Use and Assessment of Growth Curves in Myopia Consultation and Choice of Treatment Strategy

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July 9, 2026

By Pascal Blaser, MSc

Written in collaboration with Dr. Thomas Aller and Dr. Michael Bärtschi

This guide explains how to leverage axial length growth curves, specifically through the Myopia.Care platform, to elevate your clinical practice, improve patient communication and implement evidence-based treatment strategies.

Growth curves in pediatrics

Growth curves, also known as percentile curves, have been used in pediatrics for years. They are based on statistically collected data that compares the height and weight of children with those of children of the same age. These curves can be used to determine whether a child is too tall or too short or whether they are underweight or overweight. This enables effective communication with parents about the child’s developmental status and the derivation of necessary measures to minimize risk, for example in the case of weight anomalies.

Why Axial Length Growth Curves Matter

Just as pediatricians have long used percentile curves to track a child’s height and weight, eyecare practitioners can now use axial length growth curves to monitor eye development. These curves are based on statistical data from large populations and provide an objective way to assess whether a child’s eye is growing at a normal or accelerated rate.

The growth curves used in Myopia.Care are based on the foundational Tideman et al.¹ study of European children and are adapted to include risk thresholds defined by the World Health Organization and Swiss health guidelines. An axial length over 26 mm in adulthood is associated with significantly increased risk of sight-threatening pathologies.

When using these curves, it is important to note that this is a statistical evaluation of the distribution in the respective population group, which leads to considerable differences between the curves from Asia and Europe.

An essential consideration is that eye growth patterns vary significantly between different populations. Due to the higher prevalence of myopia in Asia, the 75th percentile for axial length in Chinese children is comparable to the 98th percentile in European children. This highlights the importance of using population-appropriate data for accurate risk assessment.^1.2

Dr. Tideman and his team analyzed data from cohorts in England and the Netherlands with over 12,000 participants to create this growth curve. The Tideman percentiles presented here are median values and should not be interpreted directly as risk curves for myopia. Median values indicate how many of the test subjects had this eye length. The 50th percentile therefore indicates that exactly half of the children had an eye length below or above this line.

Since the percentiles alone do not provide meaningful information about the risk of a possible eye disease, Tidemann et al. added an additional subdivision of the degree of myopia, which distinguishes between no myopia, myopia and high myopia below -6.00D.¹

Eye lengths around the 50th percentile (highlighted in bold in Figure 1) in adults are approximately 24 mm and are considered a normal, natural risk. The risk of complications continues to increase up to the 90th and 95th percentiles, respectively, reaching a threshold value in adulthood of around 26 mm, which is referred to as high myopia by Tideman at -6.00D and above. However, in its report published in 2016, the WHO defined high myopia as -5.00D and higher. Above this threshold, the risk of possible pathological changes due to myopia increases significantly.³

In Switzerland, the List of Medical Aids (MiGeL) has regulated the services covered by compulsory health insurance for myopia management since July 2025. The limitations also specify the threshold value of -5.00D for coverage and an above-average eye length for reimbursement for treatment with glasses and contact lenses that have been proven to inhibit myopia progression. The guidelines of the Swiss Ophthalmological Society (SOG) have therefore defined a curve for the limitation that reflects the threshold value of -5.00D.⁴

Figure 1 shows an orange dot indicating an area with enhanced health risk, ranging from 25 to 26 mm in adulthood.

 

 

 

Figure 2 shows that the red dot is above the 95th percentile. According to Tideman et al., there is a high risk of eye disease and myopia in adulthood.¹

Myopia.Care Online growth curves for visualization, evaluation and consultation

The Myopia.Care platform is one of the first online tools designed to support practitioners in all aspects of myopia management. It offers a freely accessible way to visualize and assess a child’s axial length data. As Dr. Michael Baertschi notes, the platform’s clinically useful, color-coded gradations help practitioners “respond quickly, easily and clearly to the individual myopia situation of each child.”

The Traffic Light System: Simplifying Risk Communication

A key feature of the platform is its intuitive “traffic light” color-coding system, which translates complex percentile data into a simple, visual representation of risk. This system “considerably simplifies communication and the selection of possible treatment strategies.” Dr. Thomas Aller states that this intuitive visual aid “enhances our ability to communicate the need of treatment based on individual patient risks.”

The color zones correspond to the following risk levels:

• Green: Corresponds to a normal eye length (emmetropia or hyperopia).
• Yellow: Indicates a potential for developing myopia; treatment may be considered depending on the child’s overall risk profile.
• Orange, Red and Dark Red: These zones indicate existing myopia with increasing levels of risk for progression and future pathology. The orange area marks the threshold where specific health insurance benefits may apply in some regions, like Switzerland.

 

 

Treatment strategy using Myopia.Care Color Indication table

In evidence-based myopia management, each child must be assessed individually, as not only the measured values, but also environmental factors and lifestyle habits influence the treatment strategy in myopia management. The color coding in the Myopia.Care curves can help to simplify the strategy determination.

Step-by-Step Guide to Implementing Myopia.Care

1. Data Entry: Navigate to the “Growth curve” page on the Myopia.care website. Enter the required data: the child’s age, gender, and the axial length for the right and left eye. You can also input historical measurements to track the progression of eye growth over time.
2. Assess the Risk Profile: Use the Myopia.Care questionnaire to determine the child’s individual risk profile, considering factors like genetics and lifestyle habits. This profile, combined with the axial length measurement, will guide your treatment strategy.
3. Formulate a Treatment Strategy: The “Myopia.Care Color Indication” (MCCI) table provides a potential framework for deciding on a course of action

 

• Green Zone: Continue to monitor the child to ensure growth follows a normal curve.
• Orange/Red Zone: Monotherapy. For high-risk profiles, combination therapy may be considered.
• Dark Red Zone: To avoid losing valuable time, it may be advisable to immediately start combination therapy

Next Step – The Importance of the Annual Growth Curve for Assessing Treatment Success^6-9

To objectively evaluate treatment success during myopia management—typically after six to 12 months—and to adjust the chosen strategy in a targeted manner when needed, the annual growth curve is an essential tool in daily clinical practice. This curve closes the clinical gap between the initial risk assessment and ongoing follow‑up by isolating and evaluating the actual axial elongation of the eye since the previous measurement.
For a sound medical assessment, the first step is to compare the patient’s growth with both physiological (emmetropic) and untreated myopic growth.^6,7

The Emmetropic Treatment Ratio and the Myopia Control Effect (also referred to as Treatment Efficacy) are closely related, as they represent two complementary metrics within the annual growth curve that objectively quantify treatment success.^8,9

Both values analyze the actual axial growth of the eye since the last measurement, but each evaluates it against a different reference:

Myopia Control Effect

This value compares the measured annual growth with the potential untreated myopic growth (with separate reference values for Asian and non‑Asian populations).⁸ It indicates, in percentage terms, how much of the expected untreated progression has been successfully prevented by the current therapy.

Emmetropic Treatment Ratio

This value expresses the patient’s actual growth in direct relation to physiological, age‑appropriate emmetropic growth. It illustrates how closely the treated eye has returned to a natural, non‑pathological growth pattern.

The key relationship between these two metrics is that together they provide a complete, two‑dimensional picture of treatment effectiveness. While the Myopia Control Effect demonstrates the reduction of pathological growth (the “braking effect”), the Emmetropic Treatment Ratio shows the degree to which the eye approaches healthy, normal growth. This combination gives eye‑care professionals a precise, data‑driven foundation for deciding whether a therapy should be continued or adjusted, and it supports clear, comprehensible communication of treatment outcomes to parents.

The combination of these two comparisons provides an objective and easy‑to‑understand basis for clinical decision‑making. It significantly enhances communication with parents, as it allows practitioners to visually and data‑driven demonstrate how much myopia progression has already been prevented. If the analysis shows that axial growth does not sufficiently flatten despite intervention and strong progression persists, this curve can be used optimally to justify a well‑founded therapy adjustment.

Use of the Myopia.Care growth curve

Via the link www.myopia.care, you can select the Eye Length Graph page from the menu. This section provides the required input fields for age, axial length of the right and left eye and gender. In addition, historical values can be entered to display the progression graphically.

The two growth‑curve tools, Eye Length and Annual Eye Growth —used for selecting a treatment strategy and for evaluating treatment success—can be accessed through the Eye Length Graph submenu.

The new color‑coding system and the Myopia.Care growth curves have the potential to significantly improve treatment outcomes and support a more collaborative approach to myopia management. The Myopia.Care team and its advisors continuously work to refine the platform and further optimize counseling for young patients.

Statement from Dr. Thomas Aller

“The new treatment color indication system, as outlined in the recent article, represents a significant advancement in the management of myopia progression. By utilizing distinct colors, we can simplify the recommendation of treatment strategies for both clinicians and patients. This intuitive visual aid enhances our ability to communicate the need of treatment based on individual patient risks.”

“In conclusion, the new color indication system and the Myopia.Care growth curve tool are instrumental in improving treatment outcomes and fostering a collaborative approach to myopia management. We are committed to continually refining these tools to better serve our patients and advance the field of myopia control.”

Thomas Aller, OD, Board Member Myopia.Care

Statement by Dr Michael Baertschi, PhD 

“The clinically useful color-coded gradations of Myopia.Care help us in our daily practice to respond quickly, easily and clearly to the individual myopia situation of each child. The clear grading system and clinically proven treatment recommendations help us to make an objective assessment and to inform and advise those affected and their parents. A successful tool for us practitioners.”

Michael Baertschi, PhD, Eyeness AG, Switzerland, Consultant

 

Pascal Blaser, MSc, is a specialist optometrist with nearly two decades of dedicated experience in myopia management. Pascal has served in upper management for an independent, custom-made contact lens manufacturer in Switzerland, where he actively developed innovative lens designs aimed at optimizing visual quality for wearers. Driven by the intersection of clinical care and digital communication, Pascal co-developed myopia.care in 2014. Today, he continues to drive this digital mission forward as a consultant for Eyetific, the operating company behind the myopia.care platforms. Currently, Pascal serves as the Medical Director for the DACH region and Global Professional Affairs Manager at HOYA, where he focuses intensively on addressing childhood myopia on both a regional and global scale.

 

References

1. Tideman JWL, Polling JR, Vingerling JR, et al. Axial length growth and the risk of developing myopia in European children. Acta Ophthalmol. 2018 May;96(3):301-309. doi: 10.1111/aos.13603. Epub 2017 Dec 19. PMID: 29265742; PMCID: PMC6002955.
2. Sanz Diez P, Yang LH, Lu MX, et al. Growth curves of myopia-related parameters to clinically monitor the refractive development in Chinese schoolchildren. Graefes Arch Clin Exp Ophthalmol. 2019 May;257(5):1045-1053. doi: 10.1007/s00417-019-04290-6. Epub 2019 Mar 23. PMID: 30903312.
3. Report of the Joint World Health Organization–Brien Holden Vision Institute Global Scientific Meeting on Myopia University of New South Wales, Sydney, Australia 16–18 March 2015, https://myopiainstitute.org/wp-content/uploads/2020/10/Myopia_report_020517.pdf (last access 25.5.2025)
4. MiGeL Limitationen, https://augenoptik-netzwerk.ch/migel-limitation-myopie-management/ (last access 25.5.2025)
5. SOG-SSO Arbeitsgruppe Strabismus, SOG Anwendung MiGeL https://www.sog-sso.ch/fileadmin/user_upload/Datenablage/Arbeitsgruppe_Strabismus/SOG_Anwendung_MiGeL-Nr-v3.pdf (last access 25.5.2025)
6. Yii FS. Emmetropic eye growth in East Asians and non-East Asians. Ophthalmic Physiol Opt. 2023;43:1412-8.
7. Brennan NA, Shamp W, Maynes E, et al. Influence of age and race on axial elongation in myopic children: A systematic review and meta-regression. Optom Vis Sci. 2024;101:497-507.
8. Data on file. Courtesy of Prof. Mark Bullimore. https://bullers2020.com/s/Axial-Elongation-and-Myopia-Progression-with-Age.xlsx
9. Mark A. Bullimore, Kathryn J. Saunders, Rigmor C. Baraas, et al.; IMI—Interventions for Controlling Myopia Onset and Progression 2025. Invest. Ophthalmol. Vis. Sci. 2025;66(12):39. https://doi.org/10.1167/iovs.66.12.39.

 

Read more about growth curves here