A 14-year-old student presents with progressive myopia that has increased by 1.5 D over the past year. His cycloplegic refraction is -5.00 D. Which strategy has the strongest current evidence for reducing the rate of myopia progression?
- A Bifocal or progressive addition spectacle lenses
- B Increasing reading distance with good lighting only
- C Undercorrection of myopia with single vision lenses
- D Low-dose atropine 0.01% eye drops at bedtime ✓
Explanation
Low-dose atropine 0.01% has the strongest evidence base (ATOM2 and LAMP studies) for myopia control, reducing progression by approximately 50-60% with minimal side effects (minimal photophobia, minimal near vision blur) compared to higher doses. The exact mechanism is unclear but may involve non-muscarinic retinal receptors modulating scleral remodelling. PAL/bifocals have modest effect (COMET study showed ~0.25 D reduction in progression per year). Increasing time outdoors (not simply reading distance) is beneficial for preventing onset but less established for controlling established progressive myopia. Undercorrection of myopia is now shown to accelerate progression rather than reduce it.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.