兒童近視控制 8 大迷思
阿托品、OK 鏡、紅光、戶外時間，哪個最有效？

迷思 1 · 「近視只是看不清楚，長大後雷射就好」

近視的本質是眼軸過度拉長（眼軸比一般人長；成人眼軸平均約 23.6 mm，Clark & Wong 2026 統合分析）。眼軸拉長後，視網膜被往後拖、變薄、可能出現裂孔。即使日後雷射把角膜磨薄（LASIK／SMILE）矯正度數，眼軸長度不會縮短，所有與「眼球太長」相關的併發症仍然存在。

本文採國際近視學會（IMI）高度近視定義：放鬆調節時等效球面度數 ≤−6.00 D。不同研究可能使用其他門檻，應依各研究定義閱讀。高度近視族群成年後的併發症風險如下（Haarman 2020 整合分析）：

• 視網膜剝離 — 勝算比約 12.6（與非近視者相比）
• 青光眼 — 風險增加約 2–3 倍（中、高度近視勝算比 2.9）
• 近視性黃斑部病變 — 是亞洲不可逆失明的主要原因之一
• 白內障 — 後囊下白內障勝算比約 4.6、核性白內障約 2.9

控制目標是減緩進展並降低長期風險，沒有某個最終度數能保證不會發生併發症。

迷思 2 · 「假性近視多休息就會好，不用看醫生」

假性近視（Pseudomyopia）是睫狀肌長時間用眼後痙攣，造成暫時性調節力過強，看遠模糊。但睫狀肌一放鬆就恢復。真性近視（軸性近視，axial myopia）則是眼軸真的拉長，不可逆。

外觀上兩者完全一樣 — 都是「看遠模糊」。唯一可靠的方法是散瞳後驗光（cycloplegic refraction），也就是點睫狀肌麻痺眼藥水，等睫狀肌充分放鬆後再驗光；藥物種類與等待時間由眼科醫師決定。如果散瞳前後度數差很多 → 假性近視為主；如果散瞳後仍有度數 → 真性近視已經形成。

第一次發現孩子看遠模糊就應該立刻就醫，不能只是觀察。原因：即使是假性近視，也代表近距離用眼過多，應及早檢查並調整用眼習慣。國健署建議每年定期檢查視力 1–2 次，並定期散瞳驗光，掌握孩子的遠視儲備量。

迷思 3 · 「低濃度阿托品（Atropine）0.01%／0.05% 哪個好？」

2019 年香港 Yam JC 等人發表的 LAMP 研究（低濃度阿托品控制近視進展研究，Low-concentration Atropine for Myopia Progression），將 438 位 4–12 歲華人兒童隨機分配到三組，比較三種濃度的低濃度阿托品。第 1 年結果發表在 Ophthalmology 2019，第 2、3 年延伸資料陸續發表。關鍵結論：

解讀建議：

• 近視進展較快（每年 > 0.50 D；國際近視研究院 IMI 2019 臨床管理指引把過去每年加深 > 0.50 D 列為之後進展較快的指標） → 從 0.05% 開始；畏光不耐受可降階。
• 進展緩慢、學齡前 → 可從 0.025% 或 0.01% 試試。
• 停藥反彈（rebound） — ATOM2 停藥後追蹤（Chia 2014）顯示，0.5% 與 0.1% 停藥後反彈較大，0.01% 反彈最小。LAMP 第 3 年資料顯示，三種濃度停藥後的反彈雖隨濃度略增，但差異在臨床上很小；停藥時年紀較大、濃度較低，反彈較小。

醫師依進展、年齡、副作用與耐受性選擇濃度。低濃度阿托品的臨床選擇與健保給付條件是不同問題。

迷思 4 · 「角膜塑型片（OK 鏡）會傷角膜、得感染」

角膜塑型片（Orthokeratology，Ortho-K）是夜戴日取的高透氧硬式隱形眼鏡，睡眠時暫時把角膜中央壓平，白天不戴就能看清楚。研究顯示可減緩眼軸增長約 40–50%（ROMIO 試驗 43%；美國眼科醫學會 AAO 技術評估約 50%），機轉被認為是改變周邊視網膜的離焦訊號。

美國一項回溯性研究（Bullimore 2013）估計，微生物性角膜炎約每 10,000 人年 7.7 例（整體）、13.9 例（兒童）（約每年 0.077%–0.139%），與其他夜戴型隱形眼鏡相近；不同研究、族群與照護條件不能直接視為個人保證。清潔照護與定期回診仍重要。

• 每天用無菌沖洗液清潔，不要用自來水。
• 鏡片使用 1–1.5 年要更換，鏡盒每 3 個月換新。
• 感冒、發燒、眼睛紅停戴。
• 每 3 個月回診檢查角膜。

適合對象：依各產品經衛福部核准的說明書而定，例如有產品限近視 5.00 D 以下、散光 1.50 D 以下、12 歲以上，也有產品限 9 歲以上；孩子也要配合度好、能確實清潔照護。

迷思 5 · 「多焦點離焦鏡片（DIMS）只是噱頭，普通眼鏡就夠了」

DIMS（Defocus Incorporated Multiple Segments）鏡片由香港理工大學開發，商品名為 MiYOSMART（豪雅 HOYA；台灣品名「新樂學」，已取得衛福部醫療器材許可證）。原理：中央正常區域提供清晰視覺，周圍密布數百個 +3.50 D 微透鏡，讓周邊視網膜接收「近視性離焦」訊號，抑制眼軸生長。

2020 年 Lam CSY 等人在 British Journal of Ophthalmology 發表的 2 年隨機對照試驗（RCT；隨機分派 183 位 8–13 歲兒童，160 位完成）結果：

• DIMS 組近視進展 -0.41 D vs 普通鏡片組 -0.85 D（減緩 52%）
• 眼軸增長 0.21 mm vs 0.55 mm（減緩 62%）
• 2023 年 6 年追蹤（90 位完成原試驗的孩子；Lam 2023）顯示持續配戴仍有控制效果，停戴者未見反彈；2026 年平均 9.4 年的觀察性追蹤（60 位；Leung 2026）顯示眼軸減緩效果可持續到青少年晚期，但沒有同期的單焦鏡片對照組

優點：無侵入性、孩子最容易配合（就跟戴普通眼鏡一樣）。缺點：價格較高，參考價格約 NT$ 20,000–30,000／副（各院所不同，也視框架材質、鍍膜與通路而定）；加上每 1–2 年需隨度數變化更換，長期累計花費不低。可作為單一治療，或搭配阿托品做組合療法。其他類似產品：HAL 鏡片（高度非球面微透鏡，Highly Aspherical Lenslets；依視路 Essilor Stellest，2025 年 9 月獲美國 FDA 核准，用於 6–12 歲開始治療的兒童）、CARE／DOT 鏡片。

迷思 6 · 「重複式低能量紅光治療（RLRL）— 安全嗎？台灣有嗎？」

重複式低能量紅光治療（RLRL）使用 650 nm 紅光，每天 2 次（間隔至少 4 小時）、每次 3 分鐘、每週 5 天照射。Jiang 2022 多中心試驗：264 人隨機分組，246 人納入分析；以下為 12 個月調整後結果（RLRL vs 單焦眼鏡）。

• 眼軸（AL）增長 +0.13 mm vs +0.38 mm（RLRL vs 單焦眼鏡）。
• 等效球面度數（SER）進展 −0.20 D vs −0.79 D（RLRL vs 單焦眼鏡）。
• 各研究須分別看眼軸及度數結局，不能合併為同一有效率。

但有幾項重要疑慮：

• Liu 等 2023 報告一名 12 歲女童的雙眼視網膜損傷；雙眼不等於兩名病人。這是具名病例報告，不代表截至今日的全球病例總數；長期安全性仍需評估。
• 長期（>5 年）安全性資料缺乏，尤其視網膜光毒性累積問題。
• 停止治療後可能反彈：2 年追蹤研究中，停用紅光者第 2 年眼軸增長 0.42 mm，多於一直戴單焦眼鏡者的 0.28 mm（Xiong 2022，作者稱為輕度反彈）。
• 美國 FDA 尚未核准用於近視控制；澳洲 TGA 已於 2023 年將居家用近視控制紅光儀登錄為醫療器材（IIa 類）；台灣目前查無衛福部核准用於近視的許可證。

最新整合分析（Lin 2026，28 篇隨機試驗、3573 人）顯示紅光治療在 12 個月內可減緩近視，通報的不良事件多為輕微、短暫，但作者強調仍需要納入完整視網膜安全評估的長期試驗。加上已有視網膜損傷的病例報告，目前不宜作為第一線治療；若使用需審慎評估、密切追蹤眼底，並優先考慮長期資料較多的阿托品或 OK 鏡。

迷思 7 · 「戶外活動跟近視沒關係吧？」

戶外活動預防近視的證據已經非常充分：

• He M 等人 2015 年發表在 JAMA 的廣州群集隨機試驗（n=1903 位小一學童）：每個上學日多一節 40 分鐘戶外活動課，3 年內新發近視率從 39.5% 降至 30.4%。
• 台灣 Wu PC 等人系列研究：2013 年研究鼓勵學童下課到教室外活動，1 年新發近視率 8.41% vs 17.65%；2018 年 16 所小學的群集隨機試驗也顯示度數增加較少；2010 年起推動「天天戶外 120」後，小學生視力不良率由長期上升轉為逐年下降（Wu 2020）。
• 劑量反應關係：橫斷面研究的整合分析顯示，每週多 1 小時戶外時間，近視的勝算約降低 2%（Sherwin 2012）。

機轉假說（尚未完全確定）：

• 光照刺激視網膜釋放多巴胺 — 抑制眼軸生長
• 遠距離視覺 — 減少近距離調節需求
• 瞳孔縮小、景深增加 — 減少視網膜離焦

實務建議：依國健署「3010120」原則，每天累積戶外活動 2 小時以上（陰天也算），學齡前最關鍵。證據以預防近視「發生」最強（整合分析：臨床試驗合併後，新發近視風險約降低 46%）；對已經近視的孩子，延緩度數加深的效果不明確（Xiong 2017）。重點是「到戶外」，不是「運動」 — 戶外散步、戶外閱讀都行，只要在自然光下。

迷思 8 · 「近視控制是一輩子的事嗎？幾歲可以停？」

近視控制治療的「終點」並非固定年齡，而是近視進展自然停止的時間點。美國 COMET 世代研究中，近視穩定的平均年齡約 15.6 歲，18 歲時約 77%、21 歲時約 90% 已穩定（IMI 2023 回顧）。一般時間軸：

停藥前建議：

• 確認近視 連續 12 個月變化 < 0.50 D。
• 若用阿托品，可考慮先降濃度再停：LAMP 8 年結果（2026）中，0.05% 用半年、0.025% 用半年再停藥的孩子，3 年內度數進展比直接停藥少約 0.24 D（年紀較小、度數較深者差異較大），但這個差距的臨床意義仍不明確。
• 若用 OK 鏡，先停一兩週觀察度數變化。

停藥後仍要每年追蹤，尤其高度近視（IMI 定義：等效球面度數 ≤−6.00 D）族群，終身需監測視網膜健康。

台灣健保給付規定（民國 115 年 10 月 22 日更新版）

2023 年起 低劑量阿托品納入健保 是兒童近視控制的重要進展。三大主要方法的現行給付狀況：

實務建議：

• 阿托品改成健保有給付後，第一線就可以由眼科醫師依規定開立健保處方，不需自費。具體適合與否、濃度（0.01% vs 0.05% 視臨床判斷）、是否合併其他方法，請以眼科醫師判斷為準
• DIMS、OK 鏡、RLRL 仍需自費——家長與醫師討論時可一併評估費用負擔與長期使用可行性
• 健保給付規定隨時間更新，本文以民國 115 年 10 月 22 日更新版為準，最新版本請以健保署公告為主

* 來源：衛福部健保署《全民健康保險藥品給付規定》民國 115 年 10 月 22 日更新版，第 14 節「眼科製劑」14.9.6「Atropine sulfate 0.1 mg/mL–0.5 mg/mL 眼用製劑」（112/5/1、113/10/1、115/8/1）。

家長可以做的 5 件事

學齡前（6 歲前）就出現近視、家長有高度近視史、每年進展 > 0.50 D — 這三類屬高風險，建議盡早諮詢眼科專科醫師討論主動介入策略。

主要參考文獻

1. Yam JC, et al. Low-Concentration Atropine for Myopia Progression (LAMP) Study: A Randomized, Double-Blinded, Placebo-Controlled Trial of 0.05%, 0.025%, and 0.01% Atropine Eye Drops in Myopia Control. Ophthalmology. 2019;126(1):113-124.
2. Yam JC, et al. Two-Year Clinical Trial of the Low-Concentration Atropine for Myopia Progression (LAMP) Study: Phase 2 Report. Ophthalmology. 2020;127(7):910-919.
3. Yam JC, et al. Three-Year Clinical Trial of Low-Concentration Atropine for Myopia Progression (LAMP) Study: Continued Versus Washout: Phase 3 Report. Ophthalmology. 2022;129(3):308-321.
4. Chia A, et al. Atropine for the Treatment of Childhood Myopia: Safety and Efficacy of 0.5%, 0.1%, and 0.01% Doses (Atropine for the Treatment of Myopia 2). Ophthalmology. 2012;119(2):347-354.
5. Lam CSY, et al. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol. 2020;104(3):363-368.
6. Jiang Y, et al. Effect of Repeated Low-Level Red-Light Therapy for Myopia Control in Children: A Multicenter Randomized Controlled Trial. Ophthalmology. 2022;129(5):509-519.
7. Flitcroft DI, et al. IMI – Defining and Classifying Myopia: A Proposed Set of Standards for Clinical and Epidemiologic Studies. Invest Ophthalmol Vis Sci. 2019;60(3):M20-M30. IMI consensus definition.
8. Liu H, Yang Y, Guo J, Peng J, Zhao P. Retinal Damage After Repeated Low-level Red-Light Laser Exposure. JAMA Ophthalmol. 2023;141(7):693-695. doi:10.1001/jamaophthalmol.2023.1548.
9. He M, et al. Effect of Time Spent Outdoors at School on the Development of Myopia Among Children in China: A Randomized Clinical Trial. JAMA. 2015;314(11):1142-1148.
10. Wu PC, et al. Outdoor Activity during Class Recess Reduces Myopia Onset and Progression in School Children. Ophthalmology. 2013;120(5):1080-1085.
11. Gifford KL, et al. IMI – Clinical Management Guidelines Report. Invest Ophthalmol Vis Sci. 2019;60(3):M184-M203.
12. Chia A, et al. Atropine for the treatment of childhood myopia: changes after stopping atropine 0.01%, 0.1% and 0.5%. Am J Ophthalmol. 2014;157(2):451-457.e1.
13. Zhang Y, et al. Discontinuation Approach and Follow-Up of Low-Concentration Atropine for Myopia Progression: Eight-Year Results of the LAMP Randomized Clinical Trial. JAMA Ophthalmol. 2026;144(5):396-403.
14. Lam CSY, et al. Long-term myopia control effect and safety in children wearing DIMS spectacle lenses for 6 years. Sci Rep. 2023;13(1):5475.
15. Leung TW, et al. Long-term axial elongation in myopic children wearing DIMS spectacle lenses: an 8-to-10-year observational study. BMJ Open Ophthalmol. 2026;11(2):e002780.
16. Bullimore MA, Sinnott LT, Jones-Jordan LA. The risk of microbial keratitis with overnight corneal reshaping lenses. Optom Vis Sci. 2013;90(9):937-944.
17. Cho P, Cheung SW. Retardation of myopia in Orthokeratology (ROMIO) study: a 2-year randomized clinical trial. Invest Ophthalmol Vis Sci. 2012;53(11):7077-7085.
18. VanderVeen DK, et al. Use of Orthokeratology for the Prevention of Myopic Progression in Children: A Report by the American Academy of Ophthalmology. Ophthalmology. 2019;126(4):623-636.
19. Chamberlain P, et al. A 3-year Randomized Clinical Trial of MiSight Lenses for Myopia Control. Optom Vis Sci. 2019;96(8):556-567.
20. Xiong R, et al. Sustained and rebound effect of repeated low-level red-light therapy on myopia control: A 2-year post-trial follow-up study. Clin Exp Ophthalmol. 2022;50(9):1013-1024.
21. Wu PC, et al. Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized Trial. Ophthalmology. 2018;125(8):1239-1250.
22. Wu PC, et al. Increased Time Outdoors Is Followed by Reversal of the Long-Term Trend to Reduced Visual Acuity in Taiwan Primary School Students. Ophthalmology. 2020;127(11):1462-1469.
23. Sherwin JC, et al. The association between time spent outdoors and myopia in children and adolescents: a systematic review and meta-analysis. Ophthalmology. 2012;119(10):2141-2151.
24. Xiong S, et al. Time spent in outdoor activities in relation to myopia prevention and control: a meta-analysis and systematic review. Acta Ophthalmol. 2017;95(6):551-566.
25. Haarman AEG, et al. The Complications of Myopia: A Review and Meta-Analysis. Invest Ophthalmol Vis Sci. 2020;61(4):49.
26. Bullimore MA, et al. IMI – Onset and Progression of Myopia in Young Adults. Invest Ophthalmol Vis Sci. 2023;64(6):2.
27. 衛生福利部國民健康署。〈國小6年級近視率已達7成　儲備遠視量 破解近視迷思〉，2022-12-20 發布、2025-03-24 更新。hpa.gov.tw。
28. 衛生福利部。〈近視是疾病！ 國健署推動「護眼123」幫孩子從小存視力〉附表 1（106 年兒童青少年視力監測調查），2018-05-04。mohw.gov.tw。
29. Clark RA, Wong RK. Spherical Equivalent Refraction Versus Axial Length for Monitoring Childhood Myopia and Estimating Disease Risk: A Systematic Review and Meta-Analysis. Am J Ophthalmol. 2026;286:235-247.
30. Lin LY, et al. Duration-Dependent Efficacy and Clinical Safety of Repeated Low-Level Red-Light Therapy for Paediatric Myopia: A Systematic Review and Meta-Analysis. Clin Exp Ophthalmol. 2026;54(5):630-652.
31. 衛生福利部國民健康署。〈近視防治向下扎根　醫師入園守護幼兒視力〉，2026-06-25。hpa.gov.tw。
32. 衛生福利部。〈居家防疫狂用眼 Eye眼動起來〉（國民健康署護眼建議），2021-06-02 建檔、2023-07-27 更新。mohw.gov.tw。
33. 教育部。《學校照明節能改善參考手冊》表 4.4（依 CNS 12112：2012，教室照度 500 lux）。

Myth 1 · "Myopia is just blurry vision; LASIK fixes it later"

Myopia is fundamentally excessive axial elongation (an eye longer than average; mean adult axial length is about 23.6 mm, Clark & Wong 2026 meta-analysis). The lengthened eye stretches the retina thinner and may produce breaks. Even after LASIK / SMILE reshapes the cornea, axial length does not shorten — all complications of "too long an eyeball" remain.

This article uses the IMI definition of high myopia: spherical equivalent ≤−6.00 D with accommodation relaxed. Study definitions may differ. Adult complications in high-myopia populations include (Haarman 2020 meta-analysis):

• Retinal detachment — odds ratio about 12.6 versus non-myopes
• Glaucoma — about 2–3× increased risk (odds ratio 2.9 for moderate/high myopia)
• Myopic maculopathy — leading cause of irreversible blindness in Asia
• Cataract — odds ratio about 4.6 for posterior subcapsular and 2.9 for nuclear cataract

The goal is slower progression and lower long-term risk; no final refractive threshold guarantees freedom from complications.

Myth 2 · "Pseudomyopia just needs rest, no doctor visit"

Pseudomyopia is transient ciliary spasm from prolonged near work — temporarily excessive accommodation makes distance blurry, but resolves when the muscle relaxes. Axial myopia is true elongation of the eyeball — irreversible.

The two look identical externally — both manifest as "distance blur." The only reliable distinction is cycloplegic refraction, meaning cycloplegic drops are used and refraction is done once the ciliary muscle has relaxed; your eye doctor decides the drug and the waiting time. If pre/post-cycloplegia refraction differs significantly → pseudomyopia predominates; if cycloplegic refraction still shows myopia → axial myopia is established.

First report of distance blur warrants immediate evaluation, not observation. Even pseudomyopia signals excessive near work, so the child should be examined early and near-work habits adjusted. Taiwan's Health Promotion Administration recommends eye checks 1–2 times a year with periodic cycloplegic refraction to monitor the child's hyperopic reserve.

Myth 3 · "Low-dose atropine: 0.01% vs 0.05% — which is better?"

The 2019 Hong Kong LAMP Study (Low-concentration Atropine for Myopia Progression, Yam JC et al, Ophthalmology) randomized 438 Chinese children aged 4–12 to three concentrations of low-dose atropine. Years 2–3 follow-up reports came in 2020–2022. Key findings:

Practical interpretation:

• Faster progressors (>0.50 D/year; the IMI 2019 clinical management guidelines list past progression >0.50 D/year as a marker of faster future progression) → start at 0.05%; step down if photophobia is intolerable.
• Slow progressors / preschool → may start at 0.025% or 0.01%.
• Rebound on cessation — ATOM2 post-cessation follow-up (Chia 2014) showed larger rebound after 0.5% and 0.1%, and the smallest after 0.01%. LAMP year-3 data showed rebound rose slightly with concentration but the differences were clinically small; stopping at an older age and a lower concentration was associated with less rebound.

The concentration is selected according to progression, age, adverse effects and tolerability. Clinical selection and NHI eligibility are separate questions.

Myth 4 · "Ortho-K damages the cornea and causes infection"

Orthokeratology (Ortho-K) uses high-Dk gas-permeable rigid lenses worn overnight to temporarily flatten the central cornea, allowing clear unaided daytime vision. Studies show about 40–50% slower axial elongation (43% in the ROMIO trial; about 50% in the AAO technology assessment); the proposed mechanism is an altered peripheral retinal defocus signal.

A US retrospective study (Bullimore 2013) estimated microbial keratitis at about 7.7 (overall) and 13.9 (children) cases per 10,000 patient-years (0.077%–0.139% per year), similar to other overnight lens modalities. Estimates vary by population and care; they are not an individual guarantee. Cleaning and follow-up remain important.

• Daily cleaning with sterile solution, never tap water.
• Replace lenses every 1–1.5 years; cases every 3 months.
• Stop wearing during cold, fever, or eye redness.
• Cornea check every 3 months.

Candidates: this depends on each product's Taiwan-approved labeling (for example, one product is limited to myopia ≤5.00 D, astigmatism ≤1.50 D and age 12+, another to age 9+), plus good compliance with lens care.

Myth 5 · "DIMS lenses are just marketing — regular glasses work just as well"

DIMS (Defocus Incorporated Multiple Segments) lenses, developed at Hong Kong Polytechnic University and marketed as MiYOSMART (Hoya; licensed as a medical device in Taiwan), have a clear central zone surrounded by hundreds of +3.50 D microlenslets producing myopic defocus on the peripheral retina, suppressing axial elongation.

The 2020 Lam CSY et al 2-year RCT (183 children aged 8–13 randomized, 160 completed; Br J Ophthalmol):

• DIMS group myopia progression: −0.41 D vs control −0.85 D (52% slowing)
• Axial elongation: 0.21 mm vs 0.55 mm (62% slowing)
• 6-year follow-up (90 children from the original trial; Lam 2023) showed sustained control with continued wear and no rebound after stopping; a 2026 observational follow-up averaging 9.4 years (60 participants; Leung 2026) found slower axial elongation persisting into late adolescence, without a contemporaneous single-vision control group

Advantages: non-invasive, easiest compliance (worn like any glasses). Disadvantage: cost — a reference range in Taiwan is about NT$ 20,000–30,000 / pair, varying by clinic, frame and coatings; plus replacement every 1–2 years as the prescription changes adds up over time. May be used as monotherapy or combined with atropine. Similar products: HAL lenses (Highly Aspherical Lenslets, Essilor Stellest — authorized by the US FDA in September 2025 for children aged 6–12 at treatment initiation), CARE / DOT lenses.

Myth 6 · "Repeated Low-Level Red Light therapy (RLRL) — is it safe?"

Repeated Low-Level Red-Light Therapy (RLRL) uses 650 nm light, 3 minutes twice daily (at least 4 hours apart), 5 days a week. Jiang 2022: 264 randomized; 246 included in the analysis. The following are adjusted 12-month results (RLRL versus single-vision spectacles).

• Adjusted axial elongation: +0.13 versus +0.38 mm (RLRL versus single-vision spectacles).
• Adjusted SER progression: −0.20 versus −0.79 D (RLRL versus single-vision spectacles).
• Read axial-length and refractive outcomes separately; do not combine studies into one efficacy rate.

However, important concerns:

• Liu et al. (2023) reported bilateral retinal injury in one 12-year-old girl. Two eyes are not two patients; this is a named case report, not a current worldwide case count. Long-term safety remains uncertain.
• Long-term (>5 year) safety data lacking, especially regarding cumulative retinal phototoxicity.
• Possible rebound after stopping: in a 2-year follow-up, children who stopped RLRL had 0.42 mm axial elongation in year 2 versus 0.28 mm with continuous single-vision spectacles (Xiong 2022; described by the authors as a modest rebound).
• Not FDA-approved for myopia control; Australia's TGA registered a home-use myopia-control red-light device in 2023 (Class IIa); no Taiwan licence for myopia use was found.

The latest meta-analysis (Lin 2026; 28 RCTs, 3573 children) found RLRL slowed myopia over 12 months with mostly mild, transient adverse events, but the authors call for longer trials with comprehensive retinal safety assessment. Given the reported retinal injury case, it is not first-line for now; if used, select cases carefully with close fundus follow-up, and prefer atropine or Ortho-K, which have more long-term data.

Myth 7 · "Outdoor time has nothing to do with myopia, right?"

Evidence is robust:

• He M et al's 2015 Guangzhou JAMA cluster RCT (n=1903 first-graders): adding one 40-minute outdoor class each school day reduced 3-year myopia incidence from 39.5% to 30.4%.
• Wu PC et al's Taiwanese studies: encouraging recess outside the classroom lowered 1-year myopia onset (8.41% vs 17.65%, 2013); a 16-school cluster randomized trial showed less myopic shift (2018); after the 2010 "Tian-Tian 120" outdoor policy, the prevalence of reduced visual acuity in primary schoolchildren reversed from a rising to a falling trend (2020).
• Dose-response: a meta-analysis of cross-sectional studies found about 2% lower odds of myopia per additional hour outdoors per week (Sherwin 2012).

Mechanistic hypotheses (not fully proven):

• Light triggers retinal dopamine release — inhibits axial elongation
• Distant viewing — reduces accommodative demand
• Pupil constriction, increased depth of field — reduces retinal defocus

Practical advice: following Taiwan's Health Promotion Administration "3010120" guidance, ≥2 hours outdoors daily (cloudy days count too) — most critical pre-school. The evidence is strongest for preventing myopia onset (pooled trials: about 46% lower risk of incident myopia); for children who are already myopic, the effect on slowing progression is unclear (Xiong 2017). Key is "being outdoors," not "exercise" — outdoor walking, outdoor reading both qualify, as long as in natural light.

Myth 8 · "Is myopia control lifelong? When can we stop?"

The endpoint isn't a fixed age — it's when myopia naturally plateaus. In the US COMET cohort, myopia stabilized at a mean age of about 15.6 years; about 77% had stabilized by 18 and 90% by 21 (IMI 2023 review). Typical timeline:

Before stopping:

• Confirm <0.50 D change over 12 consecutive months.
• For atropine, consider tapering before stopping: in the 8-year LAMP results (2026), children given 0.05% for 6 months and then 0.025% for 6 months before stopping had about 0.24 D less progression over 3 years than those who stopped directly (larger differences in younger and more myopic children), although the clinical relevance of this difference is unclear.
• For Ortho-K, suspend wear for 1–2 weeks and recheck.

Continue follow-up after cessation, especially for high myopia (IMI definition: spherical equivalent ≤−6.00 D); retinal health requires lifelong monitoring.

5 things parents can do

Three high-risk groups should consult an ophthalmologist early about active intervention: onset before age 6, parental high myopia, progression >0.50 D/year.

Key references

1. Yam JC, et al. Low-Concentration Atropine for Myopia Progression (LAMP) Study. Ophthalmology. 2019;126(1):113-124.
2. Yam JC, et al. LAMP Study Phase 2 Report. Ophthalmology. 2020;127(7):910-919.
3. Yam JC, et al. LAMP Study Phase 3 — Continued vs Washout. Ophthalmology. 2022;129(3):308-321.
4. Chia A, et al. Atropine for the Treatment of Childhood Myopia (ATOM2). Ophthalmology. 2012;119(2):347-354.
5. Lam CSY, et al. DIMS spectacle lenses slow myopia progression: 2-year RCT. Br J Ophthalmol. 2020;104(3):363-368.
6. Jiang Y, et al. Effect of Repeated Low-Level Red-Light Therapy for Myopia Control in Children. Ophthalmology. 2022;129(5):509-519.
7. Flitcroft DI, et al. IMI – Defining and Classifying Myopia: A Proposed Set of Standards for Clinical and Epidemiologic Studies. Invest Ophthalmol Vis Sci. 2019;60(3):M20-M30. IMI consensus definition.
8. Liu H, Yang Y, Guo J, Peng J, Zhao P. Retinal Damage After Repeated Low-level Red-Light Laser Exposure. JAMA Ophthalmol. 2023;141(7):693-695. doi:10.1001/jamaophthalmol.2023.1548.
9. He M, et al. Outdoor Time and Myopia Development in Children: RCT. JAMA. 2015;314(11):1142-1148.
10. Wu PC, et al. Outdoor Activity during Class Recess Reduces Myopia. Ophthalmology. 2013;120(5):1080-1085.
11. Gifford KL, et al. IMI – Clinical Management Guidelines Report. Invest Ophthalmol Vis Sci. 2019;60(3):M184-M203.
12. Chia A, et al. Atropine for the treatment of childhood myopia: changes after stopping atropine 0.01%, 0.1% and 0.5%. Am J Ophthalmol. 2014;157(2):451-457.e1.
13. Zhang Y, et al. Discontinuation Approach and Follow-Up of Low-Concentration Atropine for Myopia Progression: Eight-Year Results of the LAMP Randomized Clinical Trial. JAMA Ophthalmol. 2026;144(5):396-403.
14. Lam CSY, et al. Long-term myopia control effect and safety in children wearing DIMS spectacle lenses for 6 years. Sci Rep. 2023;13(1):5475.
15. Leung TW, et al. Long-term axial elongation in myopic children wearing DIMS spectacle lenses: an 8-to-10-year observational study. BMJ Open Ophthalmol. 2026;11(2):e002780.
16. Bullimore MA, Sinnott LT, Jones-Jordan LA. The risk of microbial keratitis with overnight corneal reshaping lenses. Optom Vis Sci. 2013;90(9):937-944.
17. Cho P, Cheung SW. Retardation of myopia in Orthokeratology (ROMIO) study: a 2-year randomized clinical trial. Invest Ophthalmol Vis Sci. 2012;53(11):7077-7085.
18. VanderVeen DK, et al. Use of Orthokeratology for the Prevention of Myopic Progression in Children: A Report by the American Academy of Ophthalmology. Ophthalmology. 2019;126(4):623-636.
19. Chamberlain P, et al. A 3-year Randomized Clinical Trial of MiSight Lenses for Myopia Control. Optom Vis Sci. 2019;96(8):556-567.
20. Xiong R, et al. Sustained and rebound effect of repeated low-level red-light therapy on myopia control: A 2-year post-trial follow-up study. Clin Exp Ophthalmol. 2022;50(9):1013-1024.
21. Wu PC, et al. Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized Trial. Ophthalmology. 2018;125(8):1239-1250.
22. Wu PC, et al. Increased Time Outdoors Is Followed by Reversal of the Long-Term Trend to Reduced Visual Acuity in Taiwan Primary School Students. Ophthalmology. 2020;127(11):1462-1469.
23. Sherwin JC, et al. The association between time spent outdoors and myopia in children and adolescents: a systematic review and meta-analysis. Ophthalmology. 2012;119(10):2141-2151.
24. Xiong S, et al. Time spent in outdoor activities in relation to myopia prevention and control: a meta-analysis and systematic review. Acta Ophthalmol. 2017;95(6):551-566.
25. Haarman AEG, et al. The Complications of Myopia: A Review and Meta-Analysis. Invest Ophthalmol Vis Sci. 2020;61(4):49.
26. Bullimore MA, et al. IMI – Onset and Progression of Myopia in Young Adults. Invest Ophthalmol Vis Sci. 2023;64(6):2.
27. Health Promotion Administration, Taiwan. Press release on myopia in 6th graders and hyperopic reserve (2022-12-20; updated 2025-03-24). hpa.gov.tw.
28. Ministry of Health and Welfare, Taiwan. Press release with Table 1 of the 2017 national child and adolescent vision survey (2018-05-04). mohw.gov.tw.
29. Clark RA, Wong RK. Spherical Equivalent Refraction Versus Axial Length for Monitoring Childhood Myopia and Estimating Disease Risk: A Systematic Review and Meta-Analysis. Am J Ophthalmol. 2026;286:235-247.
30. Lin LY, et al. Duration-Dependent Efficacy and Clinical Safety of Repeated Low-Level Red-Light Therapy for Paediatric Myopia: A Systematic Review and Meta-Analysis. Clin Exp Ophthalmol. 2026;54(5):630-652.
31. Health Promotion Administration, Taiwan. Press release on the 2025–26 preschool vision screening pilot (2026-06-25). hpa.gov.tw.
32. Ministry of Health and Welfare, Taiwan. Home eye-care advice from the Health Promotion Administration (2021-06-02; updated 2023-07-27). mohw.gov.tw.
33. Ministry of Education, Taiwan. School lighting energy-saving reference manual, Table 4.4 (CNS 12112:2012; classrooms 500 lux).