cornea can return to its
original shape. Orthokeratology was found to have an impact
on the prevention of myopia. Its effectiveness was significant
but lower than the atropine 0.125% treatment in limiting the
progression of myopia. In a 3-year follow-up study comparing
atropine versus orthokeratology, the progression of myopia
was -0.28 D versus -0.34 D, respectively (p = 0.001), and the ax-
ial length increase was 0.28 and 0.38 mm per year, respectively
(p<0.001) (27). A 2-year study in Hong Kong of 80 children from
6 to 12 years old showed a marked slowing of myopia with or-
thokeratology, with a decrease in progression of axial length:
0.31 ± 0.27 and 0.64 ± 0.31 mm (p<0.001) for the orthokeratol-
ogy and control groups, respectively (28). In a recent random-
ized study, overnight orthokeratology lenses inhibited axial eye
growth and myopia progression compared with conventional
gas permeable lenses during a 1-year follow-up: -0.04 ± 0.08
mm and 0.09 ± 0.09 mm, respectively (29).
Microbial keratitis in orthokeratology lens wear has been
reported in case studies (30, 31) but not clinical studies (27-
29), in which complications could have been minimized be-
cause of the standard of care provided to subjects. Other
adverse events related to orthokeratology include contact
lens–induced peripheral ulcer and conjunctivitis similar to
that reported with other contact lens types (32) (Tab. I).
Surgical methods
Scleral reinforcement may slow eye elongation in patients
with high-grade myopia. A sub-Tenon injection of polyvinylpyr-
rolidone, ethylacrylate, and acrylamide dihydrazide allows for
the formation of a scleral shell that causes collagen polymer-
ization and strengthens the sclera. In a study of 240 eyes of 182
patients from 9 to 17 years old in Russia, patients had mod-
erate to severe myopia (from -4.0 to -12.0 D) and progressive
myopia of -1.0 D or more per year. A stabilization of myopia
occurred in 90.6%, 79.6%, and 52.9% of patients 6 months, 1
year, and within 4 to 9 years after injection, respectively. In the
control group, only 26% of the patients had myopia stabilized 6
months after injection, and 11.1% had stabilization within 4 to
9 years (33). The main complication reported with surgery was
the development of a subconjunctival cyst in 3.3% of patients,
caused by injections under the conjunctive membrane instead
of under the Tenon. No other side effect was reported (33).
Slowing myopia progression
In a study performed in China among 30 patients with
a mean age of 7.5 years between 2004 and 2008, posteri-
or scleral reinforcement surgery performed on one eye re-
duced the progression of elongation of the eye as compared
with the contralateral eye: 0.75 and 0.94 mm, respectively
(p<0.0001) (34). In another study with a 3-year follow-
up, myopia increased by 1.5 ± 1.44 and 3.02 ± 1.57 D with
scleral reinforcement and control treatment (spectacles), re-
spectively (1.27 ± 0.54 and 2.05 ± 0.91 mm increase in axial
length, respectively) (35). No serious complications of poste-
rior scleral reinforcement surgery were reported by the au-
thors of 2 studies (34, 35). However, classical complications
of posterior scleral reinforcement surgery include chemosis,
choroidal edema or hemorrhage, damage to the vortex vein,
and motility problems (36) (Tab. I).
Conclusions
The prevalence of myopia has increased markedly in the
world. Time spent outdoors is important in preventing the
progression of myopia, and time spent inside on close vision
work seems to be an aggravating factor. The use of atropine,
orthokeratology, and bifocal devices (glasses or contact lens-
es) could slow myopia progression. The benefit of surgical
scleral reinforcement is reserved for severe and progressive
myopia. In this literature review, we report optical and phar-
macologic interventions for preventing the development of
myopia or slowing its progression, which require further vali-
dation and larger studies.
Disclosures
Financial support: No financial support was received for this submis-
sion.
Conflict of interest: None of the authors has conflict of interest with
this submission.
References
1. Foster PJ, Jiang Y. Epidemiology of myopia. Eye. 2014;28:202-8.
2. Seet B, Wong TY, Tan DT, et al. Myopia in Singapore: taking a
public health approach. Br J Ophthalmol. 2001;85:521-6.
3. Vitale S, Sperduto RD, Ferris FL III. Increased prevalence of my-
opia in the United States between 1971-1972 and 1999-2004.
Arch Ophthalmol. 2009;127:1632-9.
4. Meng W, Butterworth J, Malecaze F, Calvas P. Axial length: an un-
derestimated endophenotype of myopia. Med Hypoth. 2010;
74:252-3.
5. Goldschmidt E, Jacobsen N. Genetic and environmental effects
on myopia development and progression. Eye. 2014;28:126-33.
6. French AN, Morgan IG, Mitchell P, Rose KA. Risk factors for in-
cident myopia in Australian schoolchildren: the Sydney adoles-
cent vascular and eye study. Ophthalmology. 2013;120:2100-8.
7. Guo Y, Liu LJ, Xu L, et al. Outdoor activity and myopia among
primary students in rural and urban regions of Beijing. Oph-
thalmology. 2013;120:277-83.
8. Rose KA, Morgan IG, Smith W, Burlutsky G, Mitchell P, Saw S-M.
Myopia, lifestyle, and schooling in students of Chinese ethnicity
in Singapore and Sydney. Arch Ophthalmol. 2008;126:527-30.
9. Dirani M, Tong L, Gazzard G, et al. Outdoor activity and myopia in
Singapore teenage children. Br J Ophthalmol. 2009;93:997-1000.
10. Sherwin JC, Reacher MH, Keogh RH, Khawaja AP, Mackey DA,
Foster PJ. The association between time spent outdoors and
© 2015 Wichtig Publishing
Chassine et al
myopia in children and adolescents: a systematic review and
meta-analysis. Ophthalmology. 2012; 119:2141-51.
11. Chua W-H, Balakrishnan V, Chan Y-H, et al. Atropine for the treat-
ment of childhood myopia. Ophthalmology. 2006;113:2285-91.
12. Chia A, Chua W-H, Cheung Y-B, et al. Atropine for the treat-
ment of childhood myopia: safety and efficacy of 0.5%, 0.1%,
and 0.01% doses (Atropine for the Treatment of Myopia 2).
Ophthalmology. 2012;119:347-54.
13. Chia A, Chua W-H, Wen L, Fong A, Goon YY, Tan D. Atropine for
the treatment of childhood myopia: changes after stopping atro-
pine 0.01%, 0.1% and 0.5%. Am J Ophthalmol. 2014; 157:451-7.
14. Li S-M, Wu S-S, Kang M-T, et al. Atropine slows myopia pro-
gression more in Asian than white children by meta-analysis.
Optom Vis Sci. 2014;91:342-50.
15. Vasudevan B, Esposito C, Peterson C, Coronado C, Ciuffreda KJ.
Under-correction of human myopia—is it myopigenic? A retro-
spective analysis of clinical refraction data. J Optom. 2014;7:
147-52.
16. Chung K, Mohidin N, O’Leary DJ. Undercorrection of myopia
enhances rather than inhibits myopia progression. Vision Res.
2002;42:2555-9.
17. Cheng D, Woo GC, Drobe B, Schmid KL. Effect of bifocal and
prismatic bifocal spectacles on myopia progression in children:
three-year results of a randomized clinical trial. JAMA Ophthal-
mol. 2014;132:258-64.
18. Leung JT, Brown B. Progression of myopia in Hong Kong Chi-
nese schoolchildren is slowed by wearing progressive lenses.
Optom Vis Sci. 1999;76:346-54.
19. Gwiazda J, Hyman L, Hussein M, et al. A randomized clinical
trial of progressive addition lenses versus single vision lenses
on the progression of myopia in children. Invest Ophthalmol
Vis Sci. 2003;44:1492-500.
20. Horner DG, Soni PS, Salmon TO, Swartz TS. Myopia progression
in adolescent wearers of soft contact lenses and spectacles.
Optom Vis Sci. 1999;76:474-9.
21. Fulk GW, Cyert LA, Parker DE, West RW. The effect of changing
from glasses to soft contact lenses on myopia progression in
adolescents. Ophthalmic Physiol Opt. 2003;23:71-7.
22. Blacker A, Mitchell GL, Bullimore MA, et al. Myopia progres-
sion during three years of soft contact lens wear. Optom Vis Sci
2009;86:1150-3.
© 2015 Wichtig Publishing
285
23. Walline JJ, Jones LA, Mutti DO, Zadnik K. A randomized trial of
the effects of rigid contact lenses on myopia progression. Arch
Ophthalmol. 2004;122:1760-6.
24. Liesegang TJ. Contact lens-related microbial keratitis: Part I:
Epidemiology. Cornea. 1997;16:125-31.
25. Lam CSY, Tang WC, Tse DY-Y, Tang YY, To CH. Defocus Incorporat-
ed Soft Contact (DISC) lens slows myopia progression in Hong
Kong Chinese schoolchildren: a 2-year randomised clinical trial.
Br J Ophthalmol. 2014;98:40-5.
26. Anstice NS, Phillips JR. Effect of dual-focus soft contact lens
wear on axial myopia progression in children. Ophthalmology.
2011;118:1152-61.
27. Lin H-J, Wan L, Tsai F-J, et al. Overnight orthokeratology is com-
parable with atropine in controlling myopia. BMC Ophthalmol.
2014;14:40.
28. Chen C, Cheung SW, Cho P. Myopia control using toric ortho-
keratology (TO-SEE study). Invest Ophthalmol Vis Sci. 2013; 54:
6510-7.
29. Swarbrick HA, Alharbi A, Watt K, Lum E, Kang P. Myopia con-
trol during orthokeratology lens wear in children using a novel
study design. Ophthalmology. 2014.
30. Watt KG, Swarbrick HA. Trends in microbial keratitis associated
with orthokeratology. Eye Contact Lens. 2007;33:373-7.
31. Shehadeh-Masha’our R, Segev F, Barequet IS, Ton Y, Garzozi HJ.
Orthokeratology associated microbial keratitis. Eur J Ophthal-
mol. 2009;19:133-6.
32. Santodomingo-Rubido J, Villa-Collar C, Gilmartin B, Gutiérrez-
Ortega R. Orthokeratology vs. spectacles: adverse events and
discontinuations. Optom Vis Sci. 2012;89:1133-9.
33. Avetisov ES, Tarutta EP, Iomdina EN, Vinetskaya MI, Andreyeva
LD. Nonsurgical and surgical methods of sclera reinforcement in
progressive myopia. Acta Ophthalmol Scand. 1997;75:618-23.
34. Xue A, Bao F, Zheng L, Wang Q, Cheng L, Qu J. Posterior scleral
reinforcement on progressive high myopic young patients. Op-
tom Vis Sci. 2014; 91:412-8.
35. Chen M, Dai J, Chu R, Qian Y. The efficacy and safety of modi-
fied Snyder-Thompson posterior scleral reinforcement in ex-
tensive high myopia of Chinese children. Graefes Arch Clin Exp
Ophthalmol. 2013;251:2633-8.
36. Thompson F. Scleral Reinforcement in Myopia Surgery. New
York: Macmillan; 1990:267-97.