Myopia Treatment Comparison:
All 9 Modalities Ranked by Efficacy

Every evidence-based myopia control treatment ranked by axial length reduction efficacy. Efficacy values represent reduction in axial elongation vs. untreated control at RCT endpoints — not cure rates or final AL targets.

Ranked by Axial Length Reduction Efficacy

Combination Therapy

60–75%AL reduction (modelled†)

Optical myopia control + pharmacological (e.g. Stellest® + atropine 0.025%). No single RCT validates the composite figure — modelled from multiplicative formula. IMI 2025 endorses combination for high-risk patients. Minimum age: varies by components.

† No single RCT directly validates this range. Estimated from multiplicative combination of individual modality efficacies, capped at 75%.

Stellest® (HALT lens)

67%AL reduction

Spectacle lens. Highly Aspherical Lenslet Target design. RCT: Bao et al. 2022 (JAMA Ophthalmol), 2-year endpoint. Suitable from age 6. Moderate compliance dependency (wear hours). No contact lens handling required.

MiSight® vs Stellest® deep comparison →

Atropine 0.05%

58%AL reduction

Pharmacological. RCT: Yam et al. 2019 (LAMP study, Ophthalmology). Higher efficacy but more side effects (photophobia, near blur). Significant rebound risk on cessation. Used as monotherapy or combination.

Atropine 0.01% vs 0.025% vs 0.05% comparison →

MiSight® 1 day

55%AL reduction

Soft daily disposable contact lens. Dual-focus myopic defocus design. RCT: Chamberlain et al. 2019 (Optom Vis Sci), 3-year endpoint. FDA-approved for myopia control. Suitable from age 8. Requires daily lens care and handling.

MiSight® vs Stellest® comparison →

MiyoSmart® (DIMS)

52%AL reduction

Spectacle lens. Defocus Incorporated Multiple Segments design. RCT: Lam CSY et al. 2020 (Lancet), 2-year endpoint. Suitable from age 6. Similar positioning to Stellest® but different optical mechanism.

Orthokeratology (Ortho-K)

50%AL reduction

Rigid gas-permeable lenses worn overnight; reshape cornea temporarily. Composite efficacy from multiple RCTs (Cho 2005, Santodomingo 2012). Useful when daytime correction is impractical. Microbial keratitis risk ~1/2,500/yr. Post-discontinuation rebound 0.10mm (IMI 2025).

Orthokeratology — full evidence review →

Atropine 0.025%

45%AL reduction

Middle-dose atropine. RCT: Yam et al. 2019 (LAMP). Better efficacy than 0.01% with manageable side effects. Used in combination therapy as adjunct to optical control.

Atropine dose comparison →

Atropine 0.01%

30%AL reduction

Low-dose atropine. RCT: Chia et al. 2012 (ATOM2, Ophthalmology). Minimal side effects; commonly used as adjunct to optical treatment. Lower rebound risk vs higher concentrations.

Atropine 0.01% — full evidence →

Outdoor / Behavioural

18%AL reduction

≥2 hrs/day outdoor time (≥1,000 lux). RCTs: Wu et al. 2013; He et al. 2015. More protective against onset than progression. Recommended as adjunct for all children regardless of other treatment. Low efficacy but zero cost and no side effects.

All efficacy values represent reduction in axial elongation vs. untreated control at ~2-year RCT endpoints. Treatment availability and regulatory approval vary by country. This page does not provide prescribing guidance.

Head-to-Head Quick Comparison

Treatment	Efficacy	Min. age	Modality	Key RCT
Combination	60–75%†	Varies	Optical + pharma	Modelled
Stellest® HALT	67%	6 yrs	Spectacles	Bao 2022
Atropine 0.05%	58%	Any	Eye drops	LAMP 2019
MiSight® 1 day	55%	8 yrs	Contact lens	Chamberlain 2019
MiyoSmart® DIMS	52%	6 yrs	Spectacles	Lam 2020
Ortho-K	50%	6 yrs	Overnight lens	Cho 2005 + others
Atropine 0.025%	45%	Any	Eye drops	LAMP 2019
Atropine 0.01%	30%	Any	Eye drops	ATOM2 2012
Outdoor/Behavioural	18%	Any	Lifestyle	Wu 2013; He 2015

How to Choose the Right Treatment

For high-risk patients (AL ≥95th percentile, growth >0.30mm/yr, onset <8 years): Consider high-efficacy optical (Stellest® or MiSight®) + low-dose atropine combination. Start early; do not wait for further progression.

For moderate-risk patients (AL 75th–95th percentile, growth 0.20–0.30mm/yr): Start with high-efficacy optical monotherapy. Review in 6 months. Add atropine if progression continues.

Age and compliance considerations: Under 8 → Stellest® or MiyoSmart® preferred (no contact lens handling). Over 8 with good compliance → MiSight® is an option. Night-time preference → Ortho-K.

Detailed Treatment Resources

Deep Dive

MiSight® vs Stellest®

Head-to-head RCT data, mechanisms, patient selection, and prescribing guidance.

Pharmacology

Atropine 0.01% vs 0.025% vs 0.05%

LAMP and ATOM2 dose-response data with side effects and rebound risk.

Overnight Lens

Orthokeratology — IMI 2025 Evidence

10-RCT IMI 2025 median (0.30mm), keratitis risk, rebound data.

Emerging

Red Light Therapy — 4 RCTs Reviewed

Jiang 2022, Xiong 2022, Xu 2024 — including rebound warning from IMI 2025.

Summary

Best Myopia Treatments Ranked (2026)

Full evidence-based rankings with all modalities in one place.

Timing

When Should Treatment Start?

IMI 2025 treatment triggers — age, AL percentile, growth velocity.

Compare Treatments for Your Patient

Enter age + axial length to see all 9 treatments projected side-by-side for this specific patient — not population averages. Free, no login.

Open Myopia Calculator →

No signup · No credit card · Under 30 seconds

Bao J et al. JAMA Ophthalmol 2022 · Chamberlain P et al. Optom Vis Sci 2019 · Yam JC et al. (LAMP) Ophthalmology 2019 · Chia A et al. (ATOM2) Ophthalmology 2012 · Lam CSY et al. Lancet 2020 · IMI 2025 Digest (Tahhan N et al.)