Ortho-k vs. myopia-control lenses vs. glasses: an independent comparison

Ordinary glasses fix the blur and do nothing to the length of the eye. Three optical treatments do slow that lengthening, each with proper trial evidence: orthokeratology (rigid lenses worn overnight), soft daily contact lenses designed for myopia control, and spectacle lenses with a treatment zone built into the surface. On the trials’ own figures they take between a third and a half off the rate of eye growth while worn, each asks something different of your household, and none reverses anything. A fourth treatment, low-dose atropine drops, is often prescribed alongside one of the three. A fifth, red-light therapy, has the most dramatic numbers of all and an unresolved safety question, which is why it is not on my list.

I am a father, not a clinician, and I have nothing to sell you. The choice is yours and your optometrist’s or ophthalmologist’s; this page is so you walk in knowing what each option buys.

The floor first: full glasses, actually worn

Every trial below measured its treatment against a child in correctly made, properly worn glasses — a baseline a surprising number of children never get. Pooled studies of whether children wear the glasses they are given put the figure at four to five children in ten.1 Evidence: MODERATE A pair in a case on the windowsill is not a correction, and nothing layered on top of it will work as it did in the trials.

And refuse a deliberately weak prescription so the eyes “have to work”. It was tested: children under-corrected by three quarters of a dioptre progressed faster, and the international guidance is now one sentence — full correction, worn full time.2 Evidence: STRONG The figures on the card are decoded in what the number on the prescription means.

Night lenses (ortho-k): the strongest number, and one risk you cannot opt out of

Orthokeratology uses a rigid lens the child sleeps in and removes on waking. Overnight it very slightly flattens the centre of the cornea, so the child sees clearly all day with nothing on their face; stop, and the effect fades within a day or two. The living Cochrane review found about 0.18 millimetres a year less eye growth than with ordinary correction — one of very few findings in myopia control rated at moderate rather than low certainty.3 Evidence: STRONG For scale, around a tenth of a millimetre a year is normal growth and two or three tenths is myopia taking hold,14 so 0.18 is a meaningful bite.

Now the part leaflets tend to bury. Sleeping in a contact lens carries a risk of corneal infection, which can scar and can cost sight. It is rare — the best estimate in children is about 13.9 cases per 10,000 years of wear, roughly one child in seven hundred a year — but that figure rests on two cases in the whole dataset, so the true rate could be several times lower or higher.4 Evidence: LIMITED The infection is permanent when it happens, and it is driven almost entirely by hygiene and by whether anyone is checking — which makes ortho-k the treatment where the practitioner matters more than the product. The rules are not negotiable: water never touches the lenses or the case; hands are washed and dried before every handling; the case is replaced on schedule. A red, painful or light-sensitive eye in the morning means the lenses come out and somebody looks at that eye today — book the appointment first. Your practitioner should be seeing your child regularly and telling you what they are watching for.

Daily soft lenses: the tidiest long-term data

A soft lens goes in after breakfast and is thrown away at bedtime. It corrects the distance blur through the centre and changes how light lands towards the edge of the retina, which appears to be the signal that slows growth. The first such lens was approved by the US regulator in November 2019 for children aged eight to twelve at the start, and over its three-year trial the treated children’s eyes grew about half as much as controls’.5 Evidence: STRONG A separate American trial of high-add multifocal lenses found just under half a dioptre less myopia after three years than single-vision lenses.6 Evidence: STRONG

A lens discarded every night carries much less infection risk than one that is reused, but the same rule applies — a sore, red or light-sensitive eye means the lens comes out and the eye is seen today.

Myopia-control spectacles: the easiest to accept, the youngest evidence

For most families this is the least frightening option, because it is a pair of glasses. Around a clear central zone the lens carries hundreds of tiny optical elements — defocusing segments in one design, minute lenslets in another — so the child sees normally through the middle while the edge of the retina receives the slowing signal. The effect is real and its size still argued. In the two-year trial of the segmented design, treated children’s eyes grew about 60 per cent less than controls and their prescriptions moved about half as fast; have both figures, not just the flattering one.7 Evidence: MODERATE In a two-year trial of the lenslet design, treated children finished about 0.8 of a dioptre better off, and those wearing the lenses twelve hours a day or more did better still.8 Evidence: MODERATE Wearing time is the dose — something you can check on a school morning.

In September 2025 the US regulator created a new device category for these lenses and authorised the first, for children aged six to twelve with prescriptions between −0.75 and −4.50.9 The condition attached says more than the approval: the maker must study what happens after children stop, because nobody yet knows.

The three, in one paragraph

Night lenses have the best-graded number — about 0.18 mm a year less growth — in exchange for a nightly routine, several fitting visits and a rare but permanent infection risk that hygiene controls. Daily soft lenses roughly halved eye growth over three years, with lower infection risk because nothing is reused, at the price of a daily consumable. Myopia-control spectacles cut progression by around half in two-year trials, ask nothing beyond wearing them for as many waking hours as possible, and have the shortest track record. Different trials, lengths and ages: read them as the shape of the evidence, not a league table. How each behaves when treatment stops, and when to combine two, is a chapter-length discussion in the book.

The one I cannot recommend yet

You will meet a fifth option, because it is spreading quickly. Repeated low-level red-light therapy is a desktop device the child looks into for three minutes, twice a day, five days a week. In a twelve-month randomised trial the treated eyes grew 0.13 millimetres against 0.38 in controls.10 Evidence: LIMITED They are the best numbers on this page, and the Cochrane reviewers still rate the certainty of the evidence as very low.

Two things trouble researchers. First, stopping: children who came off the device grew 0.42 millimetres in the following year and shifted nearly a dioptre — much of the gain handed back.11 Evidence: LIMITED Second, the light itself. Two laser-based units were measured reaching recognised retinal safety limits in 1.4 and 2.8 seconds, against sessions designed to last 180.12 Evidence: LIMITED The International Myopia Institute’s 2025 review calls these therapies experimental, citing reduced density of cone cells at the centre of the retina and a child who lost vision in both eyes.13

If your child already uses one, that is not a reason to panic; the reported harms are rare and some appear to have recovered. It is a reason to ask three questions before starting: which device, and is it laser or LED; what published measurement shows its output against the safety limit; and what retinal imaging will be done, before and how often after. A practitioner who cannot answer those should not supervise it. More in red-light therapy for myopia.

Not on the list at all: eye exercises, blue-light filters, tinted lenses, supplements and weak prescriptions. Vision therapy treats one real diagnosis — eyes that fail to converge on close work — and does not shorten an eye. Laser surgery leaves the eye’s length alone, and no laser is approved in the United States under eighteen.

Two questions to take into the appointment

1. “Which of these do you offer here, which would you choose for my child specifically, and why that one?” The why is what you are listening for.
2. “Do you measure axial length, and can I see it plotted?” Eye length is the number every treatment is aimed at, and the only way the six-month review can tell you whether it is working.

Treatment ends when the eye stops growing, not on a birthday. The drops and the six-month review are in the myopia-control hub.

Drawn from Chapter 14 and Chapter 15 of Children's Eyesight Problems, second edition. Report a correction.