Improving Myopia Conversations – Q&A with Professor James Loughman

Ocumetra is closely linked to my original role as Head of the Centre for Eye Research Ireland (CERI). CERI became a major clinical trial hub for myopia management, involved in studies across atropine, contact lenses, spectacle lenses, light therapies, and more. We built a strong nationwide referral network, and clinicians regularly referred children suitable for trials. 

When myopia treatments started becoming commercially available—beginning with MiSight 1 day and later myopia control spectacles lenses —we expected referrals to drop as clinicians managed these children themselves. Surprisingly, that didn’t happen. 

We brought in a PhD student to investigate why, and her work identified barriers that are now well recognised: communication challenges, chair-time pressures, and confidence around integrating myopia management into routine practice.¹  Ian Flitcroft and I had already been collecting large datasets for other research purposes, and we realised those data could underpin a software solution to directly address these barriers. Ocumetra emerged from that—primarily to support clinical confidence, improve efficiency, and the commercial side of making myopia management viable as a practice priority.

The biggest challenge was and still is communication—specifically, how to have an effective, confident conversation with parents. Most optometrists are uncomfortable with “selling,” and myopia management often involves proposing a new care pathway with cost, time, and lifestyle implications that parents weren’t expecting. 

Parents often view myopia as a lifestyle inconvenience, whereas we understand it as a risk factor for future ocular disease.²  Explaining that clearly, simply, and without overwhelming families takes time and skill. Early on, these conversations can be long and frustrating, especially when parents say, “Let me think about it,” and don’t proceed with treatment. 

Chair time and communication are tightly linked. The original mEYE® Guide, Ocumetra’s first clinical tool, was designed to visually and clearly explain why myopia management matters and what it means for that individual child. It took nearly two years of iterative development with clinicians, academics, and parents to refine what worked—and what didn’t.

Centile charts are fundamental because they put meaning to numbers. Telling a parent their child is –1.00D doesn’t mean much, even if the parent is myopic themselves. Showing them where their child sits relative to peers of the same age, sex, and ethnicity does. 

Centiles allow us to say, for example, “Your child is at the 98th centile—only 2% of children are more myopic.” We can then project forward: what might this look like at age 20 if we don’t commence treatment? 

For myopic parents, projecting outcomes such as –6.50D or –7.00D often resonates immediately. For parents without lived experience of myopia, we developed a cutting-edge vision simulator to show them. We’ve all used trial frames to demonstrate blur, but importantly, these tools can be shared at home, allowing the parent or carer who doesn’t attend the exam to engage with the decision-making process.

We often use the braces analogy—parents readily invest significant money in orthodontics because they understand long-term consequences, and arguably, these are not as consequential as untreated myopia progression risks. Once parents truly understand the long-term implications of myopia progression, uptake changes dramatically. We’ve seen practices move from 10% uptake to 80–100% once communication becomes clear, personalised, and visual using our mEYE® Suite tools.

The first conversation is critical, but long-term success depends on keeping children on treatment for as long as clinically needed. A unique challenge in myopia management is that progression still occurs—even with effective treatment.

At follow-up, clinicians and parents need help interpreting whether observed progression is acceptable. That’s where the mEYE® Score tool comes in. It helps determine whether changes in refraction or axial length are within expected limits for that child’s profile and treatment.

If progression is acceptable, clinicians need to show parents what’s been achieved: “Here’s where your child might have been without treatment, and here’s where they are now.” Visualising a shift from a projected –6.00D to –2.75D can be far more meaningful than percentages alone. The information and outputs from the mEYE® Score tool makes it all clearer, and the conversation becomes easier.

It provides evidence-based interpretation. Most clinicians are comfortable with dioptres, but not millimetres. If you asked an optometrist what 24.3mm axial length means in an eight-year-old girl—normal or not—most wouldn’t have an intuitive answer. Even clinicians measuring biometry don’t necessarily have the tools to interpret it fully, and supports vary by device and region. 

mEYE® Score compares axial length change against expected physiological growth for that child’s profile, helping clinicians understand whether growth is normal, accelerated, or well controlled. It can also indicate expected change by the next visit, based on typical treatment effectiveness.

 This is a different pattern of eye care, ensuring everything is evidence-based. Traditional myopia management has relied on intuition and clinical experience. In this era, where we’re trying to slow axial elongation, there’s more to consider. Tools that underpin decisions in an evidence-based way are key. Every time you enter axial length, we provide centile position and what’s normal for that child’s profile, so clinicians can build intuitive understanding and awareness. We also built in an axial length estimator to help educate clinicians to get started with understanding the millimetres, and to support learning over time and the transition to biometry when the time is right. 

The axial length estimator exists to educate and lower barriers to getting started. There’s increasing evidence that axial length is the metric we most need to measure in myopia management. But if we set the bar as “you must buy a biometer before you start,” adoption will slow further. Our goal is better eye health and vision for children, and that means more clinicians doing myopia management earlier.

 Estimation helps build an individual risk profile. You can infer a lot from refraction, as we know that refraction and axial length typically correlate.³  In some children however, refraction and axial length don’t align as expected— you can have low-to-moderate myopia with a very long axial length—effectively a high-risk eye. We’re currently working toward axial-length–based definitions of high myopia for this reason. 

However, we don’t recommend using estimated axial length to track progression over time. Estimation has a margin of error and is not ideal for long-term monitoring or long-term clinical decisions. It’s useful for risk identification and for supporting the initial decision to start myopia management, but monitoring treatment response over time really requires measured biometry.⁴ 

A major focus is progressing toward FDA approval as a medical device. Longer-term, using large data sets, we want to be able to guide initial clinical decisions: for a child’s profile in a particular practice or group, in a particular country, we want to be able to tell you which treatment or combination appears most effective. That will require years of data collection and a more advanced medical device approach. We also want to support decisions when treatment isn’t working as well as desired.

 We’re also excited about the choroid as a biomarker. It’s currently more of a research tool, but it may help indicate response to treatments like atropine, spectacle or contact lenses, and light therapies, and support identification of children at long-term risk based on the choroid as well as their axial length. We’re doing machine learning work to determine whether existing images can be used to make this clinically useful, without needing to wait for major technology changes.

On integration, we’re working on embedding these tools into devices and record systems—partnerships with Topcon for their Harmony system and Ocuco for Acuitas, and others—so clinicians can run reports seamlessly without duplicate data entry. Ideally, as clinical data is entered, prompts could identify high-risk children and open a myopia management report directly, integrating into normal workflow.