Adopting a simpler approach to myopia management can go a long way with patients and parents.
sponsored content
March 6, 2026
By Shalu Pal, OD, FAAO, FSLS, FBCLA, FIAOMC
Photo provided by CooperVision
Over the last 15 years, I have immersed myself in learning all I could about myopia and its management, the benefits of providing treatment and the extent to which we can make an impact on the lives of our young patients. Many of my colleagues have joined me in this mission. But when it comes to myopia management, are we truly doing it correctly? Or are we making things harder for ourselves?
I want to challenge our profession and offer a different perspective. Here’s a roadmap of what I’ve learned so far.
Overcoming Barriers: Cost, Time and Information Gluts
Once my goal was clear, I faced three hurdles that I needed to overcome.
Hurdle #1: Cost
For the patient, this included the cost for additional testing, the myopia assessment, an annual management fee and higher product costs. From my side, I had bought an expensive piece of equipment—axial length interferometry that was not being used because I was saving it for the small group of parents who agreed to a myopia assessment. It was neither being used effectively nor being paid off. With my new goal in mind, my vision became clear on what I wanted. I just had to figure out how to get there.
So, I removed this hurdle.
I started to include axial length measurements as part of our pre-test on every child 19 and younger, and I did not charge for it.
Hurdle #2: Time
Not every parent was able to bring their child back one-to-three times a year to monitor progression of their child’s myopia. We, as a profession, are told to create packages for one year of treatment that parents will want to follow and that all will sign up if we just explain it properly. The reality is … parents and children are busy—not every parent has the time (or funds) to follow through with this annual plan. And when discussing how long I want to keep a child in this treatment plan, the costs are quickly calculated and the reality of maintaining this program was often paralyzing and just not feasible for many parents from both a time and financial perspective.
So, I removed the hurdle.
With proper understanding, if a parent did not want, for any reason, to return during the year between annual checkups, I would not deny a treatment option to their child.
Hurdle #3 Information Overload
In the beginning, I was giving parents too much information and too many options. I explained all treatment options, risk factors, showed them graphs and charts and provided them with studies to validate my recommendations. I truly was just confusing them. I was asking parents to make all the decisions about their child’s health when they were simply coming to me to give them my best recommendation. By bombarding them with so much information, I was doing the exact opposite of what I should have been doing.
So, I removed the hurdle. I stopped with the charts and the graphs and the studies and the options. I actually started behaving like the doctor that I was trained to be, and I started prescribing.
In this case, I was the hurdle, but I had to remove the problem. So, I stopped talking so much.
Changing Single Vision Mindsets
We also know that if we prescribe single vision glasses or contact lenses, or if we under-correct a child with myopia, we are going to cause a child’s myopia to progress.1,2 Although prescribing single vision correction remains the predominant choice for the initial management of myopia, optometrists are increasingly prescribing myopia control and intervening earlier at lower levels of myopia.3 Despite these discussions, myopia control is still generally implemented only in cases of moderate-to-high myopia.3
In good conscience, how can a single vision option ever be our best recommendation?
Adopt a Simpler Approach
Why are we as a profession making myopia management so complicated?
We all need to be given the education to feel confident to prescribe the same way we were all educated to prescribe for conditions such as glaucoma. But the rest, in my humble opinion, needs to stop. The path for patients to receive treatment needs to be much simpler for the prescribing doctor, the parents and the patient.
So how do we simplify the message in the exam room? We remove it completely and we just do what we were taught to do… we prescribe. The sooner we start, the better the outcomes. Their future is in our hands.
 |
Dr. Shalu Pal is the owner of The Yorkville Eye Institute in Toronto. She is an SCCO graduate who did her Cornea and Contact Lens Residency at NSU. Dr. Pal is the co-founder of contact lens workshops–now known as STAPLE, founder of the Canadian Contact Lens Academy and Locals supporting Locals. She lectures and runs workshops globally. She is a research member of the study, Myopia in Practice, member of the Education Planning Committee for Vision Expos and CE advisor for the Academy of Ophthalmic Education. She is the Canadian Ambassador for Global Ophthalmic Women and the British Contact Lens Association. Dr. Pal has been honored with the CLCS Achievement Award for her educational contributions to the industry and awarded the Legends Award by the American Optometric Association. Dr. Pal has most recently graduated from the Global Healthcare Executive Education Program at Harvard Medical School. |
References
- Flitcroft DI. The complex interactions of retinal, optical and environmental factors in myopia aetiology. Prog Retin Eye Res. 2012;31(6):622–660.
- Walline JJ, et al. Myopia Control with Multifocal Contact Lenses: A Randomized Clinical Trial. Optom Vis Sci. 2013;90(11):1207–1214.
- Di Marco, A. Chow A. Acs M et al. Myopia in Practice (MIP) Study. American Academy Optom. 2023. Poster no 235334.
