January 5, 2026
By Andy Cheng, OD, FAAO
Photo Credit: Getty Images
My journey in pediatric eye care started long before optometry school. In college, I worked as a vision therapist, helping children with vision challenges. Caring for these children instilled a love for pediatrics that ultimately guided my career. Thinking back to my own childhood, my young cousins and a lot of the neighborhood children spent a lot of time playing at our house, so pediatrics was always the specialty that made sense and felt most natural for me.
After optometry school at SCCO, I completed a residency at SUNY focused on pediatric primary care and disease. From there, I joined SUNY as a clinical faculty member in the pediatrics department, supervising residents and interns.
Eventually, I returned to Maryland, where I joined one of the largest pediatric ophthalmology groups as their first optometrist. This experience taught me how to navigate a busy specialty environment, while carving out a niche for my own clinical focus.
Building a Program That Works for You and Your Practice
When I first started incorporating myopia management, it wasn’t just a matter of clinical knowledge—it required designing systems that worked efficiently in a busy pediatric setting. At first, neither my colleagues nor staff had experience fitting contact lenses for children. A staff member who had prior contact lens experience became our go-to primary trainer for insertion and removal. From there, we designated a separate room and scheduled insertion and removal training during quieter parts of our day, creating a process that fit seamlessly into our already packed schedules. We also created simple handouts with QR codes linking to training videos, helping families and children gain confidence before they even tried the lenses.
Myopia control is extremely important to start as early as possible, and we are now fortunate enough to have multiple available treatment options. One thing that has helped a lot is engaging directly with the patient—not just their parents. I always try to get the child’s input to gauge their readiness and tailor support. This approach gives children a sense of control and makes them more invested in their care.
I have children as young as 6 wearing MiSight contact lenses, and they’re doing great—don’t underestimate children! After all, children love to make adults proud. Even more so, they love to make their friends at school jealous—going to school with contact lenses while their friends still have to wear glasses is a point of pride for them. Over the years, I’ve learned that involving children in the conversation versus speaking only to their caregivers improves compliance and helps families to make shared, informed decisions.
Helping Families Understand Their Options
Parents often arrive with a basic understanding of myopia, but limited awareness of its long-term risks or treatment options. I explain myopia using simple analogies that are easily understood. If explanations are too complicated or technical, the message often gets lost in translation. Progressive myopia can be related to a balloon that’s getting blown up too much. As the eye grows, the tissues get stretched thinner and weaker, just like a balloon. This increases the risk of complications later on in life. Together, we review all of the evidence-based interventions—lifestyle adjustments, low-dose atropine, orthokeratology and FDA-approved myopia control soft contact lenses like MiSight 1 day.
Follow-up is structured to balance evidence-based care with practical scheduling. I see children every four to six months for at least the first two years. If a child’s progression remains stable and they’re into their teenage years (when myopia tends to naturally slow down), these visits may transition to annual monitoring—though many prefer continuing with semiannual care. This schedule reflects both clinical evidence and real-world experience, allowing for close observation during the most critical years of eye growth.
Real-World Impact and Practical Takeaways
The true value of myopia management becomes clear in the stories from patients. One 13-year-old who had been progressing roughly 1-1.5D per year from age 6-10 had never been offered intervention by previous providers. After starting him in MiSight 1 day at age 10, his progression has been virtually halted for three years. His mother’s reaction—“Why didn’t we find you four years earlier?!”—underscored the importance of early intervention.
Many children start hesitant about contact lenses, gradually gaining confidence and even mastering insertion without having to use a mirror. We celebrate their success at each follow-up. Practice makes perfect!
Contact lenses offer distinct advantages over pharmacologic therapy, especially for children who are more active. They provide clear, unobstructed vision during sports, eliminate the need for nightly drops and boost self-esteem in children who might otherwise struggle with spectacles. Yet every child is different, and it is our role to guide families toward the most suitable, evidence-based option for their child’s age, temperament, and lifestyle.
Just Start
For clinicians considering adding myopia management to their practice, the advice is simple: start. Begin with what you can manage and refine your processes as you gain experience. Engage both parents and their children in decision making, communicate early on and lean on evidence-based approaches. Over time, you will see undeniable results in slowing progression, improving quality of life for children and building family trust in your care. That trust speaks volumes—happy patients and parents will shout your praises. In just a few short years, I’ve managed to build a large following and referral network because word of mouth spreads fast!
As we look ahead, new technologies, such as novel myopia control glasses, will expand options, particularly for younger children who may not be ready for contact lenses. Despite evolving treatments, the core principles remain: early intervention, shared decision making and tailored, evidence-driven care.
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Dr. Andy Cheng is the Chief Pediatric Optometrist at Kids Eye Care of Maryland, a large pediatric ophthalmology group that is also a collaborator in The Pediatric Eye Disease Investigator Group (PEDIG). He received his Doctor of Optometry degree from Southern California College of Optometry. He also completed his Pediatric Optometry residency at SUNY College of Optometry, after which he served as an Attending in the Pediatric Optometry clinic supervising residents and interns. His current clinical interests include amblyopia and strabismus treatment and management, as well as pediatric myopia control. Dr. Cheng has been a Fellow of the American Academy of Optometry since 2015. |
