AAOpt 2026: Managing complex pediatric myopia cases

Magdalena Stec, OD, FAAO, and Noreen Shaikh, OD, MEd, FAAO, who both practice at Lurie Children’s Hospital of Chicago, discuss their presentation on myopia management, titled “From Toolbox to Treatment: Managing Out-of-the-Box Myopia Cases in the Real World,” which included complex pediatric myopia cases. They describe reviewing available tools for controlling myopia and considering how to use them in situations where the standard evidence does not clearly support a particular treatment. Their focus was not only on established approaches, but also on the difficult cases clinicians encounter when the right course of action is uncertain.

Stec and Shaikh identify several common clinical dilemmas: deciding whether to treat a patient or refer them elsewhere, determining whether to investigate another diagnosis before beginning treatment, and assessing whether a treatment is likely to work. They explain that applying existing treatments to these less straightforward situations requires careful judgment. Stec and Shaikh also stress the value of teamwork and discussion with colleagues, noting that clinicians can often reach better answers by working through challenging cases together.

Patient and family engagement is another central theme. Shaikh emphasizes that the best treatment is ultimately the one the patient will actually use. Having multiple options in the clinician’s “toolbox” is helpful, but treatment success also depends on discussing those options with families and finding an approach that fits the patient. Stec and Shaikh present that conversation as an important part of making myopia management effective.

Stec is enthusiastic about the prospect of a commercially available atropine eye drop. She says compounded atropine can vary considerably from one pharmacy to another, and that greater consistency would be valuable in clinical practice. Shaikh adds that commercial availability could improve access to care if insurance covers the medication, potentially making it more affordable for more patients. They also see atropine as a possible option for combination treatment or for young children who are just on the edge of myopia.

Finally, Stec and Shaikh argue that myopia management should become standard practice for optometrists. They encourage clinicians who do not yet offer it to consider incorporating myopia control into their practices. Alongside treatment options, Stec and Shaikh highlight environmental habits as an important part of management: encouraging children to spend more time outdoors, eat well, and use their near vision in healthy ways.