July 15, 2025
By Ashley Tucker, OD, FAAO, FSLS, ABO Diplomate
One of the most challenging conversations in myopia management is explaining to parents why their child’s myopia has still progressed—even when they have committed to treatment. They have followed every instruction, properly used the prescribed contact lenses or compounded atropine and encouraged outdoor time. So, when the prescription still increases or axial length continues to grow, they feel confused and discouraged.
As clinicians, we understand that myopia management is not about halting progression completely—it’s about slowing it. But for families, this nuance is often lost. “Why is it getting worse if we’re ‘managing’ it?” is a question we hear regularly, and it’s one we must be prepared to answer with clarity, empathy and evidence.
Reframing Expectations
The first step is reframing expectations from the beginning. Myopia progression is a physiological process influenced by multiple factors: age, genetics, environment and more. Unfortunately, no currently available treatment can stop it—but our goal is to reduce the rate of progression over time, often by 30% to 60% depending on the method and patient profile.1-3
Framing this in relative terms is powerful: “With treatment, your child may progress less each year than they would have without it.” This may become especially meaningful when paired with visual tools like progression charts and axial length growth curves.
Normalizing and Contextualizing Progression
We must also normalize progression during treatment. Children with faster progression may still have increases even with treatment—and this doesn’t mean the treatment is failing. It means the child likely would have progressed even more without it.
When families see that 0.50D increase and feel alarmed, we can re-contextualize it: “Without treatment, this may have been closer to a full diopter or more. This is a sign the treatment is helping, even if there’s still change.” It may also be impactful to remind the family how much progression was happening prior to treatment. If in the months or years leading up to treatment, the child progressed more than the current progression, this will also help solidify the positive impact of treatment.
That distinction—less progression is still success—is crucial. The challenge is that success doesn’t always feel successful to parents, particularly for those with type A personalities. Many expect a straight line, not a curve. But in reality, myopia control is about altering the slope of that curve, not flattening it entirely.
This is also where ongoing communication becomes key. We must prepare parents for the long game. Myopia management isn’t a one-time fix—it’s a multi-year strategy. Regular progress reviews with axial length data and age-based benchmarks help keep the family grounded in the broader context. Without these touchpoints, it’s easy for parents to interpret any increase as failure.
The Power of Validation
Finally, emotional validation goes a long way. Parents are often anxious and self-critical, wondering if they have missed something or done something wrong. We can affirm their efforts: “You’re doing everything right. Your child is doing everything right. The fact that we’re seeing less change than expected means you’ve helped protect your child’s future vision.” That kind of reassurance reinforces trust and commitment to the treatment plan.
In myopia management, measurable success isn’t always obvious or clear cut – it can still look like progression. Helping parents make sense of this reality is part of our job—and it’s one of the most meaningful ways we can support both children and their families.
References
1 Zhang G, Jiang J, Qu C. Myopia prevention and control in children: a systematic review and network meta-analysis. Eye (Lond). 2023 Nov;37(16):3461-3469. doi: 10.1038/s41433-023-02534-8. Epub 2023 Apr 27. PMID: 37106147; PMCID: PMC10630522.
2 Sarkar S, Khuu S, Kang P. A systematic review and meta-analysis of the efficacy of different optical interventions on the control of myopia in children. Acta Ophthalmol. 2024 May;102(3):e229-e244. doi: 10.1111/aos.15746. Epub 2023 Aug 14. PMID: 37578349.
3 Schmidt DC, Hvid-Hansen A, Jacobsen N, Jakobsen TM, Larsen PM, Lindblad KK, Møller F, Slyngborg A, Subhi Y, Kessel L. Efficacy of interventions for myopia control in children: A systematic review with network meta-analyses. Acta Ophthalmol. 2025 Apr 11. doi: 10.1111/aos.17496. Epub ahead of print. PMID: 40219611.
