April 13, 2026
By Christine Yeung, OD, FIAOMC, IACMM
Photo Credit: Getty Images
Eye care practitioners have historically viewed myopia as a refractive error, and have instinctively treated it as such over the years.
At the same time, eye care practitioners have also long understood how to manage chronic, progressive eye disease. Glaucoma taught us that success lies not in reacting to damage, but in identifying risk early, monitoring carefully and intervening before vision is permanently affected.
Today, myopia demands that same mindset.
Using Our Glaucoma Skillset to Strengthen Myopia Care
In glaucoma management, eye care practitioners have become adept at gathering multiple clinical data points to determine risk. We evaluate intraocular pressure, pachymetry, optic nerve structure, retinal nerve fiber integrity, visual fields, family history and progression patterns. No single measurement defines the disease; rather, it is the integration of data—combined with clinical judgment—that guides management.
This process is strikingly similar to modern myopia care.
When screening for risk of myopia progression, the indicators differ, but the approach is identical. Instead of focusing on IOP or nerve fiber loss, we consider:
- Refraction and rate of change over the year
- Axial length and growth trajectory
- Age of onset
- Environmental factors such as near work and outdoor time
The same analytical skills we routinely use in glaucoma apply directly here. We gather data, interpret risk and determine whether monitoring alone is sufficient or whether intervention is warranted.
For optometrists new to myopia management, the learning curve often feels steep. Yet eye care practitioners already possess the core competencies required. As with glaucoma, the more we assess risk and follow progression, the more intuitive the process becomes. What initially feels unfamiliar soon becomes second nature—just as glaucoma screening did earlier in our careers.
Myopia management is not an entirely new discipline. It is an extension of the preventive clinical reasoning eye care practitioners already practice every day.
Why Early Intervention Matters
The rationale for early myopia management is grounded in long-term ocular health, not simply refractive correction.
Large epidemiological studies have consistently shown that increasing myopia and longer axial length are associated with substantially elevated lifetime risk of vision-threatening pathology, including retinal detachment, myopic maculopathy, open-angle glaucoma, and earlier cataract development.1-3
Eyes exceeding approximately 26 mm axial length have been associated with significantly higher risk of later visual impairment, with risk rising progressively as axial length increases.3 Risk assessment is subject to each patient individually. For example, having a 26mm AL doesn’t automatically categorize patients as high risk if they also have a flat cornea (flat K <40D). ECPs need to be prudent to not get caught up in AL data alone—just like glaucoma providers wouldn’t look at IOP alone.
Importantly, Bullimore and colleagues emphasize that reducing final myopia by even 1.00D can meaningfully lower the lifetime risk of myopic maculopathy, underscoring why slowing progression matters clinically.4
This principle, again, mirrors glaucoma care. Once glaucoma damage occurs, it cannot be reversed—only slowed. Likewise, once myopia develops, we cannot shorten the eye or undo elongation. We can only intervene to reduce future progression and associated risk.
The earlier intervention begins, the greater the opportunity to influence final refractive outcome and axial length—and therefore the patient’s lifetime visual prognosis.
Evidence-Based Tools Are Already Here
Recent research has firmly established that effective, evidence-based options exist to help slow myopia progression. Pharmacologic therapy with low-dose atropine has demonstrated clinically meaningful reduction in progression in large trials such as ATOM and LAMP.5,6 Optical strategies are similarly supported: peripheral-defocus soft contact lenses showed significant slowing of myopia progression in the BLINK study,7 while orthokeratology has demonstrated effectiveness in reducing axial elongation in randomized trials such as ROMIO.8 Myopia control spectacle lens designs have also shown benefit in controlled clinical studies.
Taken together, the research base is no longer emerging—it has been established. Myopia management is not experimental; it continues to be an accepted component of preventive eye care.
Importantly, not every optometrist must personally provide every treatment modality—just as not every clinician directly manages glaucoma. However, every optometrist should understand when a child may benefit from intervention and have a clear threshold for initiating management or referring to a colleague who provides these services.
From Correcting Vision to Managing Risk
Historically, myopia was framed primarily as a refractive issue: prescribe correction and monitor annually. Today, that perspective is evolving.
Modern optometry increasingly recognizes childhood myopia as a condition requiring:
- Intentional risk assessment
- Longitudinal monitoring
- Evidence-based intervention when indicated
- Education to families about long-term implications
Again, not every optometrist must provide every treatment modality. However, every optometrist can identify at-risk patients, initiate the conversation and either manage or refer appropriately.
Perhaps the most heart-breaking moment in clinic is when a parent says:
“How come no one told us this earlier?”
In glaucoma care, such a statement would feel unacceptable. Increasingly, the same should be true for myopia.
A Familiar Path Forward
Optometry does not need to reinvent itself to embrace myopia management. The profession already knows how to manage progressive ocular conditions. We have decades of experience assessing risk, monitoring structural change, counseling patients and intervening early to preserve vision.
The tools are familiar.
The reasoning is familiar.
Only the application is new.
If we apply the same preventive urgency and structured clinical thinking to myopia that we already bring to glaucoma, we can do more than correct vision in childhood—we can influence ocular health for a lifetime.
And that is a powerful opportunity for our profession.
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Christine Yeung, FIAOMC, IACMM, OD, is an optometrist with a special interest in myopia management and orthokeratology. She earned her Doctor of Optometry degree from the University of Waterloo, School of Optometry and Vision Science, and has completed advanced training in myopia care, including Fellowship of the International Academy of Orthokeratology and Myopia Control (FIAOMC). She is the owner of two private clinics, including a dedicated orthokeratology and myopia control centre. Dr. Yeung is passionate about helping children and families navigate myopia with greater understanding, confidence, and access to evidence-based care. Through her clinical work, she is committed to translating research into practical strategies that support both patient outcomes and everyday practice. She is also the founder of MyoPilot, a clinical software platform designed to help practitioners communicate myopia data more clearly in practice.
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References
1 Flitcroft, 2012
2 Holden et al., 2016
3 Tideman et al., 2016
4 Bullimore et al., Ophthalmic Physiol Opt, 2021
5 Chia et al.
6 Yam et al.
7 Walline et al.
8 Cho et al.
