This article systematically reviews the evidence for combination therapy in pediatric myopia control and examines the synergistic potential of optical and pharmacological interventions. A comprehensive narrative literature review of randomized controlled trials, observational studies, and meta-analyses evaluating combination approaches for myopia control in children was conducted, with a particular focus on orthokeratology, multifocal contact lenses, and defocus incorporated multiple segments (DIMS) or highly aspherical lenslet (HAL) spectacles combined with low-concentration atropine. Current evidence demonstrates that combination therapy achieves additional slowing of myopia progression compared to that with optical interventions alone. The combination of orthokeratology and low-dose atropine has been studied extensively. Although several studies have shown that combination therapies yield additional effects, these effects are not always statistically significant. Emerging evidence supports a similar efficacy for multifocal soft contact lenses and DIMS or HAL spectacles combined with atropine. Mechanistic synergy appears to involve complementary pathways; optical interventions modulate peripheral defocus signals, whereas atropine acts directly on choroidal and scleral tissues. Combination therapy may show promising effects in myopic management in specific patient groups. The convergence of evidence from multiple optical modalities combined with atropine suggests its broad applicability. However, the optimal treatment protocols, long-term efficacy beyond 2–3 years, population-specific response variations, and cost-effectiveness in different healthcare contexts require further investigation.

The prevalence of pediatric myopia continues to increase worldwide, with East Asia bearing a particularly high burden of early-onset and progressive disease. In Japan, systematic school-based vision screening enables early detection, creating a clinical environment in which myopia control is an integral part of pediatric eye care. This review summarizes the current strategies, clinical evidence, and distinctive characteristics of myopia control in Japan with a primary focus on optical interventions. In Japan, myopia control is implemented within a structured framework that integrates pharmacological, optical, and lifestyle approaches. Optical strategies play a central role in clinical practice. Orthokeratology (Ortho-K) has been widely adopted and supported by national clinical practice guidelines that emphasize safety, patient education, hygiene management, and long-term follow-up. Soft contact lenses (SCLs) for myopia control have gained increasing attention, particularly dual-focus designs supported by robust international evidence, along with emerging optical concepts such as extended depth-of-focus lenses. Although regulatory approval for myopia control remains limited, Japanese clinical practice has adopted a cautious stepwise approach that balances international evidence with local clinical experience and ethical considerations. Limited published data from Japan indicate that Ortho-K and various SCLs designs have been investigated in the pediatric population. Overall, myopia control in Japan is characterized by evidence-based practices, regulatory awareness, and an emphasis on safety and education. This experience provides insights into how Ortho-K and SCLs may be integrated into routine clinical care, and highlights the importance of continued research, guideline development, and international collaboration.

Myopia is an escalating global public health issue. The earlier onset and increasing prevalence of high myopia heighten the lifetime risk of vision-threatening complications, making the control of childhood axial elongation a central objective of contemporary myopia management. This narrative review summarizes the mechanistic rationale, clinical efficacy, safety considerations, and practical implementation of three non-pharmacologic modalities: orthokeratology (Ortho-K), dual-focus/multifocal soft contact lenses (specifically MiSight 1 day), and repeated low-level red-light (RLRL) therapy. The review emphasizes evidence-based effect sizes and monitoring needs. Evidence from randomized trials, meta-analyses, guideline perspectives, and mechanism-oriented studies was synthesized, prioritizing axial length outcomes, with spherical equivalent refraction considered as a complementary endpoint where appropriate. Key randomized trials and meta-analyses indicate that Ortho-K reduces axial elongation compared to single-vision controls by approximately 0.19 mm at one year and 0.28 mm at two years. In contrast, MiSight 1 day demonstrates a sustained effect, showing roughly 0.32 mm less axial elongation over three years. While RLRL has exhibited large short-term effects in recent trials, the certainty of the evidence remains low, and long-term retinal safety and generalizability have yet to be fully established. Overall, Ortho-K and MiSight represent established optical options with consistent efficacy and defined safety profiles, whereas RLRL is a high-interest modality with promising signals but greater uncertainty regarding long-term retinal safety and durability. Clinicians should adopt a monitoring-forward approach centered on longitudinal axial length tracking, given the substantial inter-individual variability in progression rate and response.

The global prevalence of childhood myopia is escalating, necessitating effective and non-invasive interventions to mitigate axial elongation and associated pathologies. Defocus spectacle lenses (DSLs), a category encompassing technologies such as Defocus Incorporated Multiple Segments (DIMS), Highly Aspherical Lenslets (HAL), and Cylindrical Annular Refractive Elements (CARE), have emerged as primary management strategies. Unlike conventional single-vision lenses, DSLs utilize specific optical geometries to impose a myopic defocus on the peripheral retina to inhibit eye growth, while maintaining clear central vision. This narrative review synthesizes evidence from randomized controlled trials (RCTs), long-term extension studies, and real-world datasets published until late 2025. We critically evaluated the optical designs, clinical efficacy, fitting protocols, compliance determinants, and safety profiles. Converging evidence from pivotal RCTs demonstrates that DIMS and HAL designs reduce myopia progression and axial elongation by approximately 50–60% over 2–3 years compared to single-vision lenses. Long-term data extending to 6 years for DIMS and 5 years for HAL suggest sustained efficacy with minimal rebound observed upon discontinuation, although the evidence remains limited. Emerging designs utilizing alternative mechanisms, such as contrast modulation (Diffusion Optics Technology [DOT]) and geometric phase/quality variations (e.g., CARE), also show promising efficacy. Combination therapies, particularly DSLs with low-dose atropine, have shown additional benefits for rapid progressors. Nonetheless, real-world effectiveness is heavily dependent on compliance (targeting approximately 12 h/day) and precise fitting parameters. Currently, DSLs are a well-established, scalable, and generally safe approach for myopia control. Future clinical practice should prioritize rigorous fitting standards, objective compliance monitoring, and personalized treatment selection, based on individual progression risks and optical profiles.

Childhood myopia has become a significant global public health concern, especially in urbanized regions, with adolescent prevalence rates at 80–90%. This increase poses clinical challenges and significant socioeconomic burdens, necessitating effective prevention strategies. Recent research has demonstrated that genetic predisposition and environmental exposure, such as increased screen time, intensive near work, and reduced outdoor activity, are crucial in the onset and progression of myopia. Parental myopia and specific loci identified through genome-wide association studies (GWASs) contribute to susceptibility and disease severity; however, environmental factors can accelerate or attenuate these genetic risks. Emerging strategies have focused on integrating genomic and epigenetic information to advance personalized prevention and treatment. Therefore, childhood myopia arises from the complex gene–environment interactions. Ongoing research and policy innovation are essential to safeguard the vision and health of future generations.

Myopia has reached epidemic proportions globally, with a prevalence exceeding 80–90% among young adults in East Asia. This public health crisis has catalyzed the development of artificial intelligence (AI) applications to transform myopia management from reactive correction to predictive precision prevention. This review synthesizes the advances in AI applications across the myopia management continuum, encompassing risk prediction, automated monitoring, and clinical decision support systems (CDSS). Emphasis is placed on contributions from high-prevalence regions. We conducted a comprehensive PubMed literature search for studies published between 2018 and 2025 using the terms “myopia,” “artificial intelligence,” “machine learning,” “deep learning,” and “clinical decision support.” These studies demonstrated that deep learning systems achieve areas under the receiver operating characteristic curve exceeding 0.95 for pathologic myopia detection and up to 0.97–0.98 for 5-year high myopia risk prediction in early longitudinal cohorts. Self-supervised foundation models (RETFound) enable few-shot learning for rare complications with limited labeled data. Vision transformers outperform conventional convolutional neural networks in detecting subtle lesions such as lacquer cracks. Time-series transformers (Informer, TimesNet) demonstrate 8–12% improvements in long-term refractive prediction relative to long-short term memory architectures. Federated learning frameworks enable privacy-preserving multi-institutional collaboration. AI-guided interventions reduce the incidence of high myopia by 17.8% in simulated trials. AI has achieved expert-level performance in myopia detection, risk prediction, and progression forecasting. The convergence of foundation models, federated learning, and closed-loop management ecosystems signal a pivotal era for precision myopia care; however, real-world clinical trials and cross-ethnic validation are essential before widespread deployment.

Currently, contact lenses are widely used as the primary means of vision correction, with an increasing number of users. However, long-term lens wear increases the risk of developing dry eye syndrome by disrupting the ocular surface stability and accelerating tear film evaporation. Meibomian gland dysfunction (MGD), a major pathophysiological mechanism underlying dry eye syndrome, induces changes in the tear lipid layer, thereby exacerbating tear film instability, inflammatory responses, and subjective discomfort. Conventional treatments for dry eye disease, such as artificial tear instillation, warm compression, and anti-inflammatory medications, rely on the temporary relief of symptoms and often show limited therapeutic effects. Accordingly, intense pulsed light (IPL) therapy, which aims to restore the structural and functional integrity of the meibomian glands, has attracted attention. This study examined the interrelationship between contact lens wear, dry eye syndrome, and MGD and discussed the clinical efficacy of IPL treatment and its significance as a therapeutic strategy for dry eye syndrome in contact lens wearers.

Purpose: This study reports the results of a survey on the diagnosis and treatment status of Acanthamoeba keratitis among members of the Korean Contact Lens Study Society. Methods: To understand the current trends of diagnosis and treatment of Acanthamoeba keratitis in Korea, a 16-question survey was conducted on 1,189 members of the Korean Contact Lens Study Society in November 2024. Results: In total, 132 members responded to the survey (response rate; 11.1%). Among them, 79 members (59.8%) reported having encountered Acanthamoeba keratitis at least one case annually, whereas nine (6.8%) reported having experienced > 6 cases annually. Ninety-six members (72.7%) reported that they used slit-lamp microscopic findings and clinical symptoms as basis for diagnosis. Regarding first-line topical medication, 0.02% polyhexamethylene biguanide (PHMB) was the most commonly used (63.3%), followed by 0.02% PHMB plus 0.02% chlorhexidine combined therapy (26.3%) and 0.02% chlorhexidine alone (24.6%). In cases of progressive keratitis despite medical treatment, the surgical treatment options included corneal transplantation (58.6%) and corneal epithelial debridement (46%). Corticosteroids were used in 70 patients (61.9%) to manage neovascularization or corneal opacity after keratitis improved (75.9%,); 0.1% fluorometholone (64.7%) was used most frequently. After keratitis improved, 104 patients (94.5%) continued to use eye drops for > 2 months. Conclusions The survey showed the diagnosis and treatment trends of Acanthamoeba keratitis in Korea.

Purpose: To report the clinical characteristics and treatment outcome of dematiaceous fungal keratitis initially misdiagnosed as a corneal foreign body.Case summary: A 51-year-old woman with a history of corneal opacity and recurrent ocular irritation presented with aggravated pain and a brown lesion in the right eye. A well-demarcated, elevated brown lesion located at the central cornea, corneal infiltration and epithelial defects were observed by slit-lamp examination. Anterior segment optical coherence tomography demonstrated posterior signal attenuation behind the brown lesion, with intact anterior chamber. Following removal of the lesion, fungal culture and potassium hydroxide (KOH) smear examination were performed. Yeast-like organisms exhibiting both hyphal and pseudohyphal forms were observed on KOH smear. For accurate identification of the fungus, molecular analysis using DNA sequencing was performed, confirming Cladophialophora boppii. After treatment with topical amphotericin B and oral itraconazole, corneal infiltration and clinical symptoms gradually improved. No recurrence was observed after discontinuation of antifungal therapy. Conclusions The patient presenting with a brown corneal lesion initially misdiagnosed as a corneal foreign body was diagnosed with dematiaceous fungal keratitis through microbiological culture and was successfully treated with antifungal agents.

Purpose: The study was designed to evaluate the combined therapeutic effect of topical 2% rebamipide and 0.5% carboxymethylcellulose sodium (CMC) for managing dry eye following cataract surgery compared with 2% rebamipide monotherapy. Methods: We retrospectively analyzed medical records of patients who underwent cataract surgery and were diagnosed with dry eye one week postoperatively. Among these, patients who received combined therapy with 2% rebamipide and 0.5% carboxymethylcellulose (CMC) eye drops (combined therapy group), or 2% rebamipide alone (monotherapy group), for at least two months were included. Clinical data were collected at one and two months after surgery, including Schirmer’s test, tear break-up time (TBUT), ocular surface staining scores, tear film osmolarity, tear lipid layer thickness, and Ocular Surface Disease Index (OSDI) scores. Results: In the combined therapy group, we observed a significant improvement in Schirmer’s test, TBUT, and ocular surface staining scores at both one and two months post-surgery compared to baseline (1 month: p < 0.001, < 0.001, 0.005; 2 months: p < 0.001, respectively). OSDI remained unchanged throughout the entire follow-up period. The combined therapy group exhibited significantly longer Schirmer’s test results (p < 0.001, 0.003), longer TBUT (p = 0.022 at 1 month), and a lower ocular surface staining score (p < 0.001, respectively) compared to the monotherapy group. Conclusions Following cataract surgery, the combined use of rebamipide and CMC eye drops resulted in improvements in Schirmer’s test, TBUT, and ocular surface staining scores. This suggests that combination therapy may be a promising option for patients who do not achieve adequate relief with rebamipide eyedrops.