Myopia Rebound: What Happens When You Stop Treatment?

One of the questions optometrists hear most often from parents of children on myopia control treatment is some version of: "If we stop the atropine, will his eyesight get worse really fast?" It is a fair concern — and the honest answer is more nuanced than a simple yes or no. Myopia rebound after stopping treatment is real for some modalities and essentially absent for others, and understanding the difference matters enormously for counselling families and planning long-term management.

This post summarises the current clinical evidence on myopia rebound across the four main treatment types — atropine eye drops, orthokeratology (ortho-K), soft multifocal contact lenses (including MiSight), and myopia control spectacle lenses (DIMS/MiYOSMART) — and outlines what the evidence says about when and how to stop.

What Exactly Is Myopia Rebound?

Before diving into the data, it is worth being precise about what rebound means. Myopia rebound is defined as axial elongation or refractive progression that is faster after stopping treatment than in an age-matched untreated control group. This is a stricter definition than simply "progression resumes when treatment stops" — the eye returning to its baseline rate of progression is not rebound. True rebound is an acceleration beyond what was expected without treatment.

This distinction matters because older papers sometimes compared post-cessation rates to rates during active treatment. Naturally progression looks faster when you stop a working treatment than when it is running — that is not rebound, that is losing the benefit. The landmark 2025 reanalysis by Bullimore and Brennan (Ophthalmic and Physiological Optics, 2025) corrected this methodological error across 24 treatment groups from 19 studies, showing that prior estimates of rebound had been substantially inflated.

Atropine Eye Drops: The Concentration-Dependent Effect

Atropine is the treatment where the rebound evidence is most nuanced — and most clinically important.

High-dose atropine carries significant rebound risk

The ATOM 1 trial (Chia et al., Ophthalmology, 2012), conducted at the Singapore National Eye Centre (SNEC), was the first large randomised controlled trial to document the rebound effect systematically. Children in the 0.5% and 1% atropine groups experienced faster myopia progression during the one-year washout period after stopping treatment compared to those on lower concentrations. The net treatment benefit — accounting for this rebound — was substantially reduced in high-concentration groups.

This finding reshaped global practice. Clinicians who had been prescribing high-dose atropine for its greater short-term efficacy had to weigh that against a rebound that eroded the gains.

Low-dose 0.01% atropine: a different picture

The ATOM 2 trial (Chia et al., Ophthalmology, 2016) followed up by comparing 0.01%, 0.1%, and 0.5% atropine over two years, plus one washout year. It confirmed that 0.01% atropine produced the least rebound of all three concentrations. Progression during the washout year was mild enough that 0.01% outperformed the higher-dose groups on five-year net myopia change despite having a weaker in-treatment effect.

The LAMP Study Phase 3 (Yam et al., Ophthalmology, 2021) from Hong Kong provided additional granularity. The 0.025% and 0.01% groups showed no detectable rebound — progression during washout was consistent with age-expected untreated rates. The 0.05% group showed a small but statistically detectable rebound of approximately 0.04 mm additional axial elongation per year, which the authors described as clinically insignificant.

A 2024 systematic review and meta-analysis in Frontiers in Pharmacology (Lee, Tsai, Chiu, Wang, and Chiu) added important risk stratification: rebound after atropine cessation is more pronounced in children who are younger at cessation, who received shorter treatment duration, and who had higher baseline spherical equivalents. These factors should inform clinical timing decisions.

The corrected Bullimore and Brennan 2025 estimate puts average atropine rebound at +0.05 mm/year of axial elongation — modest but real, and concentrated in the six months immediately after stopping rather than persisting indefinitely.

Orthokeratology: Rebound Requires Careful Planning

The rebound picture for orthokeratology is clearer — and more concerning.

A 2024 systematic review (PMC10779574) that examined 14 studies and 703 participants found that ortho-K showed a strong rebound effect across eight cessation studies. Post-cessation axial elongation was significantly faster than baseline in the majority of studies reviewed. The mechanism is proposed to involve reversal of ortho-K-induced choroidal thickening and loss of the peripheral myopic defocus signal that suppresses axial growth during active lens wear. When the structural and optical adaptations induced by the lenses unwind, progression accelerates beyond expected age-related rates.

The review authors conclude that counselling families about this rebound risk before initiating ortho-K is "highly necessary," and that monitoring for at least 12 months after cessation is required. The Bullimore and Brennan 2025 paper grouped ortho-K with high-dose atropine and repeated low-level red light therapy (RLRL) as the treatment categories most associated with measurable rebound — in contrast to spectacle- and contact lens-based optical interventions.

Clinically, this means the decision to stop ortho-K should not be taken lightly. Most practitioners recommend not discontinuing before age 14, and only when axial length has demonstrated genuine stability.

MiSight 1 Day and Soft Multifocal Contact Lenses: Good News

For parents and clinicians using soft multifocal daily disposable lenses like MiSight 1 Day (CooperVision), the rebound data is reassuring.

In the seventh year of CooperVision's longitudinal MiSight study, all participants were switched from MiSight to single-vision soft contact lenses. The result: no rebound effect was observed. Axial elongation and refractive progression returned to age-expected rates without acceleration, and all the treatment gains accumulated over the prior years were retained. Earlier cessation data — from a two-year treatment followed by one-year washout period — had already shown the same pattern.

The MASS Study (Current Eye Research, 2021) independently confirmed no rebound after MiSight discontinuation in a Spanish cohort.

The mechanistic explanation is that soft multifocal lenses achieve their myopia control effect through optical signals (peripheral defocus) that return to baseline on cessation, without inducing the structural choroidal or scleral changes that then reverse. When the lens is no longer worn, the eye simply resumes its natural course rather than overshooting.

DIMS and MiYOSMART Spectacle Lenses: No Rebound Detected

Myopia control spectacle lenses — including the DIMS (Defocus Incorporated Multiple Segments) technology used in the MiYOSMART lens — have the longest cumulative dataset among spectacle-based interventions.

Six-year and eight-year follow-up data from HOYA and the Hong Kong Polytechnic University showed no rebound effect on discontinuation. The Bullimore and Brennan 2025 paper confirmed this as a category finding: spectacle-based myopia control interventions show no rebound. The same mechanistic reasoning applies as for soft CLs — the optical signal disappears with the lenses, but no structural adaptation reverses.

Rebound Risk by Treatment Type: A Summary

Treatment	Rebound Risk	Key Evidence
High-dose atropine (0.5–1%)	High	ATOM 1; ATOM 2
Medium-dose atropine (0.05%)	Low-moderate	LAMP Phase 3
Low-dose atropine (0.01–0.025%)	Minimal	ATOM 2; LAMP Phase 3; WA-ATOM 2024
Orthokeratology	Moderate-high	PMC10779574 (8 studies)
MiSight / soft multifocal CLs	None detected	MiSight 7-year; MASS 2021
DIMS / MiYOSMART spectacles	None detected	MiYOSMART 8-year; Bullimore 2025
Repeated low-level red light (RLRL)	High	Bullimore 2025

When Is the Right Time to Stop?

No universal age cut-off exists in current clinical guidelines. The cleaner approach is to use stability criteria:

Refractive change less than 0.25 D per year
Axial length increase less than 0.1 mm per year
Both criteria met over a minimum 12-month observation period

The 2025 Korean Myopia Society Consensus and the International Myopia Institute (IMI) 2025 Interventions update both cite these thresholds. In practice, about 75% of myopic individuals have stabilised by age 18, which is why most practitioners target the mid-to-late teens as a natural cessation window — but a 17-year-old whose axial length is still growing 0.3 mm per year is not a candidate to stop, regardless of age.

The critical principle

A patient still showing active progression should not have treatment stopped. The decision should be driven by measured stability, not school year, parental fatigue with drops, or the child reaching a milestone age. For Singapore children — who tend to have later stabilisation than Western cohorts due to higher academic screen demands — erring toward continuation through late secondary school is generally prudent.

How Should Treatment Be Stopped?

Tapering atropine

The 2025 WSPOS (World Society of Paediatric Ophthalmology and Strabismus) Myopia Consensus Statement and the IMI 2025 Interventions paper both recommend gradual tapering rather than abrupt cessation for atropine, particularly at concentrations above 0.01%. A commonly discussed step-down approach moves from 0.05% to 0.025% to 0.01% over several months before stopping, or reduces from daily to alternate-day dosing. No standardised taper protocol has yet been established in formal guidelines, but a 2025 expert opinion paper (PubMed PMID 41705331) outlines several clinical approaches.

For 0.01% atropine, the rebound risk is low enough that abrupt cessation is more defensible — but continuing to monitor every six months for at least a year after stopping is still recommended.

Stopping ortho-K

Ortho-K cannot be tapered in the same way, but the stopping decision carries greater weight given the rebound risk. Ensure axial length stability is documented before discussion with the family. Have a rebound monitoring plan in place — measurements at three, six, and twelve months after cessation is a reasonable minimum.

Stopping optical interventions

MiSight and DIMS spectacle lenses can be discontinued without tapering. The family simply transitions to standard correction. However, continued monitoring for 6–12 months is still good practice to confirm that progression rates remain within expected ranges.

What to Monitor After Stopping

Regardless of which treatment was used, the post-cessation monitoring period matters:

Axial length measurement at 3–6 months, then annually — this is the most sensitive indicator of acceleration
Refraction under cycloplegia at each visit — rebound shows up here too, but axial length changes often precede refractive changes
Return-to-treatment decision criteria: if post-cessation progression exceeds 0.25 D/year or 0.1 mm/year in axial length, resuming treatment should be discussed

For optometrists managing a busy myopia clinic, having a structured recall system that flags post-cessation patients for timely follow-up is essential. Missing a rebound in the six months after stopping — when it is most likely to occur — means the window to re-intervene before meaningful additional prescription accumulates is lost.

Track Your Child's Myopia Trajectory

Before deciding when and whether to stop myopia control treatment, it helps to understand where your child's prescription is likely to land under different scenarios. CarrotByte's free Myopia Progression Calculator models projected outcomes from now to age 17 under untreated, atropine, ortho-K, and spectacle lens scenarios, using published treatment effect sizes from peer-reviewed trials.

Try the free Myopia Progression Calculator →

For optometrists looking to discuss cessation timing with patients in a data-driven way, the calculator can help frame the conversation around where the child is likely to stabilise — making the rebound discussion more concrete for families.

Key Takeaways

The myopia rebound picture varies enormously by treatment type. The major clinical messages from current evidence are:

Rebound is a real concern with ortho-K and higher-dose atropine, and should be discussed with families before treatment begins, not after
Low-dose atropine (0.01–0.025%) carries minimal rebound, making it a more forgiving choice when cessation timing is uncertain
Soft multifocal contact lenses (MiSight) and DIMS spectacle lenses show no rebound in the evidence to date — a meaningful clinical advantage
Stopping decisions should be based on axial length stability criteria, not age alone
Atropine above 0.01% should be tapered rather than stopped abruptly
Post-cessation monitoring for at least 12 months is recommended regardless of which treatment was used

Singapore's own SNEC-led ATOM trials were foundational in establishing these principles globally. The low-dose paradigm that most Singapore clinicians now follow is, in part, a direct result of understanding the rebound risk — and managing it well starts with measuring axial length consistently before, during, and after treatment.

Myopia Rebound: What Happens When You Stop Treatment?