Childhood Myopia Part II: Treatment Mechanisms, Emerging Options, and Considerations

The rapidly increasing prevalence of myopia and its association with vision-threatening complications in later life has intensified efforts to identify treatments that can prevent the onset and slow the progression of myopia in children. These efforts have led to the development of several optical, environmental, and pharmacological myopia control treatments. Investigations of additional treatment options are ongoing and have shown great promise for clinical translation. Although significant progress has been made in identifying potential pathways and modes of action of these treatments, a complete mechanistic understanding is still lacking. This critical review article explores the potential mechanisms underlying the myopia control effects of contemporary treatments for childhood myopia. It also provides an evidence-based overview of emerging and experimental myopia control therapies. Additionally, the article addresses key considerations, including patient-related factors, treatment limitations, clinical trial designs, efficacy, and cost-effectiveness. This article is the second part of the commissioned paper "Treatment of Childhood Myopia" submitted to the National Academies of Sciences, Engineering, and Medicine for the consensus study Focus on Myopia-Pathogenesis and Rising Incidence. For a comprehensive overview of contemporary treatments for childhood myopia in and outside the United States, readers are referred to Childhood Myopia Part I: Contemporary Treatment Options. The findings in this review article underscore the need for continued research to deepen our understanding of the mechanisms underlying myopia treatments, evaluate the long-term safety and efficacy of current and emerging therapies, and identify patient- and treatment-related factors to optimize treatment outcomes in the clinical care of children with myopia.