WSPOS Myopia Consensus Statement 2025: What Parents and Practitioners Need to Know

Myopia, or nearsightedness, has become one of the most pressing pediatric health issues of our time. What used to be dismissed as a common vision problem now carries deeper implications. Around the world, childhood myopia rates are climbing fast—and while genetics still play a part, research continues to show that our modern lifestyle is the main driver.

We can’t yet predict which children will develop high-risk complications. But we do know this: early intervention makes a difference. That’s why the World Society of Paediatric Ophthalmology & Strabismus (WSPOS) has released its most comprehensive Myopia Consensus Statement yet. 

The 2025 report offers clear, evidence-based guidance for doctors, parents and policy-makers alike. Here’s what it tells us.

What doesn’t work: Methods to avoid

The consensus is clear: several once-popular methods lack scientific support. These include undercorrection, pinhole glasses, blue-light blocking lenses, bifocals, progressive addition lenses (PALs), standard soft and rigid gas permeable contact lenses. 

According to the WSPOS consensus, none of these have shown statistically or clinically significant effects on myopia progression.

What works: Evidence-based strategies for myopia control

1. Behavioral and environmental interventions

If you’re a parent or clinician, the good news is this: there’s now a robust set of strategies that do work—many of them supported by years of research and real-world results.

1. Start with the basics: Outdoor time

This might sound simple, but spending time outdoors is one of the most proven strategies. Cross-sectional and longitudinal studies across continents consistently show that children who spend more time outside are less likely to develop myopia. 

Randomized controlled trials in Asia further confirm that 40–80 minutes of structured outdoor time per day can significantly reduce incidence and progression.^1-5

One trial⁵ even confirmed a dose-response relationship—the more time spent outdoors, the greater the protective effect.

5 systematic meta-analyses^6-10 and 2 overviews of meta-analyses^11,12 concluded that each additional hour of outdoor time per week reduces the relative risk of myopia onset by 24-46%. The key factor? Luminance exposure, not just “being outside”.

[Our WSPOS Myopia Workflow Masterclass series with top experts]

2. Reduced time on near tasks 

The relationship between near work and myopia isn’t quite as universally accepted as outdoor time, but the evidence is growing. A meta-analysis of five studies across continents found that heavy near work—things like reading, homework and device use—was linked to an 80% increased risk of developing myopia.¹³ Every additional hour of near work per week added about 2% more risk.

One particularly striking example comes from a study of Orthodox Jewish children.¹⁴ Despite having no screen exposure, early and intense book-based learning was associated with 80% myopia prevalence—highlighting that it’s not just about screens, but the type, intensity and duration of the task.

Meanwhile, a Taiwanese study¹⁵ showed that children who took breaks every 30 minutes had significantly lower myopia rates than their peers who didn’t. And during the COVID-19 pandemic, some studies^16-17 documented sharp spikes in childhood myopia—especially in kids aged 6 to 8—closely tied to increased screen time and reduced time outdoors.

In short: it’s not just what children are doing up close, but how long, how close and under what lighting conditions.

2. Optical treatment for myopia control

Modern strategies for managing myopia in children are increasingly focusing on optical interventions that influence how the eye grows and how it processes visual stimuli. By targeting retinal defocus and contrast sensitivity—two key visual cues—spectacles and contact lenses can potentially regulate the development of refractive error and slow the progression of myopia.

READ MORE: Outsmarting Myopia

1. Spectacle lenses targeting peripheral defocus

Defocus-Incorporated Multiple Segment (D.I.M.S.) Lenses, like Hoya’s Miyosmart, are designed with a central clear zone and a peripheral ring of lenslets that create a type of myopic defocus. 

In clinical trials, these lenses reduced the rate of myopia progression by over 50% after two years¹⁸, and these benefits held steady in follow-up studies up to six years.¹⁹ They’ve been shown to work across populations and are comparable to orthokeratology.²⁰ Interestingly, combining D.I.M.S. lenses with low-dose atropine drops resulted in even better outcomes.^21-22 And, no rebound effect was documented.

READ MORE: HOYA Vision Care Shares Key Myopia Management Findings at ARVO 2025

The highly aspherical lenslet (H.A.L.) lenses by Essilor (Stellest) use a different lenslet architecture to create myopic defocus. A two-year randomized study showed that HAL lenses reduced myopia progression and axial length growth significantly. Continued benefit was observed in a third-year extension of the study, especially for children switching from Single-Vision (SV) or slightly aspherical (SAL) lenslet lenses to HAL.²³

HAL lenses also influenced choroidal thickness—a potential biomarker for myopia control—with early thickening followed by stabilized thinning.^24-25 Bilateral application was effective in unilateral myopic anisometropia²⁶, and no rebound was observed.²⁷

READ MORE: Embracing the promise of myopia control-specific spectacles

2. Diffusion optics technology (DOT) spectacle lenses

Another innovative approach is diffusion optics technology (DOT) lenses by SightGlass Vision. These lenses aim to reduce contrast uniformly across the retina using microscopic diffusers. The CYPRESS trial—conducted in North America—found these lenses reduced refractive error and axial elongation significantly in children as young as six.²⁸

An extension study (CYPRESS part 2) confirmed continued effectiveness into year four with a significant difference from the control group.²⁹

READ MORE: DOT Lenses: Our New Ally in the Fight Against Childhood Myopia?

3. Contact lenses: myopic defocus 

This intervention involves soft multifocal contact lenses and orthokeratology. 

Soft multifocal contact lenses, with concentric or gradient plus zones, deliver myopic defocus while providing central vision correction. The MiSight 1 Day lens by CooperVision showed a 59% reduction in myopia progression and 52% less axial elongation over three years.³⁰

Results over six years confirmed the cumulative benefit, with 23% of eyes showing no meaningful progression.³¹ Relative peripheral hyperopia was significantly linked to treatment efficacy.

The BLINK trial further validated these findings, showing that high-add (+2.50 D) lenses outperformed medium and single-vision options over three years.³² A study in Caucasian children also demonstrated a positive response to MFCL (MYLO) lenses.³³ While some increase in higher-order aberrations was reported, no negative impact on vision functionality was observed.³⁴

READ MORE: BLINK2 Study Finds No Rebound Effect for Multifocal Myopia Control Contact Lenses

And then there’s orthokeratology (Ortho-K)—overnight lenses that reshape the cornea. The mechanism includes central corneal thinning and mid-peripheral thickening, resulting in a myopic defocus effect.

Systematic reviews estimate a reduction in axial elongation by about 0.25 mm over two years compared to control lenses. Three prospective studies—ROMIO, MCOS, and TO-SEE—showed consistent results across different populations, with a 36.9% treatment effect.³⁵

Effectiveness was highest in the first year, particularly among children with larger pupils and higher initial myopia. However, not all children responded equally: 40% responded well, while 25% showed minimal to no effect.³⁵

READ MORE: The Promise of Ortho-K: An Alternative to Laser Eye Surgery

3. Pharmacological treatment: Atropine 

Atropine eye drops have emerged as one of the most researched and promising pharmacological interventions for controlling myopia progression in children. The WSPOS 2025 Myopia Consensus highlights atropine’s dose-dependent efficacy, long-term safety and evolving global research landscape. Despite the mechanism being incompletely understood, clinical outcomes have driven its widespread use.

READ MORE: European Approval for Sydnexis’ Pediatric Myopia Treatment

Atropine works by blocking muscarinic receptors in the eye, although its precise mechanism in myopia control is believed to be non-accommodative, acting through retinal and scleral pathways. Early high-dose studies like ATOM 1 (1% atropine) showed a 77% reduction in myopia progression but had notable side effects like photophobia and blurred near vision.³⁶ This led to ATOM2, which demonstrated that 0.01% atropine maintained moderate efficacy with minimal side effects.^37,38

Subsequent studies, especially the multi-phase LAMP trials, compared lower concentrations (0.01%, 0.025%, 0.05%) and identified 0.05% as the optimal dose, balancing effectiveness and tolerability.^39-41 After five years of follow-up, children using 0.05% consistently had significantly less refractive progression and axial elongation.

Meta-analyses confirm that 0.05% atropine ranks among the most effective treatments with a strong safety profile. However, response varies by region. Some Western studies, including MOSAIC⁴² and Repka et al.⁴³, reported limited benefits of 0.01% atropine possibly due to differences in iris pigmentation, age and formulation pH.¹¹

READ MORE: MOSAIC Study Unveils 3-Year Results on Atropine Regimens for Myopia Control

Atropine also shows potential in delaying myopia onset in pre-myopic children, especially at 0.05% concentration, as shown in the LAMP2 trial.⁴⁴

Adverse effects are generally mild at low concentrations, and long-term studies found no increased risks of cataract or ocular damage. A key concern remains the rebound effect—a spike in progression after stopping treatment—which is more likely with higher doses and abrupt cessation.

WSPOS concludes that 0.05% atropine represents the best balance between safety and efficacy for most children, with 0.01% being appropriate for those sensitive to side effects. Proper dosing, tapering and formulation quality are essential for maximizing long-term benefit and minimizing rebound.

4. An emerging option: Repeated low-level red-light therapy

Repeated low-level red-light (RLRL) therapy is a newer approach that uses safe, low-intensity red light (650 nm) to slow axial elongation. It’s typically administered via home-use devices twice daily for three minutes per session. Unlike bright light exposure, RLRL may enhance choroidal blood flow, which in turn may stabilize axial length elongation.

One of the earliest and most notable trials was conducted in China using the Eyerising RLRL device. In a 12-month randomized study of 264 children aged 8–13, those receiving RLRL plus glasses experienced 69.4% less axial length (AL) elongation and 76.6% less myopic shift compared to children wearing single vision glasses alone.⁴⁵

READ MORE: JAMA Ophthalmology Viewpoint Examines Impact of China’s Red Light Therapy Regulations

Follow-up real-world data confirmed the long-term efficacy of RLRL. Children who remained on therapy for two years showed the least myopic progression (AL: 0.16 ± 0.37 mm; SER: -0.31 ± 0.79 D). A modest rebound effect was observed in those who discontinued treatment, similar to patterns seen with other myopia therapies.⁴⁵

Over 20 peer-reviewed studies and 5 systematic reviews have consistently shown that RLRL reduces axial elongation. One large multicentre review even reported axial shortening (>0.05mm/year) in over 26% of treated children—a phenomenon rarely seen in other treatments.⁴⁶ Notably, RLRL shows particular promise in high myopia cases.⁴⁷

While the science is promising, regulation is still catching up. In China, where most RLRL studies originate, authorities have halted further sales of red-light devices as of July 1, 2024, pending stricter Class III medical device certification.⁴⁸ Manufacturers must now conduct primates-based safety testing and long-term studies.

One manufacturer, Eyerising International, has already achieved regulatory approval outside China and continues offering RLRL in parts of Europe and Asia. 

READ MORE: Red Light Therapy Device Manufacturer Welcomes China’s Stricter Red Light Therapy Reclassification for Myopia

Overall, the WSPOS Consensus Statement recognizes RLRL as a compelling, emerging tool in the fight against pediatric myopia. While more long-term and ethnically diverse studies are needed, early data suggests RLRL could become a mainstay—especially for children who are unresponsive to other treatments or who seek non-pharmacological alternatives.

What this means for families and clinicians

The WSPOS Myopia Consensus Statement 2025 marks a pivotal moment in the global response to childhood myopia. It doesn’t just outline what works—it helps us understand why these strategies are effective, and how to personalize them for each child’s needs.

From increasing outdoor play to considering optical lenses, atropine drops, or even red-light therapy, we now have a wide-ranging toolkit backed by global research. But the key takeaway is this: intervening early matters. Myopia is not just about needing glasses—it’s a condition with lifelong implications. With the right evidence-based interventions, it is possible to change that trajectory for millions of children.

Editor’s note: For references and further details, see the full WSPOS Myopia Consensus Statement 2025 here. This content is intended exclusively for healthcare professionals. It is not intended for the general public. Products or therapies discussed may not be registered or approved in all jurisdictions, including Singapore.

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