A Clinical Approach to Modifying Your Myopia Treatment Plans

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April 1, 2026

By Stephanie Ramdass, OD, MS, MBA, FAAO, FSLS

Routine refraction tells us what prescription is needed to see 20/20 today. However, myopia management tracks progression over time and aims to reduce the rate of eye growth. We know eye growth is subtle—yet accelerated—in our youngest myopes.¹ For this reason, assessing myopia management success goes beyond checking whether a child can see clearly on the eye chart. Axial length measurements, when available, alongside refractive changes, provide critical clinical insight into how the eye is responding to treatment.² These objective markers help eye care professionals determine whether a child’s individualized plan is effectively slowing myopia progression or whether a modification may be needed to better protect long-term eye health.

What Defines Treatment Success?

Treatment success in myopia management is determined through regular, structured monitoring, typically every three to six months, and sometimes more frequently depending on the treatment modality used and the child’s age or risk profile. Objective measurements of axial length and refractive error are evaluated in comparison to a child’s baseline measurements prior to treatment initiation.

The rate of change over time, rather than a single data point, is what guides clinical decision-making. As clinicians, our goal of  managing is to limit the absolute refractive error and to stabilize axial length. As a general reference for axial length change in established myopes, ≤0.10–0.15 mm/year is optimal, 0.15–0.20 mm/year is acceptable and >0.20 mm/year (commonly seen in untreated myopes (~0.30 mm/year in children <10) is indicative of inadequate control.³ Even small reductions in eye growth can meaningfully lower the lifetime risk of myopia-associated eye disease.⁴ In this context, any amount of myopia progression that is slowed or prevented matters.

Equally important are practical considerations such as treatment compliance and family fit. A therapy that works well for one child or family may be less effective for another, underscoring the need for individualized, adaptable care plans.

The 5 Clear Signs it Might be time to Switch Treatment Modalities:

1. 
   

   Progression Despite Treatment

If a child demonstrates more than 0.50D of myopia progression per year or axial elongation of 0.30 mm or more annually, this raises concern that the current monotherapy may not be providing adequate control. Interpretation should still be individualized, as the clinical significance of each 0.25D of refractive change or 0.10 mm of axial elongation depends on the child’s age, baseline risk, prior progression pattern and treatment context. In untreated childhood myopia, progression of approximately 0.50D per year is commonly seen after onset.⁵

When a myopia management strategy is effective, the aim is to reduce that rate meaningfully, often by around 50% or more.⁶ This means that treatment success does not necessarily require progression to stop completely, but it should result in substantially slower progression than would be expected without treatment. As a practical benchmark, a meaningful treatment response would ideally limit progression to no more than 0.25D over one year. Even when this threshold is not fully achieved, modest slowing may still provide cumulative long-term benefit. However, if refractive progression remains high or axial elongation exceeds the thresholds outlined above, the current treatment plan should be reassessed and may need to be adjusted or supplemented to better support the child’s long-term visual outcomes.

2. Poor Treatment Compliance

Each myopia management modality has specific usage requirements that align with the treatment effects demonstrated in randomized, controlled clinical trials. These protocols guide evidence-based decision-making and are essential for achieving meaningful myopia control. When recommended wear time for contact lenses or spectacle-based treatments is inconsistent, or when doses of atropine are missed, the expected treatment benefit may be reduced.⁷ 

Follow-up visits provide an important opportunity to review treatment expectations, identify barriers to adherence and ensure families feel supported rather than discouraged. If, despite best efforts, the recommended usage cannot be maintained, this does not reflect a lack of commitment. It signals that the current modality may not be the right fit. In these cases, transitioning to an alternative treatment approach may improve both compliance and clinical outcomes.

3. Lifestyle or Maturity Change

As children grow, their visual demands and daily routines evolve, which can influence how well a myopia management strategy continues to work. In pre-myopic children who may initially be managed with lifestyle modifications alone, increases in near work, academic demands, or screen time may warrant a step up the treatment ladder to maintain minimal myopic progression as eye growth continues.

In older children and adolescents, preferences and tolerance often shift. Some may no longer wish to wear myopia-control spectacles and may prefer a contact lens-based option. Others may experience side effects from nightly atropine, such as light sensitivity or near blur, that interfere with schoolwork or extracurricular activities. In these cases, reassessing the treatment modality ensures that therapy remains both effective and realistic.

Ultimately, successful myopia management requires considering the whole child, including lifestyle, maturity and daily visual demands to determine whether maintaining the current approach or transitioning to a different modality will provide the best long-term outcome.

4. Ocular Health or Comfort Issues

Using any myopia management treatment should not feel painful or result in discomfort. During follow-up visits for myopia spectacle wearers, we evaluate for adaptation to ensure a child is not experiencing headaches during spectacle wear and has excellent acuity and binocular vision status. Low-dose atropine drops can result in stinging upon instillation, ocular surface sensitivity or photophobia in bright lighting conditions. We may need to adjust concentrations or move to preservative-free formulations. Myopic patients who are using a contact lens modality to treat their myopia need to maintain excellent care and handling protocols. Improper use of contact lenses poses a serious threat to ocular and visual health and a modality switch may be needed to keep a child’s eyes healthy. 

5. Age-related Treatment Ceiling

Myopia progression does not occur at the same rate throughout childhood and adolescence.⁸ At different stages, a treatment may approach the limits of either its clinical benefit or its practical suitability for a child’s daily life. When progression has slowed to an age-appropriate rate or appears to have plateaued, it may be reasonable to simplify or modify the treatment plan rather than intensify it further. For example, some children may be able to transition from soft daily disposable myopia control contact lenses to single-vision daily disposable lenses for refractive correction alone.

Conversely, when myopia onset is early or progression is rapid, escalation of therapy may be warranted to reduce long-term risk. In a young fast progressor, combination treatment such as low-dose atropine with spectacle or contact lens therapy may offer better control. By contrast, low-dose atropine may be less suitable as a first choice for an older progressing teenager, particularly one preparing to drive, where side effects such as glare or reduced near clarity may be more problematic.

Recognizing when a child has reached an age-appropriate limit with a given treatment modality, and when a different approach is more appropriate, helps ensure that myopia management remains both effective and individualized as the child’s visual needs continue to evolve.

Switching vs. Combining Treatments

For children who present as fast progressors, clinicians may consider combination therapy rather than switching modalities outright. Current evidence is strongest for the combination of orthokeratology and low-dose atropine (0.01%), which has demonstrated greater slowing of axial elongation compared to OrthoK alone.⁹ Emerging data also suggest potential additive benefits when atropine (0.025-0.05%) is paired with myopia-control spectacle lenses¹⁰ or dual-focus soft contact lenses,¹¹ though these combinations require further study.

The decision to combine treatments is highly individualized and guided by objective measurements, treatment tolerance and the child’s response over time. In all cases, combination therapy is used strategically, not routinely, to enhance control when a single modality is insufficient. If there are concerns about safety, treatment adherence, or the practical burden of a given modality, switching to a simpler and more sustainable option may be preferable. For example, if a child or parent is struggling with daily contact lens wear, a spectacle-based myopia control option may offer a better fit while still providing meaningful treatment benefit. By contrast, when compliance is strong and the current modality is well tolerated, combination therapy may be worth considering in selected cases. In these situations, the potential additive benefit of combining treatments such as OrthoK and low-dose atropine can be weighed against cost, complexity and the individual child’s risk profile.

What Parents Should Expect During a Treatment Switch

When a myopia management plan is adjusted, parents can expect a structured and carefully monitored transition. For example, if washing out from OrthoK use, daily disposable contact lenses in variable powers should be provided to maintain adequate acuity for children. In most cases, treatments such as myopia spectacles or low-dose atropine 0.01-0.05% can be switched or discontinued without a washout period, and care is taken to ensure visual clarity and comfort are maintained throughout the process. A brief adaptation phase may occur as a child adjusts to a new lens design or medication, but this is typically short-lived.

Follow-up visits remain essential after a switch, allowing eye care professionals to confirm that the new approach is effectively slowing progression and that the child is tolerating the treatment well. 

Importantly, a change in treatment does not mean the previous approach failed. This is a data-driven response to how a child’s eyes develop and their lifestyle changes over time.

A Long-Term, Individualized Approach to Myopia Care

Myopia management is not a one-time decision, but an ongoing process that evolves with a child’s growth, lifestyle and visual demands. As the eyes change, treatment plans may need to be refined to ensure they continue to provide meaningful protection against long-term risks associated with progressive myopia.

Switching or combining treatments is a proactive step grounded in careful monitoring and evidence-based care. By regularly reassessing treatment effectiveness and remaining flexible in approach, clinicians and families can work together to support healthy visual development and preserve eye health for the future.

 

Dr. Stephanie Ramdass is in private practice in Ontario, Canada. She is a graduate of the Inter American University of Puerto Rico School of Optometry and completed a cornea and contact lens residency at the Michigan College of Optometry. Dr. Ramdass has authored and contributed to articles in Contact Lens Spectrum and Clinical & Refractive Optometry. She serves as a committee member and contributing author for the International Myopia Institute and is a Canadian MIP Research Principal Investigator.

 

References

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