Myopia control for children in Hong Kong: Ortho-K, DIMS lenses or atropine?

By Crystal Wong 王水晶, Registered Optometrist (Part I), Hong Kong | July 2026

Why control myopia rather than just wear glasses?

Myopia is not only about blurry distance vision. Progression reflects continuous elongation of the eyeball, and high myopia (commonly 6.00 D or more) significantly raises the lifetime risk of retinal detachment, myopic maculopathy, glaucoma and cataract. The goal of myopia control is to slow axial elongation during childhood to reduce these risks in adulthood.

Hong Kong has among the highest childhood myopia rates in the world. Local research during the COVID-19 class suspensions also found significant increases in myopia and astigmatism associated with axial elongation¹ — outdoor time, working distance and screen habits all play a role.

The three mainstream options

1. Orthokeratology (Ortho-K)

Custom rigid lenses worn overnight temporarily reshape the cornea so the child sees clearly in the day without glasses. The ROMIO randomised controlled trial at The Hong Kong Polytechnic University showed Ortho-K slowed axial elongation by roughly 40%³.

• Often suits: active, sporty children; faster progressors; families able to supervise lens hygiene
• Consider: strict hygiene and regular follow-up are essential; not every prescription or corneal shape is suitable

2. Defocus spectacle lenses (e.g. DIMS)

These look like ordinary glasses: the lens centre gives clear vision while the periphery introduces myopic defocus. A two-year randomised controlled trial found DIMS lenses slowed myopia progression by about 52% and axial elongation by about 62%².

• Often suits: younger children not ready for contact lenses; families wanting the simplest starting option
• Consider: full-time wear is needed for best effect; frames and lenses need regular checks

3. Low-dose atropine eye drops

Clinical trials such as ATOM2 show low-dose atropine slows myopia progression with fewer side effects than higher concentrations⁴. In Hong Kong atropine is a prescription medicine managed by an ophthalmologist; the optometrist co-manages monitoring and follow-up.

• Often suits: children unsuited to lens options, or combined with optical methods
• Consider: requires medical prescription; concentration and tapering need professional supervision

How fast is "too fast"?

Progression of 0.75–1.00 D per year or more is generally considered fast and worth treating. But a single number is not the whole picture: the younger a child becomes myopic, the higher the risk of high myopia later, so children myopic at six to eight years old deserve early assessment even with slower progression. Axial length change is a better indicator than prescription alone, which is why it is measured at follow-up visits.

Three things parents can do today

1. More outdoor time: around two hours daily helps prevent and slow myopia
2. Manage near work: keep reading and screens at about 40 cm, with a distance break every 20–30 minutes
3. Regular comprehensive examinations: school screenings do not measure axial length or assess binocular vision

Crystal Wong 王水晶

Registered Optometrist (Part I, Optometrists Board, Hong Kong), BSc (Hons) in Optometry (The Hong Kong Polytechnic University), PhD researcher in vision neuroscience. Seven years of clinical and research experience in paediatric vision, binocular vision and myopia management. Full professional profile →