Partnering with Pediatricians to Improve Myopia Outcomes

Based on current trends, in just 25 years, half of the world's population is expected to have some degree of myopia.¹ In certain regions, the prevalence of myopia already exceeds 90%.²

Given myopia’s association with sight-threatening complications, early detection and intervention are critical to mitigating its prevalence; as such, pediatric vision screening can be a powerful lever to intervene in the trajectory of myopia progression.

The American Academy of Ophthalmology (AAO) and the American Optometric Association (AOA) align on the importance of pediatric vision evaluations. Early vision screenings, beginning in the newborn months and repeated at the appropriate intervals (see below), can identify risk factors to vision development.

Instrument-based screeners, like photoscreeners and auto-refractors, and age-appropriate visual acuity tests can flag potential vision problems, including myopia, and prompt the need for a comprehensive eye examination to confirm the diagnosis and for long-term management.

Since families typically have regular interactions with pediatricians and school, pediatricians and school nurses naturally can be optimal partners on a child’s team in monitoring and supporting a child’s vision development. Vision screenings with these partners have the potential to be efficient and well-utilized, while establishing a smooth hand-off for referrals when concerns arise.

Their involvement can increase access to care within the community, especially for underserved populations, and baseline awareness of the importance of vision for learning and development.

Myopia is very common in school-aged children; however, its ubiquity can often soften the perception of its potential complications. If left unmanaged, myopia can lead to vision-threatening problems such as retinal detachment, glaucoma, and macular degeneration later in life. The risk of these changes increases with the degree of myopia, so early detection is an opportunity to mitigate the onset and progression of myopia.

It is critical for parents and community partners to understand the known risk factors contributing to myopia, which is a mix of nature as well as nurture. Research highlights a strong genetic link to refractive errors, with myopia risk increasing when one or both parents are myopic.⁵

However, outdoor activity is a practical, evidence-based approach to reducing this risk. Regular time outdoors—whether through sports or play—can slow the progression of myopia, even in children with a genetic predisposition.⁶

The outdoors and natural environment seem to provide critical feedback for proper eye growth. How children spend their time at school and on weekends should be carefully considered to optimize their visual environments.

As with any new program, the first step is to establish clear goals and expectations.

While engaging every pediatrician and school in a 10-mile radius is an admirable goal, it might be more effective to break this down into manageable steps. Consider starting with the elementary school in your neighborhood or the pediatrician’s office in your building.

The program can naturally grow as the word gets out, or you can have longer-term goals for future expansion. Arrange meetings with the right stakeholders to explain the objectives and benefits of a vision screening program. At a school, you would likely meet with the principal and school nurse, while at a pediatrician’s office, you may connect with the doctor and office administrator.

Come prepared with a handout that can then be distributed to families, such as the one provided below. In addition, to streamline your efforts, take advantage of resources like the Myopia Collective by CooperVision and AOA, which offer materials to facilitate a smoother introduction to schools.

Once you have the school’s support, determine the best time to implement the program. Consider recommending within the first months of the school year to facilitate a strong foundation for the new year.

Timing in the calendar year is not as relevant for pediatrician’s offices, as they see children year-round. Instead, consider incorporating a partnership with the pediatrician for select wellness visits, such as the 2-year check.

Generally, this visit already consists of a visual acuity test or photoscreener, which is a great foundation. Additional collaboration with a pediatrician can include myopia management counseling training, improvement of a co-management framework, and even potential for collaborative research on patient outcomes.

It is important to establish the criteria that would warrant a referral to you.³

Instrument-based screeners generally indicate whether there is a risk for amblyopia. When assessing visual acuity, since visual acuity can be short of 20/20 in pre-school children, even without refractive error or vision disorders, it is important to set thresholds based on evidence-based age norms.⁷

Table 1: Average visual acuity for children < 3 to 6 years.

If the test cannot be completed due to cooperation or the results are inconclusive, a full eye examination is recommended to ensure no vision concerns are left unchecked.

Squinting, closing the eye, or resistance to having an eye covered should prompt further evaluation.

Even if they pass an initial screening, children with certain risk factors, such as a family history of genetic eye disease, history of prematurity, or developmental delays, should still have a full eye exam.

The effectiveness of a vision screening program will depend on the proficiency of the person conducting the screenings. Consistency, accuracy, and efficiency are large contributors to a program’s success.

In schools, the school nurse can oversee or perform the vision screenings. All involved staff and volunteers should receive training in using the tools, results interpretation, and appropriate follow-up procedures. Being on-site also is a great opportunity to enhance the quality of the screenings, as well as provide real-time insights and support.

On the other hand, pediatrician’s offices generally require less external support, as basic vision screenings may already be built into the wellness examination. There are still opportunities to strengthen their workflows and confidence by organizing a yearly in-service training session for the team.

Once all the pieces are together, it is time to roll out the inaugural program! By starting out small at first, the program can test its processes, identify challenges, and improve workflows. There will be plenty of lessons learned, all while getting a head start on making an impact in your community. Expect to iterate and discover ways to make it more scalable.

Addressing the rise of myopia requires an expansive approach, with early detection and intervention at its core. By using vision screenings and establishing partnerships within the community, we can create a framework towards a shared goal of healthy vision development for children.