Meta-analysis Shows Myopia Control Interventions Increase Choroidal Thickness

Researchers found that children and adolescents receiving higher-dose or combined pharmacological treatments for myopia control showed the largest short-term changes in choroidal thickness. Photo: Eyerising International. Click image to enlarge. Evidence suggests that choroidal thickness could serve as both a sensitive biomarker and a mediator of myopia progression; thinner choroids are associated with worsening myopia, while effective control interventions have been shown to lead to significant thickening. This was demonstrated in a recent meta-analysis appearing in Ophthalmology Science, in which interventions such as low-dose atropine (0.01% to 0.05%), orthokeratology and repeated low-level red light therapy (RLRL) produced early, measurable increases in choroidal thickness.To conduct the systematic review, the authors analyzed 11 randomized controlled trials comparing those three myopia control strategies against single-vision lenses or placebo groups. The analysis included a total of 2,190 eyes from children and adolescents, most between the ages of eight and 12 years. OCT was used to assess choroidal thickness at specified intervals, typically ranging from one month to two years following intervention initiation.The results revealed that RLRL therapy led to the most significant increase in choroidal thickness, with a mean difference of 24.1µm. Atropine, while producing less pronounced and more heterogeneous effects, still demonstrated a noteworthy average increase in thickness of 10.6µm. Orthokeratology also exhibited consistent results, yielding an average thickening of 13.3µm.The study authors reported that the most substantial changes in choroidal thickness were observed within the first few months of treatment across the various interventions studied. Moreover, combined or higher-dose interventions generally produced earlier and greater increases in thickness.Several previous studies have made similar observations, including one that showed 0.05% atropine combined with dual-focus contact lenses led to robust choroidal expansion and transient axial shortening, with effects persisting even after discontinuation. Similarly, another study found that children undergoing ortho-K with 0.01% atropine achieved greater subfoveal thickening than those on monotherapy, reinforcing the notion that combined therapies enhance early choroidal responses.The researchers believe that the results of this study and those preceding it “suggest a common pathway for choroidal thickening across various myopia control interventions.” They explained in their paper, “Most studies employing advanced OCT and image binarization indicate that choroidal thickening is driven by proportional expansion of both luminal (vascular) and stromal compartments, with minimal change in the choroidal vascularity index,” adding that “this has been observed across modalities, including atropine, orthokeratology and RLRL therapy, suggesting that vascular engorgement and stromal fluid shifts are the dominant microstructural responses, rather than selective angiogenesis or remodeling.”Still, the researchers caution that current evidence is insufficient to establish a common physiological mechanism for choroidal thickening. Moreover, they note that the significant and rapid thickening associated with RLRL should especially be interpreted with discretion. Although trials report strong structural responses, the mechanisms remain unclear, with the potential for red-light exposure to influence vascular tone or induce low-grade inflammatory reactions. In summary, the study authors note that while these findings are promising, they should be considered preliminary, as varying protocols and populations contribute to some heterogeneity. Nonetheless, the consistent choroidal changes observed underscore the necessity for further research, which the authors say should involve more diverse populations and extend follow-up periods to assess the long-term significance of choroidal remodeling, as well as the prognostic value of baseline choroidal features.“Large randomized trials that combine choroidal metrics with clinical outcomes are essential for understanding the role of these structural changes in pediatric myopia,” they concluded.Click here for the journal source. Martinez-Perez C, Oliveira A. Impact of myopia control interventions on choroidal thickness in children: a systematic review and meta-analysis of RCTs. Ophthalmol Sci. December 17, 2025. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.