Quick Answer: Myopia Cannot Be Reversed, But It Can Be Controlled

Once myopia (short-sightedness) develops, it cannot be reversed. The structural elongation of the eyeball that causes myopia is permanent. However, myopia progression in children can be significantly slowed through evidence-based treatments including low-dose atropine eye drops, orthokeratology (ortho-K) lenses, and specially designed spectacle lenses. Starting myopia control early is important because higher degrees of myopia are associated with increased risk of serious eye conditions later in life.

Why Myopia Cannot Be Reversed Once It Develops

Myopia occurs when the eyeball grows too long from front to back, causing light to focus in front of the retina rather than directly on it. This results in distant objects appearing blurred while near objects remain clear.

The elongation of the eyeball is a physical, structural change that cannot be undone through exercises, supplements, or natural remedies. Once the eye has grown longer, it does not shorten back to its original length.

Singapore has one of the highest myopia prevalence rates in the world. Approximately 26% of Primary 1 children are already myopic, and this figure rises to 80 to 90% by the end of secondary school. Among adults aged 40 to 80, the SEED study found 36% had myopia and 6% had high myopia.

These figures underscore why myopia management, focused on slowing progression rather than reversal, is a critical area of paediatric eye care in Singapore.

Myopia Control: Slowing Progression in Children

While myopia cannot be reversed, evidence supports several interventions that can meaningfully slow its progression in children. The three main evidence-based approaches are:

1. Low-dose atropine eye drops: Applied daily, typically at bedtime.

2. Orthokeratology (ortho-K) contact lenses: Rigid gas-permeable lenses worn overnight to temporarily reshape the cornea.

3. Specially designed spectacle lenses: Including DIMS and HAL technology.

The choice depends on the child's age, degree of myopia, rate of progression, lifestyle, and ability to comply with the treatment regimen.

Atropine Eye Drops for Myopia Control

Atropine eye drops are among the most extensively studied myopia control treatments, with Singapore's ATOM studies playing a pioneering role.

Key research findings:

• ATOM1 study: 1% atropine reduced myopia progression by approximately 77% over 2 years.

• ATOM2 study: Low-dose 0.01% atropine demonstrated sustained efficacy over 5 years with minimal side effects.

• LAMP study (Hong Kong): 0.05% atropine achieved a 67% reduction at 1 year; 0.01% achieved a 27% reduction.

Low-dose atropine is generally well tolerated. At the 0.01% dose, side effects are minimal for most children. Treatment is typically continued for at least 2 to 3 years with regular monitoring.

Orthokeratology and Speciality Contact Lenses

Orthokeratology (Ortho-K) involves wearing specially designed rigid contact lenses overnight that gently reshape the cornea during sleep, providing clear daytime vision without glasses.

Ortho-K has been shown to slow myopia progression:

• Meta-analyses of 15 RCTs show 32 to 63% reductions in axial length elongation.

• Real-world cohort data over 3 years: 56% of children experienced minimal progression, with 78% adherence.

• Combining ortho-K with low-dose atropine may provide an additional approximately 28% slowing effect.

Specially designed spectacle lenses:

• DIMS (MiYOSMART): 30 to 60% reduction in myopia progression.

• HAL (Stellest): Approximately 59% reduction in refraction progression.

Learn more at IECRC's paediatric ophthalmology service.

What About Myopia in Adults?

For adults whose myopia has stabilised, the focus shifts from controlling progression to correcting existing myopia. Options include spectacles, contact lenses, laser eye surgery (LASIK, SMILE, PRK), and implantable collamer lenses (ICL).

High myopia (above -6.00 dioptres) carries long-term risks regardless of correction method. More younger adults develop glaucoma because of untreated myopia, with high myopia creating approximately a 7-fold increased glaucoma risk, and 30% of highly myopic Singaporeans develop myopic macular degeneration. Regular comprehensive eye examinations remain important.

For more information on myopia and its associated conditions, speak with an ophthalmologist at IECRC.

Frequently Asked Questions

At what age should my child start myopia control treatment?

Myopia control is generally most effective when started early, which for many children in Singapore begins between ages 6 and 12. The earlier treatment begins, the greater the potential to reduce final myopia levels.

Are atropine eye drops safe for children long-term?

Low-dose atropine (0.01 to 0.05%) has been studied in children over periods of up to 5 years, with a favourable safety profile. Long-term follow-up from the ATOM studies has not identified significant adverse effects.

Can my child's myopia get worse even with treatment?

Yes. Myopia control treatments slow the rate of progression but do not stop it entirely. The goal is to reduce the total amount of myopia your child develops.

Will my child still need glasses even with myopia control?

In most cases, yes. Myopia control treatments slow the worsening of myopia but do not eliminate the need for vision correction. Ortho-K provides temporary clear daytime vision, but this requires ongoing lens wear to maintain.

References

1. ATOM studies: dose-finding and long-term outcomes. PMC, 2026.

2. Orthokeratology for myopia control: meta-analysis of 15 RCTs. PMC, 2026.

3. More younger adults develop glaucoma because of untreated myopia. The Straits Times, 2025.

4. AAO updated PPP guidelines for myopia management. Review of Optometry, 2026.

5. SEED Study: myopia prevalence and glaucoma risk. PMC, 2026.

Disclaimer: This article is for general informational purposes only and does not constitute personal medical advice. Please consult an ophthalmologist for guidance specific to your child's condition.