Visual Training for Myopia Control: An Independent and Additive Inhibitor of Axial Growth

Purpose: To evaluate the efficacy of visual training (VT) in retarding axial elongation in myopic children and to determine its additive clinical value when combined with standard myopia control modalities, including orthokeratology (OK), defocus spectacles (DS), and low-concentration atropine (LCA). Methods: This is a retrospective, multicenter, self-controlled cohort study. A total of 208 myopic children (mean age 9.73 ± 2.08 years) who underwent a structured visual training program were included. Subjects were stratified into five subgroups based on concurrent treatments: VT monotherapy, VT+DS, VT+OK, VT+DS+LCA, and VT+OK+LCA. Annualized axial elongation rates were calculated for the pre-training (baseline) and post-training intervals. The primary outcome was the reduction in axial elongation rate. Results: The mean axial elongation rate significantly attenuated from a baseline of 0.38 ± 0.34 mm/year to 0.23 ± 0.30 mm/year following the intervention (P < 0.001), representing a mean reduction of 0.15 ± 0.31 mm/year. There were no statistically significant differences in the magnitude of rate reduction among the five subgroups (P = 0.826), indicating that VT confers a consistent additive benefit independent of concurrent optical or pharmacological therapies. Pearson correlation analysis revealed a good positive association between baseline progression rate and treatment efficacy (r = 0.57, P < 0.001), suggesting that children with faster initial progression derived the greatest therapeutic benefit. Conclusion: Visual training effectively slows axial elongation, shifting pathological growth trajectories toward physiological norms. It functions as a universal adjunctive therapy, providing robust and independent protective effects regardless of whether the patient is using OK lenses, defocus spectacles, or atropine. These findings support the use of visual training as a priority “rescue therapy” for rapid progressors. Keywords: myopia, visual training, axial elongation, binocular vision, adjunctive therapy