March 1, 2026
By Dwight Barnes, OD, FIAOMC, IACMM
Photo Credit: Getty Images
By now, we should all know that progressive myopia is a worldwide problem. We’ve heard the powerful statistics—by 2050 half of the world’s population will be nearsighted.1 Children who are nearsighted become more nearsighted as they grow, and the increasing axial length causes an increase in their risk for vision loss from associated pathology. We also know that we have multiple options to help these children and slow myopia progression.
The problem is that we are going to walk into our clinics on Monday morning with (hopefully) a full schedule of patients who are presenting with a variety of needs. By the end of the day, you’ve been putting out fires, and you’ve helped a lot of patients, but you may not have done a great job of identifying the young myopes on your schedule and presenting treatment options to their parents. Put simply, life gets in the way.
Systemize Your Workflow
So, how do you ensure that you successfully incorporate this essential care into your clinic? The answer is that you need to systemize this into your clinic so that it is seamlessly woven into your daily workflow.
The problem of progressive myopia isn’t going away. Myopia management has been recognized by the World Council of Optometry as the standard of care since 2021. That means that this is more than a great clinic opportunity; it is our clinical duty. I’ve been providing myopia management in my clinic since about 2013, and I’ve found this area of optometry to be incredibly rewarding—both professionally and financially.
One challenge is that with shrinking vision and medical plan reimbursement, there is often limited time available to properly educate the parents of children who would benefit from this service. Over the years, as my practice has become busier, we’ve managed to build in systems that make it easier to ensure we don’t miss the opportunity.
Identify Eligible Patients
Knowing that even one diopter of reduced progression meaningfully lowers lifetime risk,2 we must reliably identify and present myopia management to every eligible child. The most reliable way to avoid missed opportunities is to build identification into your team workflow. A morning huddle can be helpful to get the entire team on the same page at the beginning of the day. Identify each patient whose age puts him or her at risk of progressive myopia. If you utilize a routing slip or checklist, use a notation to remind the team to watch for myopia.
When you have young returning patients on the schedule who have already been diagnosed with myopia, commit to presenting myopia management to them, even if they have previously said “no.” Sometimes parents need to hear something more than once to act.
Utilize an informational handout in the pre-test area. Create a simple one-page document explaining myopia and how we can slow progression. Train your medical assistants to hand this to the parent any time a young patient’s auto-refraction or lensometry shows potential myopia. When you enter the exam room, the parent holding or reading the handout can serve as an additional reminder to ensure you discuss myopia management. Don’t be afraid to ask your team to hold you accountable for presenting this clearly to every patient who would benefit.
Axial Length Measurements Can Help
If you have the ability to measure axial length, this data helps illustrate the need for intervention. Once I started measuring axial length on every young patient, it became a great education tool. Some biometers can graph the patient’s axial length over time and show the percentile they fall into. Keep a reference for expected axial length at each age and expected annual change, so you can use this data in discussions with parents.
Rethink Your Schedule
One potential challenge to effectively incorporating myopia management is trying to do everything in one visit. At a child’s comprehensive exam, you need to assess not only their vision but also their ocular health. There is time to introduce myopia management, but not necessarily time to answer multiple questions or initiate treatment. It is helpful to have a basic description of myopia management for parents, and then bring them back for further discussion and to start treatment. A handout or brochure can be valuable so they can leave the office with information. If you prefer digital media, you can have a QR code to scan that will bring the parent to a myopia page on your practice website.
The Myopia Clinic Coordinator
My clinic has multiple clinicians, and not all of them provide myopia management services. It is important to have an easy way to provide the necessary information without getting the doctors behind.
Several years back, I established the “Myopia Clinic Coordinator” position in my office. This has allowed us to have a designated team member to coordinate all aspects of our busy myopia management clinic. In her role, she can:
- Schedule evaluations
- Explain fees to patients
- Answer the many parent questions about myopia management
- Train new orthokeratology patients on insertion/removal and lens care
- Track lens orders for OrthoK and soft myopia management contact lenses
With the Myopia Clinic Coordinator, we have an expert on staff to answer questions that may be outside the scope of knowledge of our general team members.
I started this position by creating a robust “FAQ” document that has evolved over time. Later, I invested in bringing this employee to continuing education events like Vision by Design. My Myopia Clinic Coordinator and my clinic manager are both certified in myopia management via the CMN (Certified Myopia Navigator) program through the American Academy of Orthokeratology and Myopia Control (AAOMC)
One of the biggest benefits of having a Myopia Clinic Coordinator is the time that it saves our clinicians. Because she’s able to handle patient questions and have in-depth discussions on our myopia management treatments, I’m able to focus on clinical discussions. For our other clinicians who do not perform myopia management services, they can hand off discussions to her so they don’t get bogged down with excessive patient education that could get them behind schedule.
Make Myopia Management Visible in Your Office
The final piece of the puzzle is to ensure that patients in the clinic receive myopia information in multiple areas of the office. Even if the patient in your exam chair is not a candidate for myopia management, they may have a child, cousin, or neighbor who would benefit.
We include signage throughout the office to deliver the clear message: progressive myopia is a problem, nearsighted kids get worse over time and we have solutions to help this problem. The internal messaging is extensive, so that it becomes difficult for a patient to navigate a routine exam in our office without becoming aware of myopia. When I initiate the conversation with the parents of a myopic child, they have already seen information throughout the early stages of the visit. This ensures my communication is supported by the messaging the parent has already been exposed to.
In summary, the biggest roadblocks to successfully implementing myopia management into a busy clinic are related to inconsistent messaging, lack of staff support for the doctor and trying to squeeze myopia management into standard routine vision exams. By systemizing the core aspects of this area of practice, and relying on well-trained team members, even a busy primary care office can incorporate this essential service into their clinic. Myopia management doesn’t require more time—it requires better systems.
References
1 Holden BA, Fricke TR, Wilson DA, Jong M, Naidoo KS, Sankaridurg P, Wong TY, Naduvilath TJ, Resnikoff S, Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050, Ophthalmology, May 2016 Volume 123, Issue 5, Pages 1036–1042.
2 Bullimore MA, Brennan NA. Myopia Control: Why Each Diopter Matters. Optom Vis Sci. 2019 Jun;96(6):463-465. doi: 10.1097/OPX.0000000000001367. PMID: 31116165.
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Dr. Dwight Barnes attended Southern College of Optometry, where he graduated Magna Cum Laude, in 2002. After graduation, Dr. Barnes completed a residency in primary care optometry and ocular disease at the Department of Veterans Affairs in Boston. He is co-owner of Cary Family Eye Care in Cary, NC, with his wife Kelly. In addition to routine care, Dr. Barnes has a passion for myopia control and orthokeratology, and he established a Myopia Control Clinic within Cary Family Eye Care to focus on helping slow progression of myopia in young patients. He is a Fellow and Board Member of the International Academy of Orthokeratology and Myopia Control (FIAOMC) and also has the designation International Academy Certification in Myopia Management (IACMM). Dr. Barnes has lectured and written articles on various aspects of practice management and myopia management, and he provides consulting services to doctors adding/expanding myopia management services. He is currently the co-host of “The Corrected View,” which is the AAOMC’s myopia management podcast. |
Learn more about implementing myopia management with our Getting Started guide here
