A 12-year-old boy with progressive myopia of -3.00 D is counselled about myopia control. Which of the following interventions has the highest level of evidence for slowing myopia progression in children?
- A Bifocal spectacles
- B Overnight orthokeratology (corneal refractive therapy) or low-dose 0.01% atropine eye drops ✓
- C Ultraviolet-B sunglasses only
- D High-add progressive spectacle lenses alone
Explanation
Multiple high-quality randomised controlled trials support two first-line myopia control interventions in children: (1) low-dose atropine (0.01–0.025%) eye drops nightly reduce myopia progression by approximately 50–60% with minimal side effects (the LAMP and ATOM2 studies), and (2) orthokeratology (OK) lenses worn overnight reshape the cornea temporarily, reducing axial elongation by 30–45% (multiple Asian RCTs). Outdoor time ≥2 hours/day also reduces incidence but less effective once myopia is established. High-add bifocals and progressives provide marginal benefit. The International Myopia Institute guidelines recommend these as first-line.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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