July 20, 2026
Photo generated with AI
Pediatric myopia care in the United States has undergone a significant transformation. It was common for eyecare practitioners to play it safe, adding power to prescriptions without prescribing interventions to slow progression.
“Over the past 12 years, pediatric myopia care in the United States has evolved from a primarily corrective model—relying on single-vision spectacles or conventional contact lenses—to a more proactive, evidence-based approach focused on slowing disease progression,” said Dwight Akerman, OD, MBA, FAAO, Dipl. AAO, Chief Medical Editor Emeritus of Review of Myopia Management.
“Today, U.S. clinicians have substantially greater knowledge and a broader range of evidence-based interventions that can be tailored to a child’s age, risk profile, refractive status, and treatment tolerance. As a result, myopia control is increasingly becoming an integrated component of routine pediatric eyecare rather than an intervention reserved only for children with severe or rapidly progressing myopia.”
However, while clinicians now have more sophisticated tools than ever, that doesn’t make myopia management easy. To learn more about the most persistent pain points in myopia management, we spoke to our Advisory Board to learn about the most common issues they face in practice today.
The Challenge of Compliance
One of the most significant hurdles remains the difficulty of ensuring long-term adherence to prescribed treatments.
Oliver Woo, BOptom, FIAOMC, explained the psychological and logistical battle involved: “I can put the best optical or pharmacological intervention in a child’s hands, but if the family isn’t truly on board, we’re fighting an uphill battle.”
Similarly, Dwight Barnes, OD, FIAOMC, IACMM, explained that compliance affects every treatment modality and typically requires a “decent chunk” of patient education to overcome barriers like busy schedules or lack of child buy-in.
“When determining the best treatment modality, I frequently ask about lifestyle and determine that the most effective modality will be the one the patient can do consistently,” Dr. Barnes said.
“A bit more conversation on the front end about lifestyle can help avoid some of the compliance issues later.”
Financial and Systemic Barriers
The cost of myopia control treatments presents a systemic barrier that can limit patients from enrolling in a myopia management program. And our board members explained that this isn’t an issue that only affects patients in the U.S.
“In Australia and across Asia, families are paying out of pocket for everything; insurance only covers a very small fraction of the costs,” Dr. Woo said.
“Health authorities are beginning to acknowledge the need for country-wide access to myopia control treatments without access inequalities due to cost, but budgets are tight and the significant benefits of myopia control are many years in the future,” said James Wolffsohn, BSc(Hons), PgCertHE, PgDipAdvClinOptom, MBA, PhD, PFHEA, FSB, FAAO, FCOptom, FIACLE, FBCLA.
Clinical Decision-Making
Another pain point in myopia management: determining the optimal treatment modality for each patient.
Daniel Press, OD, FOVDR, said that it’s difficult to know which patients will respond best to the different treatment options.
“This is where I believe the intersection of binocular vision/accommodation, vision development and myopia are critical,” he said. “For a patient with near esophoria/high ac/a ratio we are going to avoid atropine as much as we can. We are going to encourage a contact lens option due to the additional plus in the system, and we are going to avoid the spectacle options that do not have ‘usable’ plus.
“I also believe this is where there is opportunity in understanding the genetic profile of a particular patient. There may be certain genotypes that respond better to optical defocus/HOA and others that do better with anti-muscuranic agents.”
Similarly, Dr. Woo said knowing how and when to escalate patients can be a challenge.
“We have good data on individual treatments, but when a child is still progressing on atropine plus orthokeratology, spectacles or multifocal soft contact lenses, what do we do next?” he said. “The guidelines don’t give us much to work with, and that clinical uncertainty sits heavily on you when you’re looking at a 9-year-old who’s already at -4.00D.”
Navigating Parental Expectations
ECPs must also navigate the complexities of managing parents’ expectations.
“Today’s parents are highly engaged and often come to appointments having researched myopia control online or through AI tools,” said Sheila Morrison, OD, MSc, FSLS, FAAO, FCCSO. “While access to information is valuable, it can be challenging to help families navigate what is evidence-based, what is applicable to their child’s situation and what may be misinformation or marketing.
“This also involves setting realistic expectations regarding treatment goals, progression rates and the fact that myopia control aims to slow progression rather than eliminate it entirely.”
Honorable mentions
While many of our board members shared similar feelings when it came to the top pain points, there were some others they mentioned.
Here’s a look at more of the most pressing myopia management pain points:
-
Environmental modifications
“We speak about the importance of limiting screen time, encouraging outdoor time, the impact of nutrition and the importance of sleep,” Dr. Press said. “We can get nods in the exam room but rarely do we hear it transferring after follow up. This is especially true during the school year when schools are forcing screens at younger ages. It can be frustrating that we are trying to swim against the current.”
-
Public Awareness
“Despite all the studies that have been done, the ability to access information via AI and internet searches and the big increase in educational opportunities for optometrists regarding myopia management, this is still one of the ‘best kept secrets’ in healthcare,” said Dr. Barnes. “In my clinic, myopia management is a huge part of our patient care, and we have a lot of patients seeking us out specifically for this service. Even with that, I’m constantly a bit surprised how often patients have never heard of it. I live in a somewhat affluent area with a highly educated patient base, so I’m sure it is worse in other areas.”
-
Creating a consistent and efficient clinical workflow
“Myopia control visits often require additional measurements such as axial length and corneal topography, creating additional demands on clinic time, scheduling, staffing and resources,” said Dr. Morrison. “Consistency is essential both for delivering excellent patient care and maintaining the financial sustainability of the program.”
-
Collaboration within the optometric community
“For years we’ve discussed the lack of referrals between optometrists, and this is another example,” Dr. Barnes said. There are so many areas of care within the optometric profession, and not every doctor is going to provide every service. I think it is okay for an optometrist to decide they do not choose to provide myopia management in their office. However, I also think it is the duty of every single optometrist to educate parents about progressive myopia and let them know there are treatments to slow progression. If that optometrist chooses to not provide those treatments, then a referral to a colleague who does provide that care is appropriate. We need more of this!”
-
Tapering treatments
“Which patients can be safely tapered off of treatment and at what time?” Dr. Press said. “We are doing our best to minimize progression, but which patients can taper treatment at 16 versus at 18 or 22? It is a guessing game, and you don’t know until you follow up. Slow taper is typically better than cold turkey but it would be nice to know in advance.” -
Attracting children into clinical trials
“Children often don’t have their eyes checked (despite it being free in the U.K.) unless their parents perceive there is a problem,” Dr. Wolffsohn said. “While we have been approached by large primary and secondary school consortiums worried about the eyes of the children under their care, logistics have prevented large-scale screening. For studies requiring a control group, this is even harder, as engaged parents already have their children in myopia control treatments, and the known efficacy of these treatments makes allocating a child with progressing myopia to a single vision correction ethically challenging.”
Read more about ECPs’ myopia management experiences here
