Myopia has evolved from a simple refractive error into a global epidemic, with prevalence increasing from 24% in 1990 to an estimated 50% by 2050.1 For today’s children, myopia management is no longer an optional service but a clinical standard of care. Each diopter of progression significantly increases the lifelong risk of vision-threatening complications such as retinal detachment, glaucoma, and myopic maculopathy.2
Beyond the clinical necessity, myopia care represents one of the largest growth areas in modern optometry, offering a business-friendly, primarily cash-pay model that benefits both private and corporate practices alike.
Essential equipment and technology
Incorporating myopia care into your practice is more accessible than many practitioners realize. While standard exam equipment—including an autorefractor, phoropter and a slit lamp—is technically sufficient to begin managing myopic patients beyond single-vision spectacles, higher-level care does require specialized tools.
Two main pieces of equipment can transition your practice from dabbling with myopia care to advancing myopia management: a biometer and corneal topographer.
Biometer
The gold standard for monitoring myopia progression has rapidly shifted toward measuring axial length, rather than changes in prescription, though both provide an important perspective. While a practice can definitely start without a biometer, my prediction is that axial length monitoring will soon be as ubiquitous as retinal imaging was a decade ago.
Biometry allows for a more accurate assessment of risk and treatment efficacy, providing parents with objective data that builds trust. It also allows us to screen for pre-myopia more effectively and initiate treatment on at-risk patients earlier.
Topographer
A corneal topographer is also a great tool to have when expanding into custom orthokeratology (ortho-K) overnight lenses. In my practice, we take yearly topography images on all patients as part of our myopia program to help rule out corneal abnormalities such as keratoconus and pellucid marginal degeneration.
Ruling out corneal abnormalities is important as refraction alone can miss the first signs of these conditions, which are prominent in adolescents. The presence of keratoconus, for example, can also dictate how you approach your myopia treatment regimen, knowing when to intervene, and considering non-ortho-K options for that patient.
Many modern ortho-K designs have a topography-guided fitting process making this instrument essential. Newer equipment, such as the Topcon MYAH, combines topography and biometry, while the Essilor Myopia Master combines auto-refraction with biometry making for easier footprints in smaller offices.
Download the checklist here!
Myopia Management Practice Integration Checklist
Use this checklist to transition from standard refractive correction to a comprehensive myopia management clinic.
Clinical protocols and patient pathways
Developing a streamlined clinical workflow is essential for scalability. Depending on the practice setting, practitioners may choose to present treatment options during the comprehensive visit or to schedule a dedicated myopia consultation a few days later. If a consultation is scheduled, it is common to charge a separate fee, which can then be applied toward a comprehensive myopia management program.
Patient identification
Initiating the availability and need for myopia control on new patients can start before the doctor walks into the exam room. Utilizing case history discussions from technicians, proper signage around the office and informational packets available to the parents and child, allows families to understand the need for treatment and options immediately.
I review the pre-test information and the patient’s intake form prior to walking into the exam room and already know that I will be having discussions about myopia control. Once in the room and acquainted, I like to toss up some easy symptom-related questions to both the parent(s) and child in order to set-up my discussion on the importance of myopia control.
For example, for younger children, asking the parents if they move closer to the TV or are seen squinting. Some parents will tell me that their child prefers not to watch TV and to use their tablets instead, which I then explain is a major symptom of myopia.
The case history conversation should continue from the moment the patient is called back throughout the entire exam. Learning about their activity level, how they are doing in school, favorite and least favorite subjects, and participation in sports is all so vital to not only making proper recommendations for treatment but understanding how the child’s myopia is affecting their life.
When bringing up options for myopia control, I try to initially recommend one intervention that I feel will best suit the family at that time. For younger children, up to 8 or 9 years old, that’s usually Essilor Stellest anti-myopia glasses. For slightly older, more active children, 9 or 10 and older, the conversation usually goes right to contact lens options. However, every child is different, as are their needs, and I’ve had children as young as 7 years old do very well with MiSight 1-Day lenses and Ortho K.
Make sure to consider every aspect of the patient’s lifestyle, as the best option is always the one that the patient, and their parents, will do consistently. It also helps to develop a rapport with the family. Most clinicians will end up seeing their myopia patients multiple times throughout the year, and keeping them as patients long term.
Baseline testing
- Comprehensive Exam: Complete exam testing unaided visual acuities, refraction, retinal evaluation and anterior segment health analysis
- Cycloplegic Refraction: Very important metric to have the most accurate prescription, especially on younger children with immature accommodative systems.
- Accommodative Testing: A key baseline component to assess the patient's focusing system. This can help guide decision making on what treatment protocol to recommend.
- Biometry: Measuring axial length on all kids and teens provides essential objective data to guide the conversation with parents on why the eye is growing.
- Corneal Topography: A baseline requirement for any patient enrolled in a myopia program.
Follow-up protocol for myopia management
Here is a quick guideline for what testing should be done on the following myopia protocols:
| Protocol | Initial / Fitting | 1- to 3-Week Follow-Up | 1- to 6-Month Follow-Up | Ongoing / Long Term |
|---|---|---|---|---|
| Orthokeratology | Baseline measurements (topography, HVID), lens order, I&R training) | 1-day, 1-week, 3-week: VA, corneal health/staining, topography, over-refraction | 3-month, 6-month: Axial length, topography, VA, corneal check, refraction | Annual comprehensive exam, lens replacement 6-month to 1-year |
| MiSight / Soft Multifocal Lenses | I&R training, initial fit | 1-week: VA check, lens adjustment if needed | 6-month: Axial length, refraction, VA check, lens adjustment | Annual comprehensive exam |
| Essilor Stellest | Fitting with optician, ensure proper frame selection | 3-week: VA check, verify fit and wear time | 6-month: Axial length check, refraction, adjust RX if needed | Annual comprehensive exam |
| Low-Dose Atropine | Baseline accommodative function | 3-week: Check pupils, VA, near vision | 6-month: Axial length, refraction, VA | Annual comprehensive exam |
Short on time? Check out the Myopia Management Practice Integration Checklist!
Knowledge is power: Keeping up-to-date
The most important step to successfully offering myopia management is staying current with the latest research and clinical developments. Some great resources include industry podcasts, online publications and in-person conferences such as Vision By Design from the AAOMC, which offers a myopia bootcamp.
Familiarizing yourself with the important myopia studies such as the MiSight Study and the IMI white papers from the Myopia Institute.This education should extend to all members of your staff who will be communicating with parents and patients.
Empowering your team through education
Success in myopia management is a team effort. Staff are often the first to answer parent questions and the last to discuss fees; therefore, comprehensive training is vital. Designating a specific "myopia manager" can help streamline operations and ensure consistent messaging. However, most if not all staff members should be educated on myopia management and understand the practice protocols.
Providing staff with scripts and standardized educational tools, such as the Ocumetra risk profile software, Myappia.com, or BHVI tools empowers them to initiate meaningful conversations before the doctor enters the exam room.
At my office we find many instances where one parent is present and they need to communicate with their spouse before moving forward with treatment. Your staff will likely be the ones answering if patients call back with questions and concerns.
Develop a fee structure that reflects value
Historically, myopia management was centered around ortho-K, which is a highly customized and specialty skill requiring extra time for the doctor and staff as well as many visits by the patient. With that came appropriate yearly program costs of at least $2,000 to $4,000.
Since the FDA approval of MiSight 1-Day soft contact lenses in 2019, and the subsequent approval of Essilor’s Stellest anti-myopia glasses in October 2025, the cost to entry for myopia control has shifted lower.
As of July 2026, the American Medical Association (AMA) has adopted a resolution classifying myopia as a disease and supporting insurance coverage for myopia treatment. While this will not happen overnight, it is likely that some form of preventative myopia care will be covered by insurances in the next 5 to 10 years.
Ideally, access to care, which includes costs, is important for growth of myopia control. On the flip side, the education and follow-up care required for myopia programs are vital to its success for an individual. As such, practitioners should set up their fees appropriately, so as to reflect their patient base and chair time cost as well as corresponding to what other practices in the area are charging.
I like to educate the parents that myopia management requires more personalized strategy and monitoring, especially ensuring that the selected treatment is working throughout the year. I also tell them that, at this time, insurance will only cover correction, which is the bare minimum required for the child to see well, instead of prevention. When this is presented properly, families will understand what they are being quoted for, and why insurances don’t contribute much to the plan. As such, I’ve seen a wide variety of fee structures across the board for non-ortho-K myopia services, with some matching the costs of an ortho-K plan and others being much lower to provide a more “budget” option that can meet more patient’s needs. Cost of goods aside, services for follow up care should be at least a few hundred dollars per year.
Marketing and community outreach
Effective marketing should focus on education rather than sales. Social media is a powerful tool for informing your patient base about the importance of slowing myopia, especially during peak times like back-to-school or spring break.
However, community outreach remains the most significant growth driver. Building relationships with local pediatricians and school nurses ensures that your practice is the first choice for referrals when a child fails a basic screening. For example, hosting school events where students can have their axial length measured can be a highly engaging way to spread awareness.
Developing a presence on local Facebook groups, especially “mom groups” where local parents are constantly asking for healthcare recommendations, can also be very beneficial for the practice.
Tracking key metrics
Tracking conversion rates—comparing the number of patients who are offered myopia prevention against those who enroll—is a critical metric for practice success. Most electronic health records (EHRs) have the capability to filter out the number of patients who fall within certain age ranges who are diagnosed with myopia. These are great tools to help figure out conversion, who was offered and may still be a candidate next year, etc.
Be sure to utilize the family functions of your EHR as well to help the doctor and staff quickly recognize which kids have myopic parents. Losing patients to follow up is also common, so make sure you communicate the importance of follow up care in addition to yearly comprehensive visits. This allows you to adjust your protocols to improve conversion in the future.
The future of myopia management: Monitor, adjust and grow
The world of myopia management has changed quickly over the past few years. New studies are completed and new glasses and contact lens options are on the way in the future, as well as the possibility of FDA approval for low-dose atropine.
Stay informed so you can make adjustments to your practices’ offerings as new tools arrive. CE courses at major meetings such as American Academy of Optometry and AOA's Optometry’s Meeting as well as myopia-focused meetings like Vision By Design will cover anything from getting started to the latest research. Your area reps are filled with great resources and it can be extremely beneficial to develop a relationship with them to not only improve your skills but develop a reputation in your community.
As practitioners, our responsibility is to move beyond simple vision correction and embrace active prevention. By standardizing our protocols and educating our communities, we can ensure that every myopic child has access to the care they need to protect their future vision.
