Myopia management 

A guide through awareness, science and practice

Short-sightedness, medically known as myopia, has gradually and continuously crept into our school classrooms, families and optometry practices over the past decades. It is not a ‘trend’ but a global challenge that has a concrete impact on everyday working life. A fundamental question for optometrists and ophthalmologists is: How do we overcome this challenge?

Action instead of waiting: Why information is the first step

What is the biggest challenge in dealing with childhood myopia? It is not the lack of product diversity, measurement technology or knowledge about myopia among opticians or ophthalmologists – it is the awareness among parents and short-sighted people. 

For most parents, myopia is a visual impairment like any other and therefore receives little attention or is trivialized: ‘He’ll just get glasses, like I did,’ is a frequently heard response. As we now know, myopia is influenced by many factors and does not just ‘happen’. It can progress if the growth in length deviates from the natural process of emmetropization. As a result, the risk of eye diseases in adulthood may be increased. And very few of those affected are aware of this.

For this reason, myopia management does not begin with measurement, but with a discussion with the parents and the child/adolescent.

Parents are informed with patience, empathy and responsibility. Sometimes concrete examples from practice help to increase confidence in the matter.

The simple question, ‘May I show you how your child’s vision is likely to change over the next few years if we don’t act now?’ often has more impact than any technical term. It is even more impressive when parents can experience how myopia develops through special simulations. Only when the invisible becomes visible does understanding begin.

More than just visual aids: a market in motion

The good news: in recent years, an impressive range of scientifically based methods has been developed to treat the progression of myopia. And the range of options is constantly growing. 

From specially manufactured spectacle lenses (e.g. with DIMS or H.A.L.T. technology) to certified soft contact lenses (as daily, monthly, conventional and multifocal lenses) and orthokeratology contact lenses to low-dose atropine drops – the selection is diverse and there is a solution for every eye care practitioner that they feel comfortable with.

There are now also several hybrid care concepts in the market. These combine, for example, contact lenses with spectacle glasses with myopia lenses or contact lenses with atropine. The whole process can then be accompanied by digital therapy plans. The key is to remember that not every product is suitable for every child – individualization is key. It is advisable to offer at least two solutions in your portfolio.

For ECP, this means that economic decisions should never be made in isolation from medical responsibility. Gaining an overview of mechanisms of action, target groups and long-term results is not only a wise move, but also a future-proof one.

Creating structures – how to get started

Effective myopia management is not an individual project, but a team effort. It starts with a conscious decision: Do we want to establish myopia management as an integral part of our daily business? Do we have the personnel and time capacities? Are we prepared to invest in training and measurement technology?

If the answer to these questions is yes, then appropriate measures should follow:

• Training for the entire team, especially team members who are primarily involved in sales. Since they are the first point of contact with children and their parents, they should be able to provide them with information.
• Setting aside time slots in the appointment calendar for myopia management.
• Practising communication to overcome uncertainties.
• Practising confidence in using the measurement technology. Tip: Measure the axial length for every customer.
• In addition, the myopia management procedures must be defined:
• Screening from the age of six – earlier if there are risk factors.
• Measurement of axial length and family history.
• Informing parents, including written consent.
• Individual product selection and six-monthly check-ups.
• Documentation and, if necessary, communication with specialists.

Websites such as ‘Myopiacare’ or ‘Myopiaprofile’ offer questionnaires, guidelines, and marketing materials in the form of printed matter and training courses. Often free of charge.

‘Myopiaprofile’ is an English-language website with German-language training courses and materials.

‘Neyece’ is a network for ECP who are committed to myopia management.

There is now a wide range of measurement technology available to offer professional myopia management. Software for documenting and visualizing the progress is almost always included.

Between diagnosis and dialogue – the path to success

Many players in myopia management often ask themselves: Why are parents in some countries so reluctant to engage with myopia management compared to other countries? What could be the reasons for this? 

Let’s look at an example from Germany:

Health = health insurance benefit: In Germany, the healthcare system is strongly influenced by the expectation that medically necessary services will be covered by health insurance. If this is not the case, as in myopia management, for example, the measure is quickly perceived as ‘nice to have’ or even a ‘marketing ploy’.

Glasses as a solution, not a signal: For many parents, glasses are a suitable method of correcting poor vision. This image is familiar and functional. The fact that progressive myopia carries long-term risks is little known or underestimated. There is often a lack of understanding that normal glasses only correct symptoms, but do not stop the progression.

Uncertainty and lack of information: Parents today have access to a wide range of information, but the sources do not always meet the required standards of reliability. If the management of myopia is not explained clearly, concretely and confidently, many opt for the path of least resistance: they wait.

Money is rarely the main problem – rather, it is the internal value scale: Parents often make considerable investments in the form of private tuition, sports clubs or music lessons, as they see a recognizable purpose and effect in these areas. As a rule, this emotionally charged sense of purpose is not taken into account in myopia management.

How can we change the mindset of decision-makers?

Nowadays, well-conducted optical consultations are just as important as specialist knowledge. It is about building relationships, alleviating fears and activating values. Myopia management needs to be explained – not only technically, but also emotionally. Those who meet parents where they are emotionally – in their concern for the well-being of their children – build trust and open up a willingness to act. The message: it’s not just about vision, but about quality of life – even in adulthood.

Systemic thinking provides valuable insights here: parents do not make decisions purely rationally, but in the context of their roles, values and family experiences. A skillfully conducted conversation can help to break down barriers.

Making values visible: What is really important to parents?

One approach could be to start with value-oriented conversation:

• ‘What do you want for your child’s future?’
• ‘What role do independence, concentration or health play in this?’

These questions encourage reflection. In this case, myopia management is no longer seen as a cost factor, but as an active contribution to achieving these values.

Making effects tangible instead of just explaining them

Human change does not usually take place on the basis of facts, but through experiences gathered over the course of a lifetime. A quick eye test simulating higher myopia progression, a before-and-after example or a simple visualization of the change in axial length can create moments of realization. 

True to the motto: expand the scope for action through experience – not just through information alone.

Communicate responsibility instead of blame

It is crucial not to make parents feel that they have failed simply because they have not taken any action so far. Instead, ECP should signal that they value and acknowledge the parents’ willingness to invest time in an initial consultation and their desire for change.

This attitude activates a sense of self-efficacy, which is a key factor in the willingness to change.

Reframing investment: from price to meaning

A proven approach is reframing. Instead of talking about costs, the consultation can focus on the meaning. Possible statements could be:

• ‘It’s not about glasses, it’s about how your child will be able to see in ten years’ time.’
• ‘Here, you are not only investing in visual acuity, but also in learning ability, quality of life and safety.’

Change begins with relationships, not arguments

Myopia management is not purely a technical issue, but a relationship issue. This is evident in the interaction between parents and children, between ECPs and parents, and between facts and feelings. 

To strengthen the willingness to change, it is advisable to not only rely on information, but also to provide inspiration.Furthermore, myopia management is not a short-term phenomenom, but a long-term, profound change in pediatric optometry. Investing in education, equipment and training is worthwhile. This will make you a health partner on equal footing and a shaper of the future for the next generation.

The good news at the end: parents are willing to take action – but only if they are understood, listened to and supported. Dealing with myopia is not just a question of technology or products, but rather a question of relationships. This is precisely where the ECP’s greatest strength lies: creating closeness, building trust and enabling change.

Conclusion

The myopia epidemic calls for a new self-image and corresponding attention in our daily work. Those who look beyond the horizon of dispensing glasses and provide holistic support to children do more than just provide care – they offer guidance in an increasingly digital and visually demanding world. It’s not just about good vision. It’s about the future.

Guide to myopia management – the status quo

The most important findings of the IMC (International Myopia Conference) 2024 are summarized below:

Definition and significance of pre-myopia:

• Children with less than +1.50 D hyperopia at the age of 6–7 are considered high risk for progressive myopia.
• Recommendation: Early start with preventive measures (e.g. behavioral changes, myopia glasses or contact lenses if necessary).

Axial length measurement is and remains the gold standard:

• Axial eye growth > 0.2 mm/year is considered a critical threshold.
• Length measurement before refraction changes alone (especially in younger children, a reliable statement about the success of myopia management by means of refraction is not valid) – recommended for every myopia check-up.

Combination therapies:

• Combination of ortho-k + low-dose atropine (0.01–0.05%) initially shows stronger progression inhibition.
• In the long term, the additive effect flattens out – further studies are needed.

Conclusion

Daylight intensity is crucial:

• New studies show: > 120 minutes per day outdoors at a minimum of 1,000 lux has a strong preventive effect.
• Classrooms with low light levels (<500 lux) are associated with higher rates of myopia.

Close work confirmed as a risk factor:

• Reading at a distance of <20 cm for long periods (>30 min) is significantly associated with myopia progression.
• Recommendation: 20-20-2 rule (look into the distance for 20 seconds every 20 minutes + 2 hours of daylight daily)

Innovative technologies and outlook

Red light therapy (RLRL):

• Initial controlled studies with repetitive low-level red light show a significant reduction in axial length growth.
• No long-term data on safety and sustainability available yet – use only recommended with strict indication.

AI-supported myopia prognosis:

• Prototypes of AI systems can calculate individual risk very precisely based on refraction data, axial length and family history.
• Goal: integration into screening tools and electronic patient records.

Clinical practice & recommendations

Therapy discontinuation and rebound:

• DIMS, MiSight and Ortho-K show little to no rebound effects at the end of therapy – in contrast to higher atropine concentrations.
• Important: Gentle tapering or gradual transition.

Individualized treatment plans as a recommendation:

• One-size-fits-all is outdated – a combination of axial length, age, progression rate and behavior is crucial.
• Treatment matching is becoming standard practice.