Aldo Vagge, Matteo Baldi, Maria Musolino, Veronica Rivarone, Carlo Catti, Michele Iester
Myopia has emerged as a global public health crisis, with prevalence exceeding 80% in East Asian urban populations and rising rapidly worldwide. High myopia substantially increases the lifetime risk of sight-threatening complications, including myopic macular degeneration, retinal detachment, and glaucoma. Multiple interventions have been investigated to slow myopia progression in children. Behavioral strategies, particularly increased outdoor exposure, demonstrate protective effects against myopia onset and may modestly slow progression, whereas several historically used approaches show no clinically meaningful benefit. Spectacle lens interventions include simultaneous defocus designs (e.g., DIMS, HALT, CARE) and contrast-modulating diffusion optics (DOT) lenses; collectively, these technologies have demonstrated consistent and clinically meaningful reductions in axial elongation across randomized clinical trials. Contact lens modalities, including dual-focus soft lenses and orthokeratology, have also demonstrated substantial efficacy in slowing progression in controlled studies. Low-dose atropine remains a cornerstone pharmacological therapy, particularly at concentrations between 0.01% and 0.05%, offering significant efficacy with minimal side effects. Repeated low-level red-light therapy has shown promising short-term reductions in axial elongation, although long-term safety and rebound effects remain uncertain. Combination therapy targeting complementary optical and pharmacological pathways shows additive benefits, particularly in children inadequately controlled with monotherapy. Contemporary clinical management emphasizes risk stratification based on axial length, age-specific growth targets, and structured longitudinal monitoring. The goal of modern myopia management is not merely to slow progression, but to prevent high myopia and reduce the lifetime burden of vision-threatening complications through a proactive, individualized approach increasingly regarded as the standard of care.