October 1, 2025
By Kevin Chan, OD, MS, FAAO, IACMM
September has traditionally been a busy month of the year for state and national conferences. Recently, I co-hosted the ‘Getting Started with Myopia Management’ event at Vision Expo West alongside Dr. Ashley Tucker, OD, FAAO, FSLS and esteemed guest speaker, Dr. Sheila Morrison, OD, MS, FAAO, FSLS. I was pleased and grateful to recognize the hunger and spotlight on myopia management has been more prevalent than ever. In particular, the paradigm shift from vision correction to therapeutic intervention for myopia has gained tremendous momentum throughout the entire optometric industry.
Myopia Spectacle Lenses
As I was writing this editorial, big news broke in the myopia management community. Essilor’s Stellest lenses were officially FDA approved1 in the U.S. to slow the progression of pediatric myopia. The news is undeniably a big triumph in the myopia space for several reasons. For starters, this will certainly open the doors for many children and parents who have yet to hear about myopia interventions. In addition, spectacles could be an ideal option for those who may not be deemed suitable for other optical or pharmaceutical interventions, such as orthokeratology, soft contact lenses or topical atropine drops.
Being a Discerning Practitioner
Nevertheless, practitioners should understand that having a new intervention on the market can potentially create more complexity. It can also spark further scrutiny and questions. Some common questions may arise, including, but not limited to: How does it work? How different is it compared to other treatment modalities? Which treatment works the best? How do I pivot conversations with parents and patients who were previously told that glasses do not work to treat myopia? Having more players added into the field doesn’t necessarily make clinical decisions easier or more intuitive; rather, it warrants practitioners to stay atop of the subject and ask the right questions responsibly and strategically.
A few key questions for you as practitioners to ponder when it comes to patient candidacy and discussing the relative clinical efficacy in general:
- How is the patient’s corneal and refractive data at baseline?
- Under what rationale is the patient deemed a good candidate for treatment X,Y,Z?
- Should myopia control spectacles be selected for patients, is the patient still a good candidate for contact lens wear or the use of topical eye drops at the age of consultation? Why or why not?
- How is the patient’s lifestyle and preference aligned with your clinical recommendation?
- When it comes to patient education, are you comparing the relative clinical efficacy reported from one study with another study of a completely different demographic and/or dataset? What metric is used for making the comparison?
Clinical Decision-making
The intention of probing into these questions isn’t meant to favor any viewpoint or specific treatment intervention. It neither supports nor refutes any particular clinical findings reported in any study. Rather, the objective probing from different directions is meant to encourage and foster more deliberate clinical decision-making. This will ultimately yield the best possible clinical outcomes for patients.
In fact, implicit biases2 in clinical practice (not limited to optometry) is not uncommon; it is either an overwhelming favoritism or reluctance toward a specific treatment intervention. Notably, confirmation bias and availability bias are considered the biggest landmines practitioners should be mindful of.
Confirmation Bias
So, what is confirmation bias? Confirmation bias refers to the tendency to seek out, interpret and favor information that confirms one’s pre-existing beliefs, while diluting or neglecting information that appears contradictory to or not aligned with the preconceived beliefs.3
Research has found that individuals with poor health literacy and negative prior beliefs about certain topics are generally more prone to confirmation bias.4 In the realm of myopia management, some parents may be “primed” to pick or be swayed toward specific treatment modalities for their child for any number of reasons. Some may want a certain treatment because they’ve heard success stories from neighbors or friends. Others may see comments online that confirm their beliefs about one treatment over another. Nonetheless, it may not necessarily represent or align with what the objective data shows. In addition, the parents’ preferred treatment may not align with the patient’s own clinical data.
More subtly, practitioners can also be vulnerable to confirmation bias based on what they hear from vendors or what patients told them as true or is part of a viral trend. Therefore, it’s imperative that clinicians are being skeptical and critical when helping parents and patients decipher the nuances of confirmation bias among various treatment modalities. The goal is to make an objective, unbiased clinical decision. What is prevalent does not make it correct or true at all times.
Availability Bias
Are we also a victim of availability bias? In essence, availability bias occurs when individuals disproportionately make decisions solely based on the most readily or hot-off-the-press available data (or lack thereof).5
For instance, OrthoK has long been overlooked and underutilized for myopia management since its clinical use and merit has been omitted or not discussed extensively. As a result, the absence of availability has made OrthoK less appealing to patients and parents.
On the contrary, myopia control spectacles have been a buzzword, and the FDA approval has been on every practitioner’s mind—even before it was officially granted. While this can truly be a game-changer for many children, practitioners shouldn’t automatically assume that all children are ideal candidates for myopia control spectacles. There are factors to consider beyond the long-awaited anticipation and perceived ease of use. Clinical outcomes can be subject to a myriad of factors. These include a patient’s refractive status, lifestyle, clinician’s fitting philosophy, as well as the overall receptiveness toward full-time wear of glasses. Clinicians must be what I call “optimistically skeptical” when doing a full, comprehensive analysis of each patient’s clinical profile. This will allow them to avoid the pitfall of availability bias.
We are in the exhilarating time of witnessing a momentous paradigm shift in adopting a plethora of treatment interventions for myopia management. Nevertheless, if data analysis and interpretation are not properly and thoroughly conducted, we as practitioners can be vulnerable or clouded by cognitive bias, resulting in oversimplified or underrepresented judgement. Living in the paradox of weighing the best treatment available could potentially lead to decision paralysis. Let’s make it more than just a viral buzzword, but a priority to be made responsibly for every child.
References
- https://www.fda.gov/news-events/press-announcements/fda-authorizes-marketing-first-eyeglass-lenses-slow-progression-pediatric-myopia
- https://www.ama-assn.org/about/ethics/4-widespread-cognitive-biases-and-how-doctors-can-overcome-them
- https://link.springer.com/article/10.1007/s10670-020-00252-1
- https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2021.771948/full
- https://www.berkeleywellbeing.com/availability-heuristic.html
