The three clinical pillars of myopia management

Every child with myopia needs vision correction. Optical treatments are central to myopia management because they can simultaneously provide myopia correction and effective myopia control, making them the ideal first-line therapy.

Optical treatments encompass spectacle lenses, soft contact lenses, and orthokeratology. The next generation spectacle lenses for myopia control use specialized designs to provide myopic defocus or contrast modulation across the retina, while maintaining clear vision. Soft contact lenses for myopia control include established and emerging designs that provide clear vision and induce defocus. Lastly, there are now a number of orthokeratology products specifically designed for myopia management, that offer fitting and aftercare guidance in addition to the lenses themselves. 

The choice between glasses or contact lenses should consider the best treatment available to you, and which is most suitable for that child and their family. Glasses are simple and familiar, while contact lenses offer numerous functional and psychological benefits.1

The visual environment is a key pillar of myopia management, as it provides opportunities to advise families how to manage modifiable risk factors that may contribute to myopia onset and progression. 

Spending more time outdoors is the simplest and most accessible lifestyle modification to help delay the onset of myopia.2 Increased outdoor time also appears to have a modest benefit in slowing myopia progression.3  Additionally, outdoor activity naturally lends to other health benefits, such as participation in physical activities, improved fitness, and mental wellbeing.4,5

High visual demands from near work (e.g. reading, writing, screen-based work) have long been implicated as risk factors for myopia. In particular, reading at very close working distances (<30 cm) and for longer continuous periods of time (>30 minutes) is associated with greater odds of myopia.6 Notably, even though myopia tends to stabilize by the mid-teen years, myopia progression among university students engaged in intensive study is fairly common.7

Binocular vision matters for myopia management because it adds more information to the clinical picture, potentially improving the quality of clinical management. Understanding a child’s binocular vision status helps clinicians to assess myopia risk, and optimize treatment selection for comfort and efficacy.

Certain disorders have been implicated as risk factors for pre-myopia. Children with higher AC/A ratios, typically seen in esophoria, have over a 20-fold greater risk of developing myopia within one year.8 Accommodative lag may also play a role, though its influence remains uncertain.9 Intermittent exotropia has similarly been linked with increased risk of myopia onset.10

Considering a patient’s binocular vision status is also important for visual comfort, ensuring that children have the functional skills needed for reading and schoolwork, and acceptance of their correction.11,12 For example, esophoria and accommodative lag are likely to be improved in orthokeratology wear.13,14

Fortunately, many of the best optical treatments do not adversely impact accommodation or phoria.15-17 Certain treatments remain effective even in children with binocular vision anomalies, such as Essilor Stellest lenses in intermittent exotropia.18 This may be treatment-dependent, as one study found multifocal soft contact lenses less effective in children with accommodative lag.19

1. After discussing the importance of myopia management, there are three key areas of clinical focus: optical treatments, the visual environment, and binocular vision.
2. Optical treatments should be offered as a first-line option, as they integrate myopia control into a child’s everyday vision correction.
3. Providing advice on how to manage the visual environment can benefit children with myopia, as well as children at risk of developing myopia.
4. Binocular vision can potentially affect multiple aspects of myopia management, including visual comfort and treatment efficacy.