ESCRS 2026: Preventing myopia onset outweighs slowing its progression

Speaking at the 44th Congress of the ESCRS in London, Mark Bullimore, PhD, MCOptom, of the University of Houston, outlined a two-pronged approach to tackling what he called the myopia epidemic: slowing progression in children who become myopic, and delaying, or preventing, onset in the first place.

Delaying onset versus slowing progression

Bullimore said myopia control spectacle lenses, such as the Stellest lens (Essilor), can slow the progression of myopia and lower the ultimate level of myopia a child develops over their lifetime. A plano version of the Stellest lens can also be prescribed to delay onset by slowing axial elongation, he said, with the aim of preventing myopia altogether in many children and slowing progression in those who do develop it.

Referring to a paper he co-authored with Noel Brennan, titled “An Ounce of Prevention Is Worth a Pound of Cure”—a phrase they later learned originated with Benjamin Franklin, inventor of the bifocal spectacle lens—Bullimore said delaying onset by even a year is more valuable than slowing progression, since it can produce a benefit equivalent to two or three years of slowed progression. He said prevention is much better than cure, adding that clinicians need to pursue both strategies.

Delaying onset

The most effective way to delay onset, Bullimore said, is to send children outdoors more and reduce tablet use, alongside options such as low-concentration atropine and myopia control spectacles. He noted that encouraging outdoor activity also benefits children's cardiovascular health and helps address obesity.

Identifying children at risk

Bullimore cautioned against prescribing myopia prevention methods, such as glasses and drugs, to every child, particularly in Western countries. Instead, he said clinicians should identify at-risk children based on their refractive error at a young age—those with only a little hyperopia, or who are already emmetropic, are at higher risk. He cited the CLEERE study in noting that risk also varies by ethnicity and sex: an Asian female has a high probability of becoming myopic, he said, compared with a relatively low probability for a white male. Clinicians, he said, should assess refractive error alongside these other factors before discussing myopia risk with parents.