Current and emerging strategies for myopia control: a narrative review of optical, pharmacological, behavioural, and adjunctive therapies

Myopia has become a leading cause of visual impairment globally, with a rapidly increasing prevalence among children, particularly in urbanised areas of East and Southeast Asia. High and pathologic myopia can lead to irreversible complications, including retinal detachment, glaucoma, and myopic maculopathy. This narrative review synthesises current and emerging strategies for myopia control as of 2025, integrating evidence from optical, pharmacological, behavioural, and surgical domains. Multifocal contact lenses, orthokeratology, and defocus-incorporated spectacles are effective in modulating axial elongation. Low-dose atropine remains a cornerstone pharmacologic therapy with consistent efficacy. Behavioural interventions, such as increased outdoor time, provide preventive benefits and are endorsed in school-based programs. Repeated low-level red-light (RLRL) therapy represents a novel, non-invasive option with growing support. Surgical approaches, while corrective rather than preventive, are relevant in advanced cases. The review also compares intervention efficacy, discusses the rationale for combination therapies, and highlights the need for individualised, age-appropriate strategies. Key challenges include treatment variability, limited long-term data, and barriers to adherence and access. Future directions involve personalised risk prediction, global implementation frameworks, and public health engagement. A multimodal, patient-centred approach is essential to reduce the lifelong burden of myopia.