As more cases of myopia develop worldwide, clinical intervention skills grow in importance. Among the many practical questions experts are trying to work out is when to discontinue therapy and how to do so safely, as studies have shown there can be a rebound effect when treatments are discontinued. A new literature review analyzed the possible rebound effect of myopia control glasses, various contact lens designs, topical atropine and newer light-based therapies. Researchers found that the optical treatments seem to produce less rebound effect, but pharmacological and light therapies seem to achieve better control of myopia progression.

Lens-based myopia interventions seem to produce less rebound effect than others. However, many factors are at play in an individual response to any myopia mitigation strategy. Click image to enlarge.

A total of 11 full-length randomized controlled studies, as well as post-hoc analyses of randomized controlled studies reporting new findings on myopia control treatments’ rebound effect, were included.

New spectacles designs incorporating HAL or DIMS designs seem to be effective in slowing myopia progression, the researchers noted in their paper, but rebound effects were seen after discontinuation of the spectacle lenses. One study in the review measured the rebound effect six months after treatment with HAL spectacles in children and reported that the increase in axial length was three times higher in the group that stopped the treatment.

“On the other hand,” the authors countered, a different study reported that “after cessation of DIMS spectacle wear, myopia continued to progress at the same rate as when they were worn, with a 24% rapid increase in AL in the group that stopped the treatment.” The latter study was longer, measuring the rebound effect for 2.5 years following 3.5 years of treatment. “Therefore, children who ceased treatment were, on average, 14 years of age at the beginning of the follow-up period, finishing the study with a mean age of 16 years. This result seems to indicate that the centering of these spectacle designs plays a crucial role in controlling myopia progression.”

The newer option of red light therapy, not yet approved in the US, showed the highest rebound effect compared with the other myopia control treatments. “This rebound effect may be explained by the greater control of myopia progression reported in these studies,” the authors explained. “Therefore, further investigations are needed to elucidate the mechanism of action,” the team noted, “as well as the minimum potency of this therapy that achieves the best control of myopia progression with the least possible rebound effect.”

For atropine, it was reported that 12 months after treatment cessation, the rebound effect was lower in participants who had received the 0.01% concentration compared with 0.5% and 0.1% formulations. Similar results were reported by other studies, with no significant rebound effect after cessation of 0.01% atropine.

One study cited in the literature review “showed that younger children were more likely to exhibit a greater rebound effect than older children, which may be explained by the slower physiological myopia progression of the older children,” the authors noted. “Overall, these results appear to indicate that 0.01% atropine has the lowest rebound effect and achieves significant control of myopia progression, but further studies comparing the rebound effects of 0.01%, 0.025% and 0.05% atropine are needed.”

In addition, spectacles designed for myopia intervention, soft multifocal contact lenses and orthokeratology showed lower rebound effects compared with atropine or low-level light therapy.

“Being aware of the rebound effect of myopia control treatments could help healthcare professionals and patients plan for continued myopia treatment effectively and choose the most suitable treatment option,” the authors concluded.