The quandary of how to determine when myopia control treatment should be discontinued
Katrina L. Schmid
Keywords: Myopia control; myopia progression; multifocal contact lens; discontinuation
Received: 20 November 2025; Accepted: 26 February 2026; Published online: 20 March 2026.
doi: 10.21037/aes-2025-1-70
Introduction
Myopia is a common childhood refractive error that, if left untreated, can progress to high levels. The associated axial elongation is linked to an increased risk of ocular complications and vision loss. Fortunately, over the past two decades, there has been a rapid expansion of myopia control strategies aimed at slowing progression. However, as myopes who have undergone long-term treatment reach their late teenage years, a critical question arises. Can myopia control be safely discontinued without triggering renewed progression, and if so, when? Insights from major clinical trials that are now concluding, such as the BLINK2 study, provide valuable evidence to guide these decisions.
Overview of BLINK2
The BLINK2 (1) study assessed whether discontinuing multifocal soft contact lenses (MFCLs) wear led to a rebound effect. All children had previously worn MFCLs for at least two years (Biofinity Multifocal D, high add, +2.50 D periphery, aspheric design, CooperVision), but wear could have extended up to seven years for those in the MFCL treatment group of the prior BLINK study (2). This was followed by one year of single vision contact lens wear (SVCL, MyDay, daily disposable, CooperVision). Children were aged 14 to 16 years at the commencement of BLINK2, meaning that their age at discontinuation of MFCL wear ranged from 16 to 18 years.
The study reports no evidence of rebound, as defined by an increase in progression greater than that measured in untreated myopes of similar age (3). After switching to SVCLs, axial elongation and myopia progression increased but remained within age-expected norms for myopes not using myopia control. The rate of axial elongation in the last year of MFCL wear was 0.05 mm; this increased to 0.08 mm after switching. Similarly, myopia increased by 0.05 and 0.22 D/year, respectively, in these two situations. The increase in myopia progression, but not axial length, over the year of SVCL wear depended on the participant’s age (progression × age interaction was significant); slightly younger participants had a smaller increase in the rate of myopia progression when switched than slightly older participants. For example: 16 years, −0.12 D increase; 17 years, −0.17 D increase; and 18 years, −0.23 D increase. The physiological reason for this age effect is unclear; however, the slightly younger participants had faster myopia progression during MFCL wear, and perhaps the poorer effect of treatment explains the smaller progression increase when myopia control was ceased. Overall, the effects of the treatment period were maintained, with children who had worn MFCLs having less myopia and shorter axial lengths than historical age comparison groups wearing SVCLs (estimated from extrapolating BLINK control group data) (2).
Several limitations of the study were discussed. All participants had previously received MFCL treatment prior to BLINK2, limiting direct comparison with untreated controls; however, this was unavoidable because ethical concerns prevent withholding treatment. Participants had varying lengths of prior MFCL treatment (ranging from 2 to 7 years), complicating interpretation of cumulative effects. In addition, the participant group was predominantly white and recruited from two sites in the United States, which may limit the applicability of findings to more diverse populations. Also, because there was no comparison group that continued MFCL treatment, BLINK2 cannot directly determine whether extending treatment would have provided additional benefit (noting this was not an aim of the study).
Analysis of this work raises several points that warrant further discussion. These include whether rebound is the best measure to monitor progression when treatment is ceased, whether rebound varies with the type of myopia control treatment, at what age myopia progression ceases and whether this varies with the degree of myopia, how clinicians can best apply this information, and what topics future research should address.
The quandary of the best comparison for treatment decisions
A potential quandary discussed in Berntsen et al. (1) is the choice of the reference, i.e., comparison, group. In assessing renewed myopia progression in clinical trials, there are three options to consider, though Bullimore and Brennan (3) are very clear that when the word “rebound” is used, the comparison should be untreated myopes.
The choices are:
- Any increase in myopia and axial length greater than that measured in age matched myopes not using myopia control (rebound).
- Any increase in myopia and axial length greater than that measured during the myopia control treatment period (renewed progression).
- Any increase in myopia and axial length greater than that measured in age matched emmetropes.
In clinical practice, a fourth approach focuses on individual rather than group averages or progression norms. Post-cessation outcomes could be assessed based on the individual child’s axial length change and lifetime risk, rather than relative comparisons to trial data. However, detecting small changes in an individual’s axial length is challenging because variability from measurement techniques, clinician differences, and biological factors can reduce repeatability and obscure these changes. Hence the need for large clinical trials to provide evidence for treatment decisions.
In the BLINK2 study (1), “age-expected norms” refer to the typical rates of axial elongation and myopia progression observed in untreated children with myopia of similar age, sex, and ethnicity. These norms were derived from growth curves provided by the Brien Holden Vision Institute calculator (4), meta-analyses of longitudinal data from untreated myopic cohorts (5), and historical data from the BLINK SVCL group (2).
In the BLINK2 study after discontinuing MFCL wear, the average axial elongation was 0.08 mm/year, and myopia progression was −0.22 D/year. These rates matched the expected progression for 17-year-old myopic children not receiving any myopia control treatment. Therefore, when the authors state that there was no rebound, they mean that eye growth and refractive changes returned to the normal rates for untreated myopic children of that age, rather than accelerating beyond those norms. If the primary aim is to determine whether ceasing the treatment is safe, i.e., it does not cause future accelerated progression when discontinued, then this comparison, i.e., option (I) is appropriate.
However, older children without myopia, i.e., emmetropes, generally exhibit slower axial elongation and minimal refractive error progression (6). The reported annual increase in axial length amongst emmetropes is approximately ≤0.1 mm, 0.05 and 0 mm for children aged 12 to 14, 15 to 16, and 17 years, respectively (7). So, if the aim is to best manage the myopia, avoid potential future axial elongation, and thus the associated increased risk of ocular pathology (8), then comparison with lower targets [option (II), based on measures during myopia control treatment, and option (III), observed in emmetropes] may be preferred and continued myopia control would be desirable. Clinicians should be aware of what reported “no rebound” means, considering both absolute progression rates and the chosen comparator.
The effect of stopping myopia control
Understanding the effects of discontinuing myopia control treatments is essential for evaluating long-term outcomes and guiding clinical decisions. The outcomes of myopia treatment discontinuation have been reviewed (9-11) and the effect of choice of comparison group described (3). Chiu et al. (9) reported a strong rebound effect in orthokeratology (8 studies), a weak rebound effect in MFCL wear (4 studies), and a variable rebound effect in peripheral-plus spectacle lenses (2 studies). According to Chiu et al. (9), rebound effects progressively diminished as the interval after discontinuing myopia control therapy increased. Sánchez-Tena et al. (10) also described rebound effects for a range of myopia control treatments. All 11 reviewed studies reported rebound, though optical treatments had less rebound than pharmacological or light-based therapies. Age at cessation of myopia control treatment was an important factor. Lee et al. (11) reviewed the effect of atropine cessation (13 studies); shorter treatment durations, younger age, and greater baseline myopia were associated with more pronounced rebound effects. The authors (11) suggested tapering the atropine treatment as this caused less rebound, and when atropine was combined with an optical myopia control treatment that was not discontinued, rebound was prevented.
Table 1 summarizes findings from some of the discontinuation studies for a range of myopia interventions, including optical, pharmacological, and light-based therapies. The duration of treatment, observed benefits, age at cessation, reasons for stopping myopia control, and the presence or absence of rebound or renewed progression have been highlighted. This includes data as reported, i.e., not modified as in Bullimore and Brennan (3). Reports indicated both the presence and absence of rebound when myopia control treatments were discontinued, and this was dependent on the type of treatment, the chosen comparison, age, and monitoring duration. As highlighted by Bullimore and Brennan (3), what constituted rebound was defined differently across studies, often as a change from refractive and axial progression that was measured during the last year (though periods as short as one month were reported in some studies) of the myopia control treatment, comparison with the group continuing with treatment, or as exceeding age-matched norms in untreated myopic children.
Table 1
| Study | Myopia control Tx | Duration of Tx (years) | % reduction in myopia and axial length | Age at Tx cessation (years), number of children (n) | Reason for discontinuation | Correction type, follow-up period (years) | Rebound severity; Δmyopia (D/year), ΔAL (mm/year) | Comparison group | Suggested cessation recommendations |
|---|---|---|---|---|---|---|---|---|---|
| Berntsen et al., BLINK2 (1), Walline et al., 2020 (2) | CooperVision soft MFCL | 2–7 | Myopia: ~43%, AL: ~37% | 16–18, n=235 | Planned study protocol, age-appropriate cessation | SVCL, 1 | None, myopia: 0.17, AL: 0.03, age effect | Untreated myopes | Continue until late teenage years, or when myopia has stabilised |
| Chamberlain et al., 2025 (12) | MiSight dual focus CL | 6 | Myopia: ~59%, AL: ~52% | ~13–15, n=83 | Clinical trial ended, stability of AL | SVCL, 1 | None, myopia: ~0.13, AL: ~0.02, age effect | Untreated myopes | Continue Tx for at least 2 years, ideally cease ≥13, ensure axial & refractive stability |
| Chiu et al., 2023 (review), 4 studies collated (9) | MFCL | 0.5–2 | Myopia: 40–60%, AL: ~30–50% | ~8–14, n>100 | Clinical trial ended | SVCL, 0.5–1.5 | Weak to moderate, myopia: ~0.1–0.3, AL: ~0.04–0.14 | Prior MFCL Tx | Stop when progression has ceased, typically during later teenage years |
| Chiu et al., 2023 (review), 8 studies collated (9) | Ortho-K | 0.5–5 | AL: ~40–60% | ~8–16, n>500 | End of study, clinical decision, patient driven | Variable, 0.1–5 | Moderate to high, cessation duration dependent, AL: 0.03–0.1 | Prior Ortho-K Tx | Continue until at least 14, cease when AL is stable |
| Zhu et al., 2023 (13) | Ortho-K | 1 | AL: ~40% | ~8–11, n=142 | Planned study protocol | SVS, 0.1 | None, AL: 0 | SVS | Rebound common, monitor for ≥6 months |
| Lam et al., 2023 (14) | DIMS spectacle lenses | 3.5 | SER: ~50%, AL: ~50% | ~14–16, n=14 | Clinical decision | SVS, 2.5 | None, increased progression was noted, myopia: 0.22, AL: 0.12 | Prior DIMS Tx, Group continuing with DIMS Tx | After ~3.5 years of wear; once stable |
| Chiu et al., 2023 (review), 2 studies collated (9) | Myopia control spectacle lenses | 0.5–3.5 | SER: ~30–50%, AL: ~30–50% | ~8–16, n=~80 | End of study | SVS, 0.5–2.5 | Weak to strong, myopia: 0.04–0.26, AL: 0.09–0.22 | Prior myopia control Tx | Late teenage years, when refraction is stable |
| Lee et al., 2024 (review), 4 studies (11) | Atropine (1%) | 2 | Myopia: ~80%, AL: elongation halted | ~12, n>500 | End of study, side effects | Variable, 0.5–2 | Strong, myopia: 1.14, taper suggested | Prior atropine Tx | After late adolescence, younger children show greater rebound, taper dose |
| Lee et al., 2024 (review), 9 studies collated (11) | Atropine (0.5–0.01%) | 1–3 | Myopia: ~50%, AL: dose-dependent | ~10–14, n>500 | End of study, side-effects | Variable, 0.5–3 | Mild to moderate, dose & age dependent | Prior atropine Tx | Taper gradually (0.05% to 0.025% to 0.01%) to minimize rebound |
| Xiong et al., 2022 (15) | RLRL | 1–2 | High efficacy during treatment. Myopia: >70%, AL: >75% | ~9–14, n=52 | Provided option to continue with RLRL or cease Tx | Variable, 1 | Strong rebound, myopia: 0.91, AL: 0.42 | Group continuing RLRL | Rebound is a concern, monitor for ≥6 months |
| Chen et al., 2023 (16) | RLRL | 1 | High efficacy during treatment. Myopia: >90%, AL: >90% | ~7 to 11, n=42 | End of trial | Variable, 0.25 | Slight rebound, myopia: 0.21, AL: 0.16 | Prior RLRL Tx | Rebound is a concern, monitor for ≥6 months |
Values are approximate; ranges reflect variation across included studies. AL, axial length; CL, contact lenses; DIMS, defocus incorporated multiple segments; MFCL, multifocal soft contact lenses; Ortho-K, orthokeratology; RLRL, repeated low-level red light; SER, spherical equivalent refraction; SVCL, single vision contact lenses; SVS, single vision spectacles; Tx, treatment.
If the aim is for the annual axial length elongation to be no more than that measured in age-matched emmetropes, or that which was measured during myopia control treatment, then axial elongation greater than this should trigger a reinstatement of myopia control treatment. This advice is consistent with the conclusion of the BLINK2 (1) discontinuation study, that for children whose axial elongation returned to rates similar in age matched untreated myopes, that myopia control treatment should be resumed.
Documented myopia progression in young adults
It is widely assumed that childhood myopia progression stabilizes and ceases during the teenage years. However, this is clearly not true for many individuals. Clinically meaningful progression can continue into early adulthood and may average 1 D between 20 and 30 years (reviewed in Bullimore et al., 2023) (17). In 2024, Brennan et al. (18) highlighted that higher levels of myopia are associated with greater risk of adult progression, meaning high myopia may require ongoing management in young adulthood. Based on re-analysis of Goldblum et al.’s data (19), Brennan et al. (18) reported that for high myopes (≥6 D), progression averaged 1.5 D during the third decade. This means that average age-matched myopia progression rates of myopes not undergoing myopia control, may greatly underestimate an individual’s propensity for further progression.
So, should high myopes remain on treatment longer? While high myopes often show continued progression into adulthood, progression patterns are highly variable, and there is limited evidence that childhood myopia control influences adult progression. Thus, recommendations for extending treatment into early adulthood remain hypothetical. A conservative approach, delaying discontinuation until very late teens or early twenties, may better align with physiological stabilization, particularly when myopia is high. A confounding issue is the lack of precision in refraction (0.25 D) and the resulting difficulty in detecting low annual myopia progression, although it is suggested that this may be overcome by axial length measurement (reviewed in Brennan et al., 2021) (8). However, detecting small changes in an individual’s axial length remains challenging.
Myopia control cessation in clinical practice
Decisions regarding discontinuation of myopia control therapy should be guided by both age and objective indicators of refractive and axial stability. Age remains a critical factor; data from the Correction of Myopia Evaluation Trial (COMET) study have been used to indicate that myopia stabilizes in the late teenage years (the mean age at myopia stabilization was 15.6±4.2 years) with progression deceleration occurring earlier (12.0±1.9 years) (20), however, the degree of individual variation was substantial. Many myopes have continued progression well into their 20s (reviewed in Bullimore et al., 2023) (17), suggesting that therapy cessation should be delayed until early adulthood. Minimal change in axial length and refraction over ~1.5–2 years is often considered a marker of stability, but refractive plateau alone does not confirm cessation of eye growth, as axial elongation can persist into the twenties or even thirties (17). A combination approach using refractive stability, axial length plateau (e.g., <0.1 mm per 12 months), and age is therefore recommended.
Furthermore, treatment modality influences the discontinuation strategy (3). Optical interventions such as orthokeratology and multifocal lenses differ from pharmacological options like atropine, where gradual tapering is advised to reduce rebound risk (11). Post-discontinuation monitoring is essential, with repeat axial length measurements over 6–12 months recommended to detect renewed progression, particularly for orthokeratology, atropine and repeated low-level red-light (RLRL). Ultimately, there is no definitive “off switch” for myopia control; stabilization is highly individual, and ongoing surveillance remains key to minimizing long-term risk of progression and associated ocular pathology. Even post-cessation, continued advice on increased outdoor time and reduced near work is warranted.
The current suggestions for ceasing myopia control are summarised in Table 1. These recommendations are diverse and have not been developed using a consensus process. Clinically, a simple primary recommendation would be to only cease most types of myopia control treatment in the late teens to early twenties when axial growth has plateaued. For some treatments, a gradual cessation and careful monitoring (both axial length and refraction for ≥12 months, at 6-month intervals) to detect any renewed progression is required.
Remaining questions and future work
Several important questions remain regarding the long-term management of myopia with MFCLs. First, as the BLINK2 study (1) primarily investigated older adolescents, it is unclear whether younger children would exhibit a rebound effect upon treatment discontinuation. Given the natural course of myopia progression, it is plausible that cessation at earlier ages could lead to renewed progression in a substantial proportion of children. Furthermore, the minimum effective duration of treatment has not been established; whether shorter intervention periods (e.g., less than 2 years) confer sustained benefits after discontinuation remains unknown. As there was no comparison group that continued MFCL treatment, it is unknown whether extending treatment would have provided additional benefit. Another consideration is the impact of switching from MFCLs to spectacle options, which may occur due to contact lens intolerance, yet this scenario has not been adequately explored. Compliance also represents a critical variable, as both treatment efficacy and rebound effects are likely influenced by adherence; poor compliance would diminish treatment benefits and potentially alter the magnitude of post-treatment progression. Finally, individual variability in the age of myopia stabilization and its relationship to renewed progression warrants further investigation, as current evidence does not adequately explain these differences.
Future research should address key unanswered questions to optimize myopia management strategies. Comparative discontinuation studies are warranted to assess outcomes when patients switch from MFCLs to single-vision spectacles or other alternatives. Studies involving younger children are needed to determine whether discontinuation of MFCL treatment prior to late adolescence, which can occur for many reasons, leads to rebound progression and to evaluate the impact of transitioning to alternative myopia control interventions. Replication of findings across diverse ethnic and geographic populations would enhance generalizability. Finally, establishing evidence-based clinical guidelines for discontinuing myopia control is essential to provide practitioners with clear, standardized protocols for managing myopia and for determining when treatment is no longer necessary.
Conclusions
Although a defined rebound effect was not observed following discontinuation of MFCL wear, the renewed increase in myopia and axial length after cessation suggests that continued myopia control treatment may have been of further benefit. This finding raises an additional challenge: identifying the appropriate point at which myopia control treatment should be discontinued because it is no longer of benefit. Discontinuation decisions are inherently complex and must consider multiple factors, including age, refractive stability, axial length trajectory, treatment modality, and baseline myopia severity. Current evidence challenges the notion of early stabilization and emphasises the need for cautious, individualized strategies—particularly for children at high-risk of further progression. Until robust, evidence-based guidelines are established, clinicians should adopt a conservative approach, incorporating extended monitoring to mitigate the risk of renewed progression and associated ocular complications.
Acknowledgments
None.
Footnote
Provenance and Peer Review: This article was commissioned by the editorial office, Annals of Eye Science. The article has undergone external peer review.
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Cite this article as: Schmid KL. The quandary of how to determine when myopia control treatment should be discontinued. Ann Eye Sci 2026;11:1.
