October 15, 2025
By Ashley Tucker, OD, FAAO, FSLS, ABO Diplomate
Photo Credit: Getty Images
The latest white paper from the International Myopia Institute (IMI), Interventions for Controlling Myopia Onset and Progression 2025, provides an updated synthesis of the evidence surrounding myopia control therapies. Building on the foundation of earlier IMI reports, this edition focuses on high-quality randomized controlled trials (RCTs) with at least 12 months of follow-up and axial length outcomes, offering a clearer, more quantitative view of efficacy across intervention categories. The result is a refined hierarchy of what truly works to slow axial elongation and refractive progression in children.
The report divides interventions into four main categories: optical, pharmacologic, behavioral/environmental and emerging light-based or novel therapies.
Optical Strategies
Within optical strategies, orthokeratology and multifocal or dual-focus soft contact lenses continue to demonstrate consistent efficacy, slowing axial elongation by approximately 0.17–0.30 mm over one to two years. Spectacle lenses designed for myopia control, such as defocus-incorporated multiple segments (DIMS) or aspherical lenslets, show smaller but meaningful effects, around 0.35 mm over two years. These findings affirm optical correction as the cornerstone of myopia management – effective, well-tolerated and accessible.
Pharmacologic Interventions
Pharmacologic interventions, primarily low-dose atropine, remain a powerful adjunct. The 2025 review confirms a clear dose-response relationship: while 0.01 % atropine provides modest control (~0.08 mm axial difference at one year), concentrations of 0.025–0.05 % yield stronger effects, approaching those of optical interventions, albeit with increased risk of side effects such as photophobia and near blur. The IMI emphasizes that the optimal concentration may differ by ethnicity, baseline progression rate and tolerance, and that clinicians should weigh efficacy against comfort and adherence.
Behavioral Intervention
Among behavioral interventions, outdoor exposure remains the most robust preventive measure for myopia onset, though its impact on progression once myopia develops is modest. The paper highlights that approximately two additional hours outdoors per day can reduce onset risk by 30–50 %, supporting public health strategies promoting outdoor play. Near-work reduction and visual hygiene, while intuitively appealing, continue to show limited and inconsistent evidence for clinically meaningful effects.
Novel Therapies
The most rapidly evolving area addressed is light-based therapy, particularly low-level red-light treatment (LLLT). Early RCTs demonstrate impressive short-term reductions in axial elongation—up to 0.40 mm at one year—making this the most potent single-year effect observed to date. However, the IMI cautions that long-term safety, durability and rebound effects remain unknown. Other emerging modalities, including daylight modulation and dual-wavelength exposure, are discussed as promising but preliminary.
Myopia Control: No Longer Experimental
A key strength of the 2025 report lies in its methodological rigor: by excluding shorter or lower-quality studies, it offers a more reliable comparison of interventions. Yet this same stringency reveals important evidence gaps, particularly the scarcity of head-to-head and combination therapy trials. The authors underscore the need for research examining additive effects (e.g., OrthoK plus low-dose atropine), long-term outcomes and real-world adherence.
Ultimately, the IMI 2025 update reinforces that myopia control is no longer experimental – it is evidence-driven, multifactorial and essential to pediatric care. The report urges clinicians to move beyond awareness toward systematic implementation, tailoring interventions to each child’s risk profile, response and lifestyle. As new technologies and pharmacologic options mature, the IMI continues to provide the profession’s most comprehensive, data-driven roadmap for protecting future vision.
Abstract
IMI-Interventions for Controlling Myopia Onset and Progression 2025
Mark A. Bullimore; Kathryn J. Saunders; Rigmor C. Baraas; David A. Berntsen; Zhi Chen; Audrey Wei Lin Chia; So Goto; Jun Jiang; Weizhong Lan; Nicola S. Logan; Raymond P. Najjar; Jan Roelof Polling; Scott A. Read; Emily C. Woodman-Pieterse; Noémi Széll; Pavan K. Verkicharla; Pei-Chang Wu; Xiaoying Zhu; James Loughman; Manbir Nagra; John R. Phillips; Huy D. M. Tran; Fuensanta A. Vera-Diaz; Jason Yam; Yue M. Liu; Sarah E. Singh; Christine F. Wildsoet
Myopia is recognized as a significant public health problem, particularly in East and Southeast Asia. This has led to the development and evaluation of a range of interventions to slow its progression and delay its onset. Since the publication of the 2019 International Myopia Institute’s review of interventions for controlling myopia onset and progression, treatment options have continued to grow in number. This article reviews the efficacy of such interventions under five categories: optical, pharmacological, environmental (behavioral), colored light, and surgical. In summarizing the efficacy of mature technologies, only randomized controlled trials were considered, although such data are very limited for emerging treatments. The overall conclusion is that there are multiple effective interventions in most categories. Further research should aim to understand the mechanisms underlying myopia progression and the modalities that slow its progression in order to develop more effective treatments.
