7 myopia management best practices: slowing myopia progression

Myopia is nearsightedness as a result of the eye growing too long. This increasingly common condition may affect an estimated 5 billion people by 2050 according to the Brien Holden Vision Institute.1 Sadly, many of those affected will be children.  

What can ECPs do to slow that progression? Whether it’s specialized glasses, contact lenses, eye drops, or a combination of approaches,  we have  many cinically proven methods to slow myopia progression. 

What is myopia management? 

Myopia management refers to the research-based methods an ECP uses to slow the growth of the eye, thus slowing the progression of myopiain children. By starting myopia management early, ECPs have a better chance of preventing eye diseases and conditions in the child’s future. 

Certain myopia management treatments or approaches include atropine eye drops, orthokeratology (ortho-k), soft contact lenses, specialized glasses, and lifestyle/habit changes. 

What is the difference between myopia management and myopia correction?  

Myopia correction is a solution for simply correcting a refractive error/blurred far vision. Myopia management is essential not only to correct but also to slow the increase/progression of myopia in children.   

Can myopia be cured or reversed? 

No, myopia is not curable or reversable – an important point to make with patients who have children. Children’s eye exams are an ideal time to start encouraging myopia awareness and to detect pre-myopia, low myopia, or high myopia. 

Then, you can share the good news: with the proper management protocol, myopia progression can be slowed or even halted.   

Best practices for implementing myopia management at your practice 

Here are some things to keep in mind as you develop a myopia management protocol for your patients. 

1. Maintain a clear myopia message

As an ECP, you’ll want to establish your myopia message and apply it throughout your practice. Educate your entire staff so they can initiate a conversation about myopia risks and treatments if the opportunity arises.  

What is your myopia message? Experts say that while correcting myopia is part of the goal for your patients, it’s truly about getting to the root of the problem: slowing down the growth of the eyes.  

2. Address and assess myopia with patients early on 

It’s critical that ECPs intervene early for children who show signs of myopia – in order to start slowing the progression. During the child’s eye exam, explain what myopia is (rapid elongation of the eye from front to back) and present its associated risks and benefits of treatment: 

• Quality of life  
• Lifetime cost 
• Better outcomes for corrective surgery  
• Lower risk of Ocular disease that could lead to vision loss 

Ideally, you want to assess, educate, and explain your goal: to maintain normal, natural eye growth for children. And for those who are pre-myopic you want to identify them as at-risk, plant the seed about myopia management, and set the right expectations for treatment and slowing that progression. 

In terms of educating parents, both correction and control need to be explained. For myopia correction, that means ensuring parents understand the functional impact of uncorrected or under-corrected myopia on their child’s participation in school, sports, and other daily activities. It’s also important to explain the expected worsening, or progression, of myopia, which is typical in childhood.  

Additionally, explaining myopia control includes laying out the short-term and long-term goals:  

• Short-term goals: A child undergoing myopia control will experience less blurred vision between eye exams, due to less frequent changes of prescription.
• Long-term goals: There is a reduction of lifelong risk of myopia-associated eye diseases like cataracts, retinal detachment, and myopic macular degeneration.  

3. Optimize your patient communication techniques 

When communicating with your patients throughout the entire process, always show empathy and ask questions. Lifestyle will tell you a lot about how you advise them to manage their myopia at home.  

Remember to keep your myopia explanations simple to understand. Avoid optical lingo, and use relatable analogies; for example, a cavity is comparable, as your patients should treat this now and get it filled before it gets bad or becomes painful, resulting in a root canal. Use visual aids (such as our dispensing mat) to explain the situation and how treatment works. 

4. Explain your myopia management process: detect, prescribe, monitor

By the time of a myopia management consultation, your patients are likely now aware of the risks and importance of catching myopia early.  

The next best practice is actually a great way for an ECP to differentiate themselves in the market: to utilize biometry to measure the length of the patient’s eye. Using a biometer allows optometrists to see if the child’s eyeball is longer than it should be, so they can detect risk before it becomes apparent. 

The use of a biometer not only allows ECPs to be extremely accurate in measuring the length of the eye, but it also improves the value of what an ECP can offer. With this added value, an ECP can charge more for their service and establish themselves as the expert. While biometry is a valuable tool, don't let it stop you from practicing myopia management if you don’t have one. It is the standard of care in Canada to offer evidence-based treatment to all myopic children. 

Then, once you’ve measured the eye or at least discussed nearsightedness and the patient’s risk level, you can review the available treatment options and their cost (whether you offer all of them or not) and discuss the pros and cons as it relates to their child and lifestyle. 

Myopia treatment options may include: 

MIYOSMART 

• 60% average slow-down  
• 6-year clinical study showing a sustained treatment effect  
• Non-invasive glasses to be worn full time  
• Can be combined with atropine for improved treatment effect  
• Available in clear, photochromic, and polarized options  

Atropine eye drops 

• 59% slow-down 
• Daily eye drops at bedtime 
• Can be used in combination with other therapies 
• Pharmaceutical – needs to be compounded at a specialized pharmacy 
• Potential side effect: light sensitivity  

Myopic Defocus Contact Lens 

• 56% slow-down  
• Daily disposable soft contact lenses 
• Need glasses to be worn evenings and weekends 
• A high level of hygiene and responsibility required  

Ortho-K 

• 45% slow-down  
• Hard “retainer” contact lens worn overnight  
• Usually, no glasses or contact lenses need to be worn during the day  
• A high level of hygiene and responsibility required  

Healthy Habits 

• 2 hours+ cumulative daily outdoor time   
• When working up close, employ the 20-20-20 rule (every 20 minutes, look into the distance 20 feet for 20 seconds) 
• Hold reading materials at arm’s length 
• Limit screen time outside of schoolwork 

At handoff, describe your recommendation: “I have prescribed MiYOSMART to treat your child's myopia.” Assure the family that you will take the next steps to fit or dispense the chosen treatment. If they choose an option you don’t offer, refer out to someone who does. Confirm their choice and offer the next steps, which should include a 6-month follow-up. 

5. Establish your myopia management pricing model 

Experts suggest charging a flat rate for the initial consultation and to do this as a separate appointment following the eye exam. The treatment and follow-up are generally billed in three ways: 

Pay an annual subscription that includes treatment and follow-ups. This will change based on the treatment chosen and the time required. 

• The benefit is the Px is locked in for the year 
• The parents don’t have to worry about additional costs 
• The drawback is it is a large upfront cost 

Pay as you go. Each follow-up appointment has a cost applied and the treatment options are charged individually. 

• The benefit is, it’s broken down into much smaller more digestible chunks 
• If treatment options change you can easily adapt with an a-la-carte approach 
• It is easy to execute and understand  

Hybrid. Annual subscription for all follow-up appointments and a separate charge for the treatment option itself. 

6. Solidify your reputation as the expert 

At pick up, review how the lens works and that it is important that the child wears the lenses as much as possible. Adjust the frame to fit as close to the face with minimal panto and wrap, confirming eyes are centered in the clear zone.  

Review proper care and cleaning. Reassure them that if they have any concerns to contact the clinic. Follow up in two weeks to one month to verify satisfaction. 

While you consult them on their myopia management treatment, be sure to explain any programs that may help with their costs, like HOYA’s Eye-M-Growing (EMG) program. EMG is HOYA’s kids program catered to children up to 16 years old; it offers children a multi-pair lens solution at a reduced cost with an enhanced warranty. As part of the EMG program we offer clear, photochromic, and polarized options for all of our lens designs, including MiYOSMART. So, this can be used for multiple lens changes or if they want to have a primary pair and a second pair of sunglasses, for example. 

EMG benefits ECPs, parents, and their kids: 

• Great for parents who want to be cost-effective while preventing myopia and other eye conditions for their children.
• Great for the ECP, who is looking for better ways to serve patients and become a trusted resource for cost-conscious eye care – especially since the EMG program grows with the child as they get older. 

7. Continued myopia management 

An essential part of myopia management is the 6-month follow-up. Children grow and change so quickly that it’s a good idea to check how the treatment is performing regularly in case adjustments need to be made. At this appointment, you can assess their progression and treatment effect. If the goal has not been achieved, this is the time to determine if another approach or combination treatment is needed.  

Myopia management is an ongoing process of monitoring and pivoting, so you'll want to schedule follow up at least every 6 months for the duration of treatment. 

Offer a myopia management checklist for your patients who are parents  

Encourage your patients who are parents to start eye exams early and to get creative when it comes to getting their kids outdoors – daylight is important for myopia management in children.

Here's a myopia management checklist for the parents: 

• Check-ups / exams 
• Know the signs  
• Increase time outside  
• Wear UV protection  
• Limit time spent on devices  
• Take frequent breaks from screens  
• Place screen a certain distance from face  
• Adjust screen brightness/contrast  

MiYOSMART: evidence-based options for myopia management 

MiYOSMART improves distance vision and at the same time provides effective myopia control. A two-year randomized clinical trial showed on average, a reduction in myopia progression by 60%2 in children 8-13 years old.  

This has since been reinforced by 3 and 6-year follow-up studies that showed the slowdown was sustained.3 The 6-year follow-up found the average cumulative myopia progression to be less than -1.00D over 6 years, and children who stopped wearing MiYOSMART lenses showed no rebound effect compared to the eye growth in “age-normative” non-treated myopic children.4

Why MiYOSMART for children? 

Slowing down the progression of myopia and preventing the associated deterioration in eyesight can greatly enhance children’s lives by improving their visual acuity and overall well-being. 

• Industry leading solution for controlling myopia 
• Clinically proven effectiveness in slowing down myopia progression 
• Child-friendly, easy to adapt and non-invasive 
• Sun solutions available 

References: 

1 Brien Holden Vision Institute. Article at: Prevalence: 50% of the world myopic by 2050. 

2 Lam CSY, Tang WC, Tse DY, Lee RPK, Chun RKM, Hasegawa K, Qi H, Hatanaka T, To CH. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomized clinical trial. British Journal of Ophthalmology. Published Online First: 29 May 2019. doi: 10.1136 bjophthalmol-2018-313739 https:// bjo.bmj.com/content/104/3/363  

3 Lam CS, Tang WC, Lee PH, et al. Myopia control effect of defocus incorporated multiple segments (DIMS) spectacle lens in Chinese children: results of a 3-year follow-up study. British Journal of Ophthalmology Published Online First: 17 March 2021. doi: 10.1136/bjophthalmol-2020-317664 https://bjo.bmj.com/content/ early/2021/03/17/bjophthalmol-2020-317664 

4 Lam, C.S.Y., Tang, W.C., Zhang, H.Y. et al. Long-term myopia control effect and safety in children wearing DIMS spectacle lenses for 6 years. Sci Rep 13, 5475 (2023). https://doi.org/10.1038/s41598- 023-32700-7