Myopia is no longer a niche refractive issue. Across Asia-Pacific, its rising prevalence has become a public health concern, with some countries reporting rates as high as 95 percent. The long-term risks of progressive myopia – including retinal detachment, glaucoma, myopic maculopathy, and irreversible visual impairment – have made early intervention increasingly urgent.
Yet, despite expanding evidence for myopia control, clinical practice remains uneven. Spectacles still dominate prescribing, while contact lens-based approaches – including myopia control soft contact lenses and orthokeratology – remain relatively underused. A new joint position statement from ophthalmology and optometry experts across the Asia-Pacific region aims to address that gap by proposing practical consensus recommendations for incorporating these lenses into routine childhood myopia care.
The statement was developed following an online survey and an in-person roundtable meeting in Kuala Lumpur. Thirty-four eye care professionals from Chinese Taipei, Hong Kong SAR, Japan, Malaysia, Singapore, and South Korea contributed to the survey, including both “expert” and “general” practitioners. Sixteen expert eye care professionals then reviewed the findings, discussed regional variation, and agreed consensus statements covering patient selection, fitting, monitoring, treatment outcomes, cessation, and combination therapy.
One of the most notable recommendations concerns age. Where local guidelines and regulations permit, the panel agreed that myopia control contact lenses may be fitted in children as young as five years old and continued into early adulthood for patients in their 20s. Treatment discontinuation, however, should generally be considered from 18 years and above, guided by stability in refraction and axial length rather than age alone.
For myopia control soft contact lenses, the panel recommended trial lens fitting as the preferred approach. Slit-lamp examination and over-refraction were identified as key fit assessments. During routine monitoring, practitioners should assess comfort, vision, centration, and primary gaze lens position, with edge alignment and push-up test recovery considered optional additions. The recommended first-year follow-up schedule is at three, six, and 12 months, with refraction and axial length measured; a one-month visit may help confirm suitability and adaptation, and a nine-month visit may also be considered.
For orthokeratology, the statement recognizes several valid fitting approaches: trial lens fitting, empirical manual calculation, and digital software based on corneal topography and refractive error. Slit-lamp examination, corneal topography, and fluorescein pattern evaluation were recommended as key assessments, while over-refraction may be used according to practitioner preference. Follow-up should be more intensive than for soft lenses, with visits at one day, one month, three months, and six months in the first year. Corneal topography is recommended at every follow-up.
The panel also set practical benchmarks for treatment success. For children of any age, the goal should be refractive progression of no more than 0.50 D over one year. For axial length, an annual increase of less than 0.20-0.30 mm was considered acceptable in children aged nine and below, while 0.20 mm or less was recommended for children aged 10 and older.
Stopping treatment should be considered when refractive progression is between 0.00 and 0.25 D over one year, and axial length increases by no more than 0.10 mm over the same period. If atropine is used in combination with myopia control contact lenses, the panel considered 0.01-0.05 percent an acceptable dose range, while noting that evidence for combination therapy remains limited and inconclusive.
The position statement authors acknowledge important limitations, including the small survey sample and regional focus. Still, the statement does offer a useful framework for aligning ophthalmology and optometry practice in a region where childhood myopia is escalating rapidly. Its central message is pragmatic: contact lens-based myopia control can be safe, effective, and lifestyle-friendly, but outcomes depend on consistent protocols, careful monitoring, and clear communication with both children and caregivers.
