Dropout rates among optical interventions for myopia control: a systematic review

Understanding adherence and discontinuation is essential for evaluating the real-world feasibility of myopia-control strategies. Although dropout is recognised as a concern in adult contact lens wear, its prevalence and causes in paediatric optical myopia-control interventions remain poorly characterised. This study systematically quantified dropout rates and examined reasons for discontinuation across optical modalities used for myopia control in children.

A systematic review was conducted in accordance with PRISMA and registered in PROSPERO (CRD420251177073). PubMed, Scopus, and Web of Science were searched through April 2025, supplemented by reference screening. Randomised and non-randomised clinical trials enrolling children and adolescents (≤18 years) and reporting discontinuations during optical myopia-control treatment were included. Data on study design, subject characteristics, dropout counts, subject-years, and reasons for discontinuation were extracted. Poisson regression with log-link and offset for subject-years estimated dropout rates with 95 % confidence intervals; Bonferroni-adjusted pairwise contrasts compared modalities.

Fifty-seven trials met inclusion criteria (22 spectacles, 20 soft contact lenses, 17 orthokeratology), representing > 7,000 subject-years. Dropout ranged from 6 % to 21 % per year across modalities (p < 0.001), lowest for spectacles and highest for soft contact lenses. Reasons for dropout also differed significantly between modalities (p < 0.001). Spectacles showed markedly lower discontinuation due to "symptoms, vision, appearance, fitting/handling issues" and "unknown" reasons (both p < 0.05) but higher dropout for administrative/logistical "other" reasons versus contact lenses (p < 0.03). Soft contact lenses had lower discontinuation for "ocular adverse events" than orthokeratology but substantially higher discontinuation for "unknown" reasons (p < 0.001). No significant differences were found between modalities for treatment/compliance or non-ocular health reasons (p > 0.05).

Dropout in paediatric optical myopia-control interventions is modality-dependent, reflecting differences in handling burden, ocular tolerance, and follow-up demands. Standardised reporting of discontinuation reasons and structured adherence-support strategies are required to improve comparability across studies, enhance patient retention, and optimise real-world myopia-control outcomes.