MiyoSmart, Stellest or low-dose atropine: the non-Ortho-K options compared

Where you are right now

Your child has been short-sighted for a year or two, the prescription keeps climbing, and Ortho-K is not on the table: perhaps your child is not keen on lenses, perhaps you are not keen on overnight wear. The optometrist has mentioned two kinds of glasses with unfamiliar names and an eye drop. This guide compares those three on what they are, what they ask of your child, and what is known about them. If overnight lenses are still a possibility, read Ortho-K, soft lenses or glasses for a child as well.

One thing to settle first: these options slow myopia, they do not reverse it. If the words are new, what myopia is explains why a rising prescription matters.

MiyoSmart and Stellest: glasses that do two jobs

Both are spectacle lenses that look like ordinary glasses from the outside. The centre of the lens gives clear distance vision in the normal way. Around that centre sits a zone of tiny lens segments or lenslets that changes how light lands on the side of the retina, which is thought to reduce the signal for the eye to keep growing longer. The American Academy of Ophthalmology describes the Stellest design as a clear centre surrounded by rings of tiny raised lenslets, and says it requires ongoing, full-time wear to get the full benefit. The MiyoSmart page describes Hoya's version and carries the trial figure the practice publishes for it. The Stellest page covers Essilor's lens.

What wearing them involves is simple: glasses on in the morning, off at bedtime. The catch is in the word full-time. A lens that is in the schoolbag during sport or on the bedside table during screen time is doing nothing for those hours. The Academy reports that some children in the Stellest trial noticed blur or haloes, and no other adverse effects were reported.

On evidence, the Cochrane living review of myopia control in children, updated in 2025, says myopia control spectacle lenses may reduce progression but that it remains uncertain about the size of their benefit, partly because most studies ran two years or less. We do not add figures for Stellest here because the practice does not publish one, and we do not repeat the MiyoSmart figure because the two come from different trials. Our Ortho-K versus myopia control glasses page sets both lenses alongside the other options we fit.

Low-dose atropine: a drop at night

Atropine is a medicine, not a lens. In New Zealand, Medsafe first approved Eikance low-dose atropine eye drops on 21 December 2023, in three strengths, as a prescription-only treatment to slow the progression of myopia when started in children aged from 4 to 14 years. The data sheet says treatment should be supervised by an eyecare professional, that at least two measurements at least six months apart are recommended before starting, and that the dose is one drop in each eye at night. It should not be used in children under four, and it is contraindicated where there is angle-closure glaucoma.

What the drops do not do is correct vision. Your child still wears glasses or lenses during the day. The most common side effects in the Medsafe consumer leaflet are blurred vision, sensitivity to bright light, allergy, sore or itchy eyes, headache and fatigue. The data sheet notes light sensitivity was much more common in the first two weeks of treatment than later, and that sunglasses or photochromic lenses help; near blur can be managed with a different lens design. Tell the prescriber if your child complains in bright sunlight or with close work.

Stopping matters. Medsafe's data sheet warns of a rebound, a faster rate of progression, if treatment stops early, and says doses may be reduced gradually before stopping. The consumer leaflet says not to stop without telling your doctor, and that the length of treatment is variable. On evidence, the Cochrane 2025 review found atropine eye drops can slow progression and reduce eye lengthening, that higher doses are the most effective, and that the effect of low doses may be small and is uncertain. Our earlier post on eye drops for myopia control gives the background.

Who prescribes atropine in New Zealand, and what it costs

Eikance is prescription-only. The Optometrists and Dispensing Opticians Board says an optometrist who is authorised to prescribe medicines is one registered in the Optometrist scope of practice without a condition prohibiting prescribing, which you can check on the ODOB public register. Ophthalmologists and GPs can also prescribe. At NVISION, Dr Catherine Jennings is a therapeutically endorsed optometrist, and low-dose atropine drops are among the options listed on our myopia control page. Ask us what the prescribing arrangement would be for your child before you count on it.

Pharmac does not currently fund it. A funding application for atropine 0.01% eye drops for myopia remains active and under assessment, according to Pharmac's July 2024 decision, so for now the drops are bought at the pharmacy on a private prescription. The pharmacy sets the price. Lens costs are on our consultation fees page and the MiyoSmart page; the Enable New Zealand children's spectacle subsidy can contribute towards frames and lenses for eligible children, and whether a myopia control lens fits within it is a question for us or for Enable.

Choosing between them, or combining them

There is no single right answer, and the American Academy of Ophthalmology notes that doctors may combine lenses and drops to increase the effect of treatment. The Cochrane review calls for better studies of combinations. A fair way to think about it:

• A child who already wears glasses happily, all day: a myopia control spectacle lens keeps everything familiar and adds no routine. This is often where a younger child starts.
• A child whose myopia keeps moving despite a control lens: ask about adding atropine. The drops work by a different route, and the Medsafe indication is written around a measured rate of progression, which is why axial length measurements matter.
• A child who will not keep glasses on: atropine alone does not help, because the blur is still there. Talk about soft lenses or Ortho-K instead.
• A child who gets bad light sensitivity on drops: the data sheet suggests sunglasses or photochromic lenses, and the prescriber can adjust the strength. Do not simply stop.
• A teenager with a low, stable prescription: it may be reasonable to correct and watch. Myopia tends to stabilise in the late teens or early twenties, and the Medsafe data sheet notes it is not established whether the benefit persists if treatment stops after that point.

When this practice is the wrong place

A child on atropine who develops a hot, flushed, dry skin, a rapid pulse or a fever, or who becomes confused or unsteady, needs a GP or the hospital emergency department the same day. Medsafe lists these as signs of atropine reaching the rest of the body. They are described in relation to stronger drops, and no systemic events have been reported with low concentrations, but they are the signs to know. Take the bottle with you.

For any child, with or without drops: call 111 or go to the emergency department for a chemical splash (flush with clean running water for at least 15 minutes first), anything that has pierced the eye, a sudden loss of vision, a shadow or curtain across the vision, or flashes with a sudden shower of floaters. A red, painful eye that cannot tolerate light needs to be seen the same day. Healthline on 0800 611 116 can help you decide. Routine questions about lenses, drops and prescriptions are what an optometry appointment is for, and no referral is needed.

What to do next

The useful first step is a myopia control assessment with recent eye test results, so the choice is made against your child's own measurements rather than in general. Book through the myopia control page or call us.