Non-pathological Myopia
Fundus findings: Mild myopic crescent (atrophic crescent around the optic disc) is observed. Temporal conus and tigroid fundus are characteristic.
Axial length: Often less than 26.5 mm.
Corrected visual acuity: Remains good.
Myopia (Summary of Simple Myopia, High Myopia, and Pathological Myopia)
1. What is myopia?
Section titled “1. What is myopia?”Myopia is a refractive error in which parallel light rays from infinity focus in front of the retina. The refractive power of the eye is excessive relative to the axial length, characterized by reduced distance vision.
Definition and classification
Section titled “Definition and classification”Pathological myopia (malignant myopia, degenerative myopia, high myopia) is myopia that causes degeneration in the posterior pole of the fundus, and refers to an axial length that is three or more standard deviations from the mean of the normal distribution curve of emmetropic eyes.
Benign myopia (simple myopia, school myopia) is myopia contrasted with pathological myopia, without organic abnormalities of ocular tissues, and is mostly mild to moderate. School myopia is thought to be related to near work and develops during school age or adolescence.
The definition of high myopia is not fixed, but it often refers to strong myopia of approximately −6D or more. Among these, those accompanied by posterior pole fundus lesions are specifically called pathological myopia.
Severity Classification (Shoji Classification)
| Classification | Spherical Equivalent |
|---|---|
| Mild | −3D or less |
| Moderate | Greater than −3D and up to −6D |
| High | Greater than −6D and up to −10D |
| Very High | Greater than −10D |
Age-Specific Diagnostic Criteria for Pathological Myopia
| Age | Refractive error | Corrected visual acuity |
|---|---|---|
| 5 years or younger | Greater than −4.0 D | 0.4 or less |
| 6–8 years | Greater than −6.0 D | 0.6 or less |
| 9 years or older | Greater than −8.0 D | 0.6 or less |
Classification by etiology
Causes of pseudomyopia include central accommodative spasm due to encephalitis, brain tumor, head trauma, etc.; administration of miotics, acetazolamide, sulfa drugs, steroids, and organophosphates; and excessive accommodation due to intermittent exotropia.
Epidemiology
Section titled “Epidemiology”More than one-fifth of the world’s population has myopia, and it is predicted to reach half by 2050 1). In a systematic prediction study by Holden et al. (2016), the global myopic population was estimated to increase from 1.3 billion to 4.9 billion, and high myopia from 160 million to 940 million between 2000 and 2050 12). Productivity loss is estimated at $250 billion annually, and loss due to myopic macular degeneration at $6 billion 1). In some parts of Asia, 80–90% of children have myopia, posing a major public health concern.
There are racial differences in the development of high myopia, particularly common in Asians. Pathological myopia exceeding −8 D accounts for about 1% of the general population and about 5% of all myopia.
According to Japanese school statistics (Ministry of Education, Culture, Sports, Science and Technology), the proportion of high school students with uncorrected visual acuity less than 1.0 is about 63% (FY2014), junior high school students about 53%, and elementary school students about 30%. Recent surveys on myopia by the Ministry suggest that myopia is becoming more severe in younger students, raising concerns about future risks of visual complications 2).
The Hisayama Study confirmed an increasing prevalence of myopic maculopathy in adults, showing that longer axial length is an independent risk factor for its development 14). The 5-year cumulative incidence of myopic maculopathy in high myopia far exceeds that in the general population, providing epidemiological evidence supporting the medical significance of myopia progression control.
Q
How common is myopia?
A
More than one-fifth of the world’s population has myopia, and it is predicted that about half will be myopic by 2050 1). The prevalence is particularly high in Asia, with about 80% of children in Taiwan affected. In Japan, about 63% of high school students have uncorrected visual acuity less than 1.0, and in recent years, there are concerns about increasing severity at younger ages 2).
2. Main Symptoms and Clinical Findings
Section titled “2. Main Symptoms and Clinical Findings”
Liu L, et al. The application of wide-field laser ophthalmoscopy in fundus examination before myopic refractive surgery. BMC Ophthalmol. 2017. Figure 1. PMCID: PMC5732481. License: CC BY.
Peripheral retinal tear with shallow retinal detachment in myopia. This corresponds to the retinal tear discussed in the section “2. Main Symptoms and Clinical Findings.”
Subjective Symptoms
Section titled “Subjective Symptoms”- Blurred distance vision: The most characteristic symptom. Near vision is relatively clear, but distance appears blurry.
- Squinting: An attempt to improve vision through the pinhole effect.
- Metamorphopsia: Occurs when pathological myopia is complicated by retinal lesions.
Clinical Findings
Section titled “Clinical Findings”Pathologic Myopia
Posterior staphyloma: Localized outward bulging of the posterior pole of the eye. The sclera expands and protrudes posteriorly.
Myopic macular degeneration: Macular lesions including Fuchs spot, choroidal neovascularization (CNV), retinal hemorrhage, and atrophy. Linear yellowish lesions due to Bruch membrane rupture (lacquer crack lesions) are also characteristic.
Myopic retinoschisis (MRS): Found in 9–34% of pathologic myopic eyes with posterior staphyloma 4).
Peripheral changes: White without pressure, lattice degeneration, and holes.
The main complications of high myopia are as follows:
The estimated increase in disease risk per additional diopter is 58% for myopic maculopathy, 20% for open-angle glaucoma, 21% for posterior subcapsular cataract, and 30% for retinal detachment 5). In a meta-analysis by Haarman et al., even mild myopia (−1D to −3D) was associated with a 3-fold increased risk of retinal detachment and a 9-fold increased risk of myopic maculopathy compared to non-myopia 13). This quantification of complication risks provides the medical rationale for interventions to control myopia progression.
Q
What fundus changes occur in pathologic myopia?
A
In pathologic myopia, axial elongation leads to fundus changes such as posterior staphyloma, Fuchs spot, choroidal neovascularization, lacquer crack lesions, retinal tears and detachment, and optic disc tilt. Myopic retinoschisis (MRS) is found in 9–34% of pathologic myopic eyes with posterior staphyloma and may be an indication for vitrectomy 4).
3. Causes and Risk Factors
Section titled “3. Causes and Risk Factors”The etiology of myopia is multifactorial, involving a complex interplay of genetic and environmental factors.
Genetic Factors
Section titled “Genetic Factors”- Inheritance pattern: Non-syndromic high myopia is most often autosomal dominant with genetic heterogeneity. Moderate myopia can be autosomal recessive, dominant, or multifactorial.
- Twin studies: The concordance rate in monozygotic twins is much higher than in dizygotic twins, indicating a genetic contribution.
- Family history: The risk for children increases if both parents are myopic.
- Ethnic differences: Among Chinese children, the prevalence of myopia is higher in those living in Singapore (29.1%) than in Sydney (3.3%), showing that environment greatly influences even within the same ethnic group.
Environmental Factors
Section titled “Environmental Factors”- Insufficient outdoor activity: The most important preventive factor, reducing the onset of myopia by up to 50%. 1) It is thought to promote retinal dopamine release.
- Near work: A weak correlation has been reported, but no significant association with computer use has been confirmed. Some theories suggest accommodative lag is involved.
- Urbanization: Urban children have been reported to have about twice the prevalence of myopia compared to rural children.
- Education: Prolonged reading and higher education are identified as risk factors. Children with higher IQ tend to have a higher prevalence of myopia.
- Nutrition: A correlation between intake of saturated fat and cholesterol and axial length has been reported.
Diseases Associated with Myopia
Section titled “Diseases Associated with Myopia”Myopia of Prematurity (MOP) is a distinct disease entity with a different pathogenesis from ordinary myopia. It is primarily caused by anterior segment developmental abnormalities such as increased corneal curvature, lens thickening, and shallow anterior chamber, rather than axial elongation. The severity of retinopathy of prematurity (ROP) and the type of treatment (cryocoagulation > laser photocoagulation > anti-VEGF therapy, in order of increasing myopia risk) greatly affect refractive outcomes.
Other associated diseases: congenital glaucoma, retinopathy of prematurity, retinitis pigmentosa, cataract, congenital stationary night blindness, keratoconus, Stickler syndrome, Marfan syndrome, Weill-Marchesani syndrome.
Q
Can outdoor activities really prevent myopia?
A
Reports indicate that increased outdoor activity can reduce the onset of myopia by up to 50%1). It is thought that high-intensity outdoor light stimulates retinal dopamine release, suppressing axial elongation. This is one of the simplest and most side-effect-free interventions for slowing myopia progression, with a 50% reduction effect shown with an increase of 76 minutes per day1).
4. Diagnosis and Examination Methods
Section titled “4. Diagnosis and Examination Methods”The diagnosis of high myopia itself is made through refraction testing and axial length measurement. Since the pathology of high myopia is essentially an abnormal elongation of the eye axis, axial length measurement is essential.
Screening
Section titled “Screening”School health checkups and vision tests in pediatric clinics are the first opportunities for detection. Detection is possible with photoscreening or autorefractometers, but these are insufficient for determining quantitative refractive error.
Definitive Diagnosis
Section titled “Definitive Diagnosis”| Examination Method | Content/Purpose |
|---|---|
| Cycloplegic Refraction | Gold standard for children. Instill cyclopentolate twice at 10-minute intervals, then perform autorefraction 45–60 minutes after the first instillation2) |
| Axial Length Measurement | Measured with an optical biometer. Important for monitoring myopia progression. |
| Dilated fundus examination | Essential for confirming posterior staphyloma, Fuchs spot, and retinal tears |
| OCT | Useful for early detection of macular retinoschisis and choroidal neovascularization |
| Fluorescein angiography | Useful for differentiating CNV from simple macular hemorrhage |
| Visual field test | Used to evaluate myopic optic neuropathy |
Cycloplegic refraction is the gold standard for children. Without eliminating accommodation, excessive minus correction is likely in children with strong accommodative ability. For infants and young children, 1% cyclopentolate (Cyplegin®) eye drops are the first choice, and management using axial length percentile curves is also useful for monitoring myopia progression 2).
Key points for differential diagnosis: Always perform cycloplegic refraction to differentiate from pseudomyopia (accommodative spasm). If there are findings suggesting rapidly progressing myopia or systemic diseases (such as Stickler syndrome or Marfan syndrome), conduct a systemic evaluation.
Monitoring criteria for myopia progression
Section titled “Monitoring criteria for myopia progression”When evaluating the indication for low-concentration atropine eye drops, progression of refractive error >0.5D or axial length elongation >0.3mm over 6 months is considered a criterion for progression.
There are two approaches for monitoring myopia progression 2):
- Absolute value comparison method: A method comparing with age-specific axial length progression rates from epidemiological studies in Japanese populations (Itoi 2021). The progression rate during treatment is compared with natural progression without treatment.
- Percentile curve method: A method that references axial length percentile curves (based on MEXT data) including emmetropic eyes, and checks where the axial length lies on the curve. This can be done using smartphone apps or software attached to axial length measurement devices.
In myopia progression management, visually demonstrating treatment effects to patients and parents using these monitoring tools is effective for maintaining motivation to continue treatment2).
5. Standard Treatment Methods
Section titled “5. Standard Treatment Methods”Myopia treatment is broadly divided into three categories: ① securing visual acuity through refractive correction, ② suppressing myopia progression, and ③ treating complications of high myopia.
5A. Optical Correction
Section titled “5A. Optical Correction”- Glasses (concave lenses): Standard correction method for childhood myopia. Highly safe and the first choice. In Japan, prescription is based on cycloplegic refraction.
- Contact lenses (CL): Generally indicated from early adolescence onward. Correction is possible, but care management is required in children.
5B. Myopia Progression Suppression Therapy
Section titled “5B. Myopia Progression Suppression Therapy”The comparative effects of each intervention for suppressing myopia progression are shown below.
| Intervention | Refractive suppression effect | Axial length suppression effect |
|---|---|---|
| Low-concentration atropine 0.05% | Up to 67%1) | — |
| Orthokeratology | — | 32–59%1) |
| MiSight 1 day (+2.00 D add) | 59%6) | 52%6) |
| DIMS spectacle lens (MiYOSMART®) | 55–59%3) | — |
Pharmacotherapy: Low-concentration atropine eye drops
Section titled “Pharmacotherapy: Low-concentration atropine eye drops”Low-concentration atropine eye drops are the most evidence-based pharmacotherapy for myopia progression suppression1). Atropine is a reversible antagonist of muscarinic receptors, and it is thought to be involved in scleral remodeling via muscarinic receptors (mainly M1/M4 receptors) present in the retina and sclera, thereby suppressing axial elongation; however, the detailed mechanism remains unclear2).
Comparison of characteristics by concentration (LAMP study)
| Concentration | Myopia progression suppression rate | Side effects |
|---|---|---|
| 0.01% | Approximately 49%1) | Minimal |
| 0.025% | Approximately 62% (moderate) 2) | Mild |
| 0.05% | Up to 67% 1) | Slightly increased photophobia and blurred vision |
Treatment is recommended for children whose parents are myopic, who spend little time outdoors, or who developed myopia at a young age (earlier onset increases the risk of higher future myopia) 2). After starting treatment, the first follow-up is performed within 1 week to 1 month, followed by regular check-ups every 3 to 6 months. It is desirable to continue until the late teens when myopia progression stabilizes. Since rebound may occur after discontinuation, follow-up should continue after stopping 2).
Optical intervention: Orthokeratology (Ortho-K)
Section titled “Optical intervention: Orthokeratology (Ortho-K)”A method in which special rigid lenses are worn during sleep to temporarily flatten the central cornea. Thickening of the mid-peripheral cornea creates peripheral myopic defocus, suppressing axial elongation.
- Effect: Meta-analyses suggest that orthokeratology tends to suppress axial elongation more than single-vision contact lenses 15). The ROMIO study (Cho 2012) showed significant suppression of axial elongation in children aged 6–10 years with orthokeratology compared to single-vision contact lenses 10). Since children can go without glasses during the day, it is especially suitable for active children or those who play sports.
- Safety: In a Japanese multicenter study (1,438 patients), the incidence of MK (microbial keratitis) was 5.4 per 10,000 patient-years 1). Washing lenses with tap water is strictly prohibited as it is a major cause of Acanthamoeba keratitis.
- Prescription range: Myopia up to approximately −4 D is the main indication. Toric OK lenses are recommended for cases with corneal astigmatism of 1.5 D or more.
- Changes after discontinuation: Corneal shape recovers reversibly within a few days to 2 weeks after cessation of lens wear. The obtained axial length suppression effect is partially maintained after discontinuation.
Optical intervention: Multifocal soft contact lenses (SMCL)
Section titled “Optical intervention: Multifocal soft contact lenses (SMCL)”CLs designed to reduce peripheral hyperopic defocus and suppress axial elongation. The AAO Ophthalmic Technology Assessment confirms that 12 RCTs, including 11 Level 1 trials, show significant suppression of myopia progression and axial elongation 6).
- MiSight 1 day (+2.00 D add): A 3-year double-blind RCT significantly suppressed refractive progression and axial elongation (Chamberlain 2019) 9). AAO assessment confirms that multiple RCTs have shown myopia progression control with multifocal soft CLs 6).
- +2.50 D add lens: 43% suppression of refraction and 36% suppression of axial length over 3 years 1).
- No serious adverse events were reported throughout the trials 6).
Optical intervention: Myopia management spectacle lenses
Section titled “Optical intervention: Myopia management spectacle lenses”Special spectacle lenses with peripheral defocus control design (multi-segment lenses) were positioned as one of the standard treatments in the 2025 guideline (1st edition) by the Japanese Society of Myopia. 3)
- DIMS (Defocus Incorporated Multiple Segments; MiYOSMART®, HOYA): A 2-year RCT in children aged 6–18 significantly suppressed refractive progression and axial elongation 8).
- HALT (Highly Aspherical Lenslet Target; Essilor® Stellest®): Full-time wear over 2 years suppressed refraction by 67% and axial length by 60% (Bao 2022). Prescription range: S −12.00 D to +2.00 D, C −4.00 D to 0.00 D.
- DOT (Diffusion Optics Technology): 2-year suppression of refraction by 59% and axial length by 38% (Rappon 2022).
- Bifocal and progressive addition spectacles: Clinical significance for myopia progression control is limited (COMET trial, 2003).
The discontinuation criteria for myopia management spectacle lenses are based on stabilization of myopia progression around age 18 ± 2 years. If no changes in refractive error or axial length are observed in two consecutive follow-up visits every 6 months, discontinuation of lens wear may be considered 3). No rebound has been observed after discontinuation.
Combination Therapy
Section titled “Combination Therapy”- Ortho-K + 0.01% atropine: In a 2-year RCT by Kinoshita et al. (2020), the combination group showed less axial elongation than the orthokeratology alone group 16).
- Dual-focus CL + 0.05% atropine, Ortho-K + repeated low-level red light (RLRL): Effective for rapid progression. 1)
- 0.01% atropine + MiSight: No additional effect was reported (Erdinest 2022). 1)
Q
What is the optimal concentration of low-concentration atropine eye drops?
A
In the LAMP study, 0.05% was most effective, showing up to 67% progression suppression 1). In Japan, 0.025% Rijusea® Mini ophthalmic solution was approved in December 2024 2). 0.01% may have limited efficacy. The choice of optimal concentration should be individualized based on the balance between efficacy and side effects (photophobia, near vision impairment).
Q
Is orthokeratology safe for children?
A
In a Japanese multicenter study (1,438 patients), the incidence of MK was 5.4 per 10,000 patient-years 1). With proper care, it is a relatively safe treatment. However, rinsing lenses with tap water is strictly prohibited as it increases the risk of Acanthamoeba keratitis.
5C. Treatment of Complications of High Myopia
Section titled “5C. Treatment of Complications of High Myopia”Myopic CNV
Section titled “Myopic CNV”Intravitreal injection of aflibercept or ranibizumab is the first-line treatment. Photodynamic therapy (PDT) and triamcinolone acetonide (off-label) are also effective but inferior to anti-VEGF antibodies.
In the natural course, most patients progress to a corrected visual acuity of 0.1 or less after 5 years, and the prognosis is poor. In patients with only diffuse chorioretinal atrophy without CNV or myopic traction maculopathy, visual acuity is often relatively well preserved.
Cases of MRS progression after intravitreal aflibercept injection (IVA) for myopic choroidal neovascularization associated with pathologic myopia have been reported 4), and attention should be paid to worsening of MRS after anti-VEGF injection.
Myopic traction maculopathy / MRS
Section titled “Myopic traction maculopathy / MRS”Vitrectomy (PPV + ILM peeling) to relieve traction is the standard treatment.
Myopic foveoschisis is essentially a progressive disease; although rare cases of spontaneous resolution exist, some cases progress rapidly.
Macular hole retinal detachment
Section titled “Macular hole retinal detachment”Vitrectomy and gas tamponade are the standard treatment. For refractory cases, macular buckling or scleral shortening is performed. With vitrectomy, final reattachment is achieved in almost all cases, but visual prognosis depends on the condition of the macula before and after surgery.
Myopic optic neuropathy
Section titled “Myopic optic neuropathy”Intraocular pressure reduction (similar to treatment for glaucomatous optic neuropathy) is performed.
5D. Refractive surgery
Section titled “5D. Refractive surgery”In cataract surgery for highly myopic eyes, reduced accuracy of IOL power calculation is a problem. AI-driven new-generation formulas (Kane, Hill-RBF) have been reported to have significantly lower MAE (0.51D and 0.52D, respectively) compared to the SRK/T formula in cases with axial length ≥30 mm, with refractive errors exceeding ±1.0D occurring in only 7.5% of cases versus 42.5% for SRK/T. Similar issues arise in cases after refractive surgery such as LASIK, so it is important to follow the indications, preoperative evaluation, and postoperative management procedures specified in the guidelines (8th edition) of the Japanese Society of Refractive Surgery 7).
6. Pathophysiology / Detailed pathogenesis
Section titled “6. Pathophysiology / Detailed pathogenesis”Mechanism of axial elongation
Section titled “Mechanism of axial elongation”The main pathology of high myopia is axial elongation. An increase of 1 mm in axial length corresponds to approximately 3 diopters of myopia. The detailed mechanism of axial elongation is not fully understood, but studies using experimental myopia models have shown that changes in growth factor expression in the sclera are involved in axial elongation.
Axial elongation is thought to be regulated by optical signals from the retina.
- Peripheral hyperopic defocus: When hyperopic blur occurs in the peripheral retina, the eye attempts to compensate by elongating the axial length.
- Dopamine hypothesis: Retinal dopamine release suppresses axial elongation. Since outdoor bright light promotes dopamine secretion, outdoor activity is considered effective for myopia prevention. 1)
- Mechanism of low-concentration atropine: It is thought to suppress axial elongation via muscarinic receptors (mainly M1/M4 receptors), but the detailed mechanism is under investigation. 1)
- Mechanism of RLRL therapy: 650 nm red light irradiation is thought to increase choroidal thickness and suppress axial elongation. 1)
Complication mechanisms of pathologic myopia
Section titled “Complication mechanisms of pathologic myopia”When axial elongation progresses severely, mechanical stretching occurs in the choroid, retina, and sclera.
- Posterior staphyloma formation: Localized outward bulging of the sclera. It causes myopic retinoschisis (MRS) via vitreous traction. MRS is observed in 9–34% of pathologic myopic eyes with posterior staphyloma. 4)
- Choroidal atrophy and CNV formation: Choroidal thinning progresses, and choroidal neovascularization invades through Bruch’s membrane cracks. Fuchs’ spot is a scarred state of CNV.
- Scleral remodeling: Structural changes that are the ultimate basis of axial elongation. Collagen fiber reorientation and proteoglycan composition changes occur. Low-concentration atropine is thought to suppress this scleral remodeling via muscarinic receptors. 1)
- Glaucoma risk: For each 1 D increase, the risk of open-angle glaucoma increases by 20% 5). Tilt and deformation of the optic disc are independently associated with visual field defects. In highly myopic eyes, glaucomatous visual field changes may occur even with normal intraocular pressure, and regular visual field testing is recommended.
7. Latest research and future perspectives
Section titled “7. Latest research and future perspectives”Repeated Low-Level Red Light (RLRL) Therapy
Section titled “Repeated Low-Level Red Light (RLRL) Therapy”RLRL therapy using 650 nm red light is a novel intervention that suppresses axial elongation by increasing choroidal thickness 1). In a multicenter RCT by Jiang et al. (2022), the RLRL group showed significant suppression of axial elongation at 0.10 mm/year (control group 0.38 mm/year) 11). A multicenter RCT by Zeng et al. (2023) suppressed spherical equivalent progression by approximately 72%. However, major studies are biased toward East Asia, and long-term safety data are still limited. As of April 2026, this therapy is not approved by Japanese pharmaceutical authorities and is not covered by insurance, being offered as self-pay treatment.
Novel Spectacle Lens Technologies
Section titled “Novel Spectacle Lens Technologies”New optical design spectacle lenses such as PLARI, NLARI, and CARE are being developed and investigated 1).
Advances in AI-Driven IOL Calculation Formulas
Section titled “Advances in AI-Driven IOL Calculation Formulas”In cataract surgery for high myopia, further improvement in the accuracy of IOL calculation formulas using AI technology is expected. Stable refractive outcomes may be achievable even in extreme axial myopia with axial length of 30 mm or more.
Environmental and Social Approaches to Myopia Prevention
Section titled “Environmental and Social Approaches to Myopia Prevention”- Impact of COVID-19: Increased near work and decreased outdoor activity during the pandemic have been reported to be associated with accelerated progression of childhood myopia. 1)
- Environmental factor research: The effects of urban planning, school lighting environment, and access to green spaces on myopia prevalence are being studied. 1)
- Need for global research: Most current data are biased toward East Asia, and data accumulation in other regions is needed. 1)
Nutritional Interventions
Section titled “Nutritional Interventions”Correlations between saturated fat and cholesterol intake and axial length have been reported, and the possibility of myopia suppression through nutritional intervention is being investigated. 1)
8. References
Section titled “8. References”- Yam JC, Zhang XJ, Zaabaar E, et al. Interventions to reduce incidence and progression of myopia in children and adults. Prog Retin Eye Res. 2025;109:101410.
- 低濃度アトロピン点眼液を用いた近視進行抑制治療の治療指針作成委員会. 低濃度アトロピン点眼液を用いた近視進行抑制治療の手引き. 日眼会誌. 2025;129(10):851-854.
- 近視管理用眼鏡ガイドライン作成委員会. 近視管理用眼鏡（多分割レンズ）ガイドライン（第1版）. 日眼会誌. 2025;129(10):855-860.
- Gopalakrishnan N, et al. Progression of macular retinoschisis following intravitreal aflibercept injection for myopic macular neovascularization. BMC Ophthalmology. 2024;24:224.
- Bullimore MA, Ritchey ER, Shah S, et al. The risks and benefits of myopia control. Ophthalmology. 2021;128(11):1561-1579.
- Cavuoto KM, Trivedi RH, Prakalapakorn SG, et al. Multifocal soft contact lenses for the treatment of myopia progression in children: a report by the American Academy of Ophthalmology. Ophthalmology. 2024.
- 日本眼科学会屈折矯正委員会. 屈折矯正手術のガイドライン（第8版）. 日眼会誌. 2024;128(2):135-139.
- Lam CSY, Tang WC, Tse DY, et al. Defocus incorporated multiple segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol. 2020;104:363-368.
- Chamberlain P, Peixoto-de-Matos SC, Logan NS, et al. A 3-year randomized clinical trial of MiSight lenses for myopia control. Optom Vis Sci. 2019;96:556-567.
- Cho P, Cheung SW. Retardation of myopia in orthokeratology (ROMIO) study: a 2-year randomized clinical trial. Invest Ophthalmol Vis Sci. 2012;53:7077-7085.
- Jiang Y, Zhu Z, Tan X, et al. Effect of repeated low-level red-light therapy for myopia control in children: a multicenter randomized controlled trial. Ophthalmology. 2022;129:509-519.
- Holden BA, Fricke TR, Wilson DA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016;123:1036-1042.
- Haarman AEG, Enthoven CA, Tideman JWL, et al. The complications of myopia: a review and meta-analysis. Invest Ophthalmol Vis Sci. 2020;61:49.
- Ueda E, Yasuda M, Fujiwara K, et al. Trends in the prevalence of myopia and myopic maculopathy in a Japanese population: the Hisayama Study. Invest Ophthalmol Vis Sci. 2019;60:2781-2786.
- Si JK, Tang K, Bi HS, et al. Orthokeratology for myopia control: a meta-analysis. Optom Vis Sci. 2015;92:252-257.
- Kinoshita N, Konno Y, Hamada N, et al. Efficacy of combined orthokeratology and 0.01% atropine solution for slowing axial elongation in children with myopia: a 2-year randomized trial. Sci Rep. 2020;10:12750.