Myopia management in ophthalmology - Q&A with Professor Andrzej Grzybowski

While refractive error has traditionally guided clinical decision-making, there is growing recognition that axial length measurement provides a more sensitive indicator of disease progression and long-term risk.¹  Advances in diagnostic technology now enable clinicians to integrate axial length, corneal topography and keratometry into routine care, facilitating a more comprehensive assessment of myopia progression and eye health. In this Q&A, Professor Andrzej Grzybowski, Professor of Ophthalmology at the University of Warmia and Mazury in Olsztyn, Poland, discusses the role of modern diagnostic devices in ophthalmological practice, with a focus on how objective measurement tools can support risk stratification, guide treatment selection, and enhance communication with patients and their families.

Andrzej Grzybowski: The device provides axial length measurements alongside corneal topography and keratometry and allows me to move beyond refractive error alone and focus on structural progression. This is particularly important in children, where axial elongation is the key driver of long-term risk.²  This enables early identification of fast progressors, even before significant refractive change is evident.³  As a result, I can initiate evidence-based interventions—such as atropine, optical treatments, red-light therapy or lifestyle modification—at the most appropriate time. The ability to track progression objectively over time also supports a more proactive rather than reactive management strategy. Ultimately, it allows me to personalize treatment decisions, stratify risk more accurately, and communicate clearly with families about why early intervention is necessary.

Andrzej Grzybowski: A recent case involved a child with relatively stable refraction over one year, which might traditionally have suggested observation rather than intervention. However, serial axial length measurements obtained with the device revealed significant elongation despite minimal refractive change. This discrepancy highlighted the limitation of relying solely on refraction and prompted a shift in management. Based on the objective progression data, I initiated myopia control spectacle lenses and introduced lifestyle recommendations, including increased outdoor time.⁴  Over subsequent visits, the axial growth rate slowed, confirming treatment effectiveness. Without access to precise axial length monitoring, this child might have been undertreated during a critical period of progression. This example illustrates how modern diagnostic technology provides deeper insight into disease dynamics and enables earlier, more targeted intervention. It also reinforces the importance of integrating structural biomarkers into routine clinical decision-making in pediatric myopia care.

Andrzej Grzybowski: Objective measurement tools such as axial length tracking significantly enhance communication with families by making an otherwise abstract condition more tangible. When parents see numerical changes over time—particularly axial elongation—they better understand that myopia is not just a refractive inconvenience but a progressive eye condition with long-term risks. Visualizing growth curves allows me to explain why early intervention matters and to justify treatment recommendations. It also helps align expectations, as families can see whether progression is stable, accelerating, or responding to treatment. This transparency improves adherence to therapies such as atropine or optical interventions. Additionally, objective data facilitates shared decision-making, as parents feel more confident when recommendations are supported by measurable evidence rather than subjective assessment alone. In my experience, this approach builds trust, improves compliance, and ultimately leads to better long-term outcomes in pediatric myopia management.

Andrzej Grzybowski: The most valuable features in modern diagnostic devices are those that provide accurate, repeatable, and clinically meaningful measurements over time. Axial length measurement is paramount, as it directly reflects disease progression and risk.^1,2 Equally important is the ability to track longitudinal data and display progression trends in an intuitive format. High repeatability ensures that small changes are clinically relevant rather than measurement noise. Integration of corneal topography and keratometry adds further value, particularly when selecting or monitoring optical treatments such as orthokeratology. User-friendly interfaces and rapid acquisition are also critical in pediatric populations, where cooperation may be limited. Additionally, devices that allow data sharing and clear visualization support patient education and multidisciplinary care. Together, these features enable clinicians to move from episodic assessment to continuous monitoring, which is essential for effective, personalized myopia management.

Andrzej Grzybowski: In my clinical workflow, the device is integrated as a component of both baseline assessment and follow-up visits for children at risk of or diagnosed with myopia. During the initial visit, axial length, keratometry, and topography are recorded alongside refraction, providing a comprehensive profile of the patient. This establishes a reference point for future comparisons. At each follow-up, repeat measurements are taken and automatically compared with previous data, allowing rapid assessment of progression. The results are then discussed with the patient and their family as part of the consultation, supporting clinical decisions and treatment planning. By embedding objective monitoring into every stage of care, it ensures that management decisions are data-driven, consistent, and responsive to changes in disease progression.