Refractive Errors

Publication Date: December 19, 2022
Last Updated: January 2, 2023

Highlighted Findings and Recommendations for Care

  • The prevalence of myopia is increasing in the United States and other industrialized societies. Increased time spent outdoors appears to be protective against myopia in children. Increased levels of near work are less of a risk factor than previously believed.
  • Increased outdoor time and low-concentration atropine have been shown to reduce the likelihood of myopia onset.
  • Antimuscarinic eyedrops, multifocal spectacles and contact lenses, and overnight orthokeratology have been shown to be varibly effective in some populations for myopia control, that is, to reduce the progression of myopia in school age children.
  • Studies from around the world have confirmed that that the incidence of microbial keratitis has not been reduced with the introduction of new lens types and that overnight wear of any contact lens is associated with a higher risk of infection than daily wear.
  • Although there are lenses approved by the FDA for extended wear, alternatives should be presented to patients for whom this mode of contact lens wear is being considered because overnight wear, regardless of contact lens type, increases risk of microbial keratitis.
  • Daily disposable contact lenses (rather than planned replacement lenses) are the safest lenses with the lowest rate of complications associated with soft contact lens wear.
  • No-rub cleaning, topping off (reuse) of solutions, contaminated lens cases, exposure to tap water, wearing contact lenses in hot tubs and showers and while swimming, and changes in water supply are associated with Acanthamoeba and fungal keratitis related to contact lens wear in the recent decades.
  • Hydrogen peroxide systems are superior to multipurpose solutions for reducing the likelihood of infections or inflammatory complications; they are the preferred mode of nightly disinfection for patients who cannot wear daily disposable lenses, especially if they have had complications of contact lens wear in the past.
  • Presbyopia can be managed by using eyeglasses; contact lenses; topical agents; intraocular lenses with multifocal, accommodating, or extended depth of focus features; and monovision strategies with contact lenses or intraocular lenses.

Recommendation Grading




Refractive Errors

Authoring Organization

Publication Month/Year

December 19, 2022

Last Updated Month/Year

August 9, 2023

Supplemental Implementation Tools

Document Type


Country of Publication


Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Outpatient, Operating and recovery room

Intended Users

Nurse, nurse practitioner, optometrist, physician, physician assistant


Treatment, Management, Prevention

Diseases/Conditions (MeSH)

D012030 - Refractive Errors


refractive errors, refractive surgery

Source Citation

Jacobs DS, Afshari NA, Bishop RJ, Keenan JD, Lee J, Shen TT, Vitale S; American Academy of Ophthalmology Preferred Practice Pattern Refractive Management/Intervention Panel. Refractive Errors Preferred Practice Pattern®. Ophthalmology. 2022 Dec 19:S0161-6420(22)00867-3. doi: 10.1016/j.ophtha.2022.10.031. Epub ahead of print. PMID: 36543603.