Editor’s Perspective

How Will A.I. Impact the Future of Myopia Management?

July 1, 2024

By Dwight Akerman, OD, MBA, FAAO, FBCLA, FIACLE

The media frenzy over artificial intelligence (A.I.) reminds me of the 2022 comedy-drama film Everything Everywhere All at Once. Every day, I read articles in the consumer media as well as professional journals about novel, exciting uses for A.I. Generative A.I. is a type of artificial intelligence technology that broadly describes machine learning systems capable of generating text, images, code, or other types of content in response to a prompt entered by a user. Generative A.I. algorithms (such as ChatGPT, Copilot, Gemini, and LLaMA) are increasingly being incorporated into online tools and chatbots that allow users to type questions or instructions into an input field, upon which the A.I. model will generate a human-like response. Generative A.I. has uses across a wide range of industries, including software development, health care, finance, entertainment, customer service, sales and marketing, art, writing, fashion, and product design.

A.I. is becoming increasingly valuable in the field of myopia management due to its ability to process vast amounts of data and provide personalized treatment recommendations. By analyzing patient data, including axial length, refractive errors, lifestyle factors, and genetic predisposition, A.I. algorithms can help eye care professionals tailor interventions to individual needs. Additionally, A.I. can assist in early detection of myopia progression by identifying subtle changes in the fundus over time, allowing for timely intervention to slow down the condition. Furthermore, A.I. can help educate both health care professionals and the public about the latest advancements and best practices in myopia management, contributing to improved awareness and outcomes. 

Recently, I tested Microsoft Copilot with GPT-4 with a hypothetical case of an 8-year-old myopic child. Overall, I was impressed with the responses. Importantly, it did not recommend single vision spectacles or contact lenses, which have no benefit in slowing the progression of myopia. Also, it reminded the reader to consult with an eye care professional for the best treatment options for the child.

Question asked to Microsoft Copilot with GPT-4 on June 16, 2024:
“What is the best intervention to slow the progression of axial elongation for an 8-year-old Asian female who has -3.00D of myopia? She spends, on average, 60 minutes per day outdoors, and five hours per day reading or working on a digital device. Her axial length in both eyes is 25 mm and both parents are -8.00D myopes.”

Microsoft Copilot with GPT-4 response:
“For an 8-year-old child with -3.00D of myopia, an axial length of 25 mm in each eye, and highly myopic parents, the goal is to slow down the progression of myopia, particularly the axial elongation. Here are some treatments that have been shown to be effective:

  1. Low-Dose Atropine Eye Drops: Research shows that low-dose atropine eye drops (0.05%) can slow progression for over three years.1 This can have a large impact if children use the drops during the peak years of myopia progression.1
  2. Orthokeratology (OrthoK): This involves the use of specially designed gas permeable contact lenses that are worn during sleep. They temporarily reshape the cornea to reduce refractive errors and have been shown to slow down axial elongation.1-3
  3. Special Contact Lenses: The MiSight 1 day soft contact lens (CooperVision) is the only FDA-approved lens to slow the progression of myopia in children 8 to 12 years of age at initiation of treatment. These lenses have been shown to slow the progression of spherical equivalent refractive error and axial elongation.4,5
  4. Lifestyle Changes: Encourage the child to spend more time outdoors and take breaks from near work, such as reading and screen time. This has been associated with a reduced risk of developing myopia and slower progression of the condition.

Given that both parents are highly myopic, it’s important to monitor the child’s vision closely as there may be a higher risk of rapid progression. Regular eye exams are crucial to detect any changes early and adjust the treatment plan as necessary.

Please consult with an eye care professional for the best treatment options for the child. They can provide guidance based on the child’s specific condition, lifestyle, and overall health.

Please note that while I strive to provide accurate and up-to-date information, this advice should not replace a consultation with a health care professional. Always seek the advice of a qualified health care provider with any questions about a medical condition.”

Source: Conversation with Copilot, 6/16/2024

Understanding How to Use A.I. in Optometry
I admit that asking Microsoft Copilot with ChatGPT 4, “
What is the best intervention to slow the progression of axial elongation…?” is an unfair question. Why? In an editorial I recently wrote, What is the Best Treatment for Childhood Myopia? I remind clinicians that they should strive to deploy a comprehensive myopia management strategy that involves decision-making based on age, lifestyle, familial risk, axial length, position on the axial length growth chart, progression rate, risk of high myopia, potential side effects, and individual preferences. This personalized approach ensures optimal long-term myopia management.

We cannot predict which myopia management treatment will work best for an individual child. The intervention that best matches their lifestyle may be the most appropriate option to maximize treatment compliance. Continual patient/parental education regarding the purpose of myopia treatment and outcome expectations is imperative to motivate children to follow the eye care professional’s recommendations appropriately. Frequent touch points allow the eye care professional to re-educate the child and parents on the importance of adhering to the prescribed treatment regimen.

While A.I. serves as a powerful tool in myopia management, it is vital to note that the recommendations provided should complement, rather than replace, the expertise of eye care professionals. Ultimately, the integration of A.I. technologies in myopia management holds great promise in enhancing treatment efficacy and optimizing patient care.

Best professional regards,

Dwight H. Akerman, OD, MBA, FAAO, FBCLA, FIACLE
Chief Medical Editor



1 Understanding Axial Length: Myopia Management. https://comptoneye.com/understanding-axial-length-myopia-management/.

2 Guidelines for Managing Myopia: a Review – Modern Optometry. https://modernod.com/articles/2022-mar/guidelines-for-managing-myopia-a-review.

3 IMI Clinical Myopia Management Guidelines Report. https://myopiainstitute.org/wp-content/uploads/2020/09/IMI-Clinical-Myopia-Management-Guidelines_FINALv2.pdf.

4 Three Case Series Report: The use of Axial Length in Myopia Management. https://contactlensupdate.com/2021/09/06/three-case-series-report-the-use-of-axial-length-in-myopia-management-clinical-decision-making/.

5 Spherical Equivalent, Axial Length, or Both to Measure Myopia Progression? https://reviewofmm.com/spherical-equivalent-axial-length-or-both-to-measure-myopia-progression/.

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