January 15, 2026
By Ashley Tucker, OD, FAAO, FSLS
A new year invites reflection. However, meaningful progress in myopia management will come from doing better – not simply doing more. As a profession, we have advanced rapidly: stronger evidence, better tools and broader adoption of active myopia management. Yet many of the habits that quietly limit our outcomes remain unchanged.
If this year is going to represent real progress, it is time for a hard reset both in what we start doing and in what we stop.
From Reaction to Prevention
One of the most persistent holdovers from traditional refractive care is the belief that intervention should follow documented progression. In myopia management, this approach may feel cautious, but it carries real cost.
Axial elongation often precedes meaningful refractive change, and lifetime risk accumulates over time. Delaying care often misses the window when treatment is most effective. Risk factors such as age of onset, family history, axial length percentile and lifestyle should drive decisions, rather than last year’s prescription change.
The reset is a shift from reactive to preventive care. Early action reflects informed intervention.
Beyond Diopters as the Primary Outcome
Diopters are familiar, easy to explain and deeply ingrained in how success is defined. Yet refractive stability does not always reflect disease stability. Children may experience clinically significant axial elongation without dramatic refractive change, particularly early in progression.
If myopia management aims to reduce long-term ocular risk, outcomes must extend beyond refraction alone. Axial length trends, growth velocity and percentile-based interpretation provide a clearer picture of structural change and future risk.
This reset reframes the role of refraction. Diopters tell part of the story. Millimeters often tell the more important one.
Redefining Success in Myopia Management
Clinical trial outcomes have helped define what is possible in myopia management, while also shaping expectations around success. When progression continues despite treatment, it is often interpreted as failure, even when meaningful risk reduction has occurred.
Myopia management centers on risk reduction. Slowing axial growth, altering a growth trajectory, or delaying critical thresholds represent meaningful success, even when progression continues.
This year calls for contextualizing outcomes over time. Success should be measured by trajectory, not perfection.
Elevating How We Communicate Risk
Risk communication in myopia management is nuanced, yet frequently reduced to binary language such as stable or progressing, low risk or high risk. While simplicity may ease early conversations, it can erode trust as outcomes evolve.
Families deserve honest, longitudinal framing. Myopia is a chronic condition with variable expression, and our role is to guide, monitor and adapt over time. Short-term clarity may gain buy-in; sustained transparency builds confidence.
Risk Before Age
Age remains one of the most overused decision points in myopia management. While it matters, age alone offers a limited view of risk. Two children of the same age may demonstrate vastly different growth patterns, genetics and environmental exposures.
The better question shifts from “Is this child old enough?” to “Is this child at risk now?” That answer rarely comes from age alone.
Myopia Management as a Process, Not a Protocol
As the field matures, protocols are becoming more common and more useful. Static, rigid algorithms cannot replace clinical judgment. Myopia management is a longitudinal process that requires reassessment, flexibility and individualized care.
Protocols should support thinking, not replace it.
The Reset Ahead
A hard reset requires refinement, not reinvention. This year, let’s commit to acting earlier, measuring what truly matters, redefining success and communicating risk openly. Myopia management will move forward through better decisions made earlier and sustained over time.
