Myopia management: The sins of commission vs. the sins of omission

About a decade ago, I was fortunate to attend a CET lecture by Professor Ed Mallen who outlined the many significant breakthroughs in our understanding of the mechanisms that drove myopic progression. He explained how a relative, under-corrected defocus in the retinal periphery could reduce to stimulus to axial elongation (figure 1, above). As a myope married to a myope and with two myopic daughters, I was curious about the potential for this breakthrough to evolve into mainstream optometry.  

While there had been some experimental intervention around the use bifocal soft contact lenses to manage myopia prior to that period, I could not help feeling that our recent, heightened understanding of the peripheral defocus mechanism could be the catalyst to a real breakthrough in mainstream clinical practice. Of course, the ability to place a relative under-correction in the periphery always leaned towards a contact lens intervention as the most obvious mode of delivery, I did not consider at that time that a spectacle lens could be designed to produce the same effect. We now know this is an option.