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Unraveling Myopia: Current Science, Clinical Impact, and Future Horizons

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: 19 August 2026 | Viewed by 10446

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Special Issue Editors

Dr. Neeraj K Singh

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Guest Editor

The Kentucky College of Optometry, University of Pikeville, Pikeville, KY, USA
Interests: myopia control; optics of the eye; accommodation; contact lenses; visual development; pediatric vision; refractive error epidemiology; retinal defocus

Dr. Pablo De Gracia

E-Mail Website
Guest Editor

School of Optometry, University of Detroit Mercy, Detroit, MI, USA
Interests: myopia control; multifocal solutions; ocular aberrations; ocular movements; optical quality and visual performance; pupil size effects; presbyopia and simultaneous vision designs
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Special Issue Information

Dear Colleagues,

The global burden of myopia is escalating at an unprecedented rate, with projections indicating that nearly half of the world's population will be affected by 2050. Alongside this epidemiological shift, we are witnessing a surge in high myopia and its associated sight-threatening complications, such as myopic maculopathy, choroidal neovascularization, and retinal detachment.

This Special Issue aims to bring together current clinical advances and future prospects in the diagnosis, prevention, and management of myopia and its complications. We welcome contributions from researchers and clinicians working on epidemiological insights, optical and pharmaceutical interventions, innovations in imaging, genetic predisposition, environmental risk factors, and the role of digital devices in myopia progression.

By consolidating current knowledge and emerging research, this Special Issue seeks to foster interdisciplinary dialogue and guide evidence-based clinical practice in myopia control and management.

We invite original research articles, systematic reviews, and clinical trials from experts around the globe.

Sincerely,

Dr. Neeraj K Singh
Dr. Pablo De Gracia
Guest Editors

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Keywords

accommodation
contact lenses
ophthalmic lenses
myopia progression
epidemiology
myopia control interventions
pharmaceutical treatments
environmental and behavioral risk factors
imaging innovations in myopia

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Published Papers (5 papers)

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Research

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18 pages, 1402 KB

Open AccessArticle

Impact of Myopia Control Spectacle Lenses on Visual Functions in Young Adults: A Comprehensive Evaluation

by Muteb K. Alanazi, Mohammed Alhazmi, Wafa Alotaibi, Basal H. Altoaimi, Alla I. Alshetwi, Niran A. Alanazi, Meshal D. Alotaibi, Bader S. Alqahtani, Rayan H. Almalki and Maria Liu

J. Clin. Med. 2026, 15(9), 3362; https://doi.org/10.3390/jcm15093362 - 28 Apr 2026

Viewed by 438

Abstract

Purpose: To evaluate the impact of a myopia control (MC) spectacle lens incorporating peripheral defocus on functional visual parameters compared to conventional single vision (SV) lenses. Methods: Thirty-nine young adults (age 21.1 ± 1.3 years; spherical equivalent −2.85 ± 2.8 D) participated in this single-session, within-subject crossover design. Distance and near LogMAR VA were assessed centrally and at 22° nasal and temporal off-axis. Distance contrast sensitivity (CS) was measured across five spatial frequencies (1.5–18 cpd) and the Area Under the Log CS Function (AULCSF) calculated. Retinal sensitivity was evaluated using automated static perimetry. Dynamic visual performance was assessed using a standardized video game platform. Outcomes were compared using repeated measures ANOVA or Wilcoxon signed-rank tests. Results: Central VA was comparable between lens types. MC lenses significantly reduced off-axis distance VA (nasal: 0.35 ± 0.15 LogMAR; temporal: 0.20 ± 0.14 LogMAR; both p < 0.001) and near VA (nasal: 0.72 ± 0.25 LogMAR; temporal: 0.34 ± 0.2 LogMAR; both p < 0.001). Off-axis AULCSF was significantly reduced with MC lenses (nasal: 12.07 ± 5.06 vs. 26.37 ± 5.00 units; temporal: 13.00 ± 6.93 vs. 27.14 ± 4.64 units; both p < 0.001), while central AULCSF remained similar between lens types (SV: 27.87 ± 5.04 vs. MC: 27.15 ± 5.02 units; p = 0.277). No significant differences were found for visual field indices (all p > 0.05). Video game accuracy was comparable between lenses, but task completion time was slower with MC lenses (20.71 ± 10.08 vs. 18.39 ± 6.65 s; p = 0.012). Conclusions: MC spectacle lenses preserve central VA, CS, and visual field sensitivity but induce significant off-axis VA and off-axis CS reductions. Dynamic visuomotor accuracy is maintained, though task completion speed is modestly reduced. These functional trade-offs should be considered when prescribing MC lenses. Full article

(This article belongs to the Special Issue Unraveling Myopia: Current Science, Clinical Impact, and Future Horizons)

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11 pages, 700 KB

Open AccessArticle

Myopia Prevalence Among 6–17 Years Students in Rural Areas of Seven Provinces of China

by Xue Li, Huayu Zhang, Xiao Fang, Xiaodi Wu, Qian Gan, Yingying Huang, Qian Zhang, Hao Chen and Jinhua Bao

J. Clin. Med. 2026, 15(9), 3261; https://doi.org/10.3390/jcm15093261 - 24 Apr 2026

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Abstract

Background/Objectives: Estimate the prevalence of myopia among children aged 6–17 years in county and rural areas across seven geographically diverse provinces of China, and identify demographic, behavioral, and geographic factors associated with myopia, with particular focus on urban–rural and ethnic differences. Methods: A multi-stage stratified cluster sampling design was employed. Seven provinces were randomly selected, one from each of seven geographical regions of China (Southeast, North, Central, South, Southwest, Northwest, and Northeast). In each province, one rural county was randomly chosen. Within each county, one urban survey site (county town) and one rural survey site (village) were selected. From each site, one primary school and one junior high school were included. In each school, approximately 20 ± 2 students per grade (grades 1–9) were recruited. Uncorrected visual acuity and non-cycloplegic autorefraction were measured. Multivariable generalized linear mixed models (GLMM) with random intercepts at the class level were used to identify factors associated with myopia, accounting for the cluster sampling design. Results: The overall myopia prevalence was 42.9% (urban 49.6%, rural 36.0%). In the multivariable GLMM, educational stage was the strongest risk factor (grades 7–9 vs. 1–3: OR = 5.54). A significant district × ethnicity interaction was found only for Mongolian children: rural residence was strongly protective (OR = 0.19) compared to Han (OR = 0.65), and the ethnic advantage disappeared in county towns. Only 14.2% of myopic students had adequate correction. Conclusions: In conclusion, myopia is highly prevalent and severely under-corrected in rural China. Educational pressure is the main risk factor, and the rural protective effect is strongest in Mongolians but erodes with urbanization. Urgent public health actions, including vision screening, affordable spectacles, and lifestyle preservation, are needed to address this growing burden. Full article

(This article belongs to the Special Issue Unraveling Myopia: Current Science, Clinical Impact, and Future Horizons)

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12 pages, 1162 KB

Open AccessArticle

Pre-Myopic Children: Trends in Myopia Development and Management in Canada

by Amy H. Y. Chow, Barbara Caffery, Angela Di Marco, Sarah Guthrie, Mira Acs, Stephanie Fromstein, Shalu Pal, Stephanie Ramdass, Vishakha Thakrar, Matthew Zeidenberg and Deborah A. Jones

J. Clin. Med. 2026, 15(7), 2748; https://doi.org/10.3390/jcm15072748 - 5 Apr 2026

Viewed by 842

Abstract

Background/Objectives: Given the growing prevalence of myopia worldwide, prevention and proactive management of at-risk children becomes increasingly important. This study sought to evaluate trends in myopia development in pediatric pre-myopic patients and determine how optometrists in Canada manage pre-myopia. Methods: In this retrospective chart review, records for children aged 6–10 years who had an eye exam between 2017 and 2021 were reviewed. Pre-myopic children were included if the presenting refraction at the first visit was between +0.75D and −0.25D (inclusive). Up to five unique patients were selected for each age (6, 7, 8, 9, and 10) and initial visit year (2017 to 2021) at each clinical site. Demographic information, refractive status and recommended interventions were recorded. Results: A total of 1740 pre-myopic patients were included across 15 practices in Ontario, of which 184 patients developed myopia (10.6%) during the years studied. Cohort year groups did not differ in baseline age (mean ± SD 8.39 ± 1.43 years) or baseline refractive error (+0.13 ± 0.27 DS). At initial encounters, most clinicians monitored without intervention (mean across cohort years 91.9%), with some recommending lifestyle changes (3.5%) and SV spectacles/CL (3.0%). This pattern remained stable over the years studied. Pre-myopic children developed myopia at a similar age over the study period (mean ± SE: 9.66 ± 0.16 years) and experienced a faster rate of loss of hyperopic reserve (loss of −0.26 ± 0.07 D/year in the 2017 cohort vs. −0.73 ± 0.18 D/year in the 2020 cohort and −0.71 ± 0.10 D/year in the 2021 cohort) regardless of patient age. Conclusions: Pre-myopic children in the 2020 and 2021 cohort years experienced an accelerated loss of hyperopic reserve compared to those in the 2017 cohort. Despite this, very few pre-myopic children were recommended lifestyle changes, which were known to be effective for delaying myopia onset. Since delaying myopia onset may be more impactful than subsequent myopia treatment, additional research should focus on effective interventions for the pre-myopic population. Full article

(This article belongs to the Special Issue Unraveling Myopia: Current Science, Clinical Impact, and Future Horizons)

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14 pages, 1240 KB

Open AccessArticle

Myopia Management in Ontario, Canada

by Amy H. Y. Chow, Barbara Caffery, Sarah Guthrie, Mira Acs, Angela Di Marco, Stephanie Fromstein, Stephanie Ramdass, Vishakha Thakrar, Shalu Pal, Matthew Zeidenberg and Deborah A. Jones

J. Clin. Med. 2025, 14(14), 5132; https://doi.org/10.3390/jcm14145132 - 19 Jul 2025

Cited by 1 | Viewed by 1421

Abstract

Objectives: To determine how optometrists in Canada manage their pediatric myopia patients and to assess whether this has changed over time. Methods: In a retrospective chart review, records for children aged 6–10 years who had an eye exam between 2017 to 2021 were reviewed. Children were grouped by presenting refraction (myopes ≤ −0.50 D or pre-myopes ≤ +0.75 D). Up to five unique patients were selected for each age (6, 7, 8, 9, and 10) and initial visit year (2017 to 2021) for each group (myopes and pre-myopes), for a maximum of 250 files per practice. Demographic information, refraction, and recommended interventions were recorded. Logistic regression was used to model the likelihood of being prescribed a myopia control intervention based on patient and optometrist characteristics. Results: A total of 2905 patients (n = 1467 (50%) female) from 15 practices across Ontario, Canada, were included, accounting for 8546 visits. Optometrists predominantly prescribed single-vision spectacle correction as a first-line intervention for myopic children, although this declined from 98.2% in 2017 to 56.7% in 2023. The use of myopia control modalities increased from 1.8% to 43.3% over this same period. Optometrists began recommending myopia control at lower myopic refractive errors over time (−2.63 DS in 2017 vs and −1.49 DS in 2020). Myopia control spectacles were the most commonly prescribed intervention, despite the observation that optometrists are not hesitant to fit contact lenses in younger children. Optometrists who had been in practice longer were more likely to prescribe older forms of myopia control (e.g., bifocals/progressives) than more recent graduates. Conclusions: While single-vision spectacle correction remains a primary approach for initial myopia management in Ontario, Canada, optometrists increasingly recommend myopia control and are initiating interventions earlier. Full article

(This article belongs to the Special Issue Unraveling Myopia: Current Science, Clinical Impact, and Future Horizons)

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Review

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16 pages, 754 KB

Open AccessReview

Next-Generation Spectacle Lenses for Myopia Control: Optical Designs, Mechanisms, and Clinical Efficacy

by Neeraj K. Singh and Pablo De Gracia

J. Clin. Med. 2025, 14(21), 7872; https://doi.org/10.3390/jcm14217872 - 6 Nov 2025

Cited by 3 | Viewed by 6469

Abstract

Myopia prevalence has risen dramatically worldwide, underscoring the critical need for effective interventions to slow its progression. Recent advancements in spectacle lens technology offer promising solutions, demonstrating significant efficacy in controlling myopia. This review critically examines next-generation spectacle lenses for myopia management, emphasizing their optical principles, mechanisms of action, clinical effectiveness, visual performance, compliance, and safety. Spectacle lenses incorporating technologies such as Defocus Incorporated Multiple Segments (DIMS), Highly Aspherical Lenslet Target (HALT), Diffusion Optics Technology (DOT), and Cylindrical Annular Refractive Element (CARE) lenses show a 40–60% reduction in refractive progression and axial elongation compared to traditional single-vision lenses. These lenses utilize optical strategies like simultaneous myopic defocus, peripheral contrast modulation, and controlled aberrations without compromising visual acuity, contrast sensitivity, accommodation, or binocular vision. High wearer compliance is attributed to excellent visual comfort, minimal adaptation issues, and favorable cosmetic appearance. Long-term studies further confirm sustained efficacy and safety profile. Ongoing research aimed at direct comparative trials, extended follow-up, and individualized lens designs will further define the role of these interventions. Collectively, the evidence positions next-generation spectacle lenses as a promising, evidence-based approach that may become an important component of global myopia management. Full article

(This article belongs to the Special Issue Unraveling Myopia: Current Science, Clinical Impact, and Future Horizons)

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