From Paper to Clinic, Episode 5: Reframing Myopia Management: Atropine, Axial Length, and Engaging Young Patients

Welcome to From Paper to Clinic, a podcast focused on evidence-based eye care and real-world clinical decision-making, hosted by Hamza Shah, OD, MS, FAAO, a faculty member at the University of Houston College of Optometry. His work spans clinical patient care, education, and mentoring, and his clinical interests include ocular disease, dry eye, perioperative care, and—above all—the challenge of translating information into meaningful patient outcomes.

In Episode 5 of From Paper to Clinic, “Reframing Myopia Management: Atropine, Axial Length, and Engaging Young Patients,” host Hamza Shah, OD, sits down with Brianna Rue, OD, to reframe myopia as a looming public health crisis rather than a routine refractive error. Rue highlights striking projections: by 2050, up to 90% of some Asian populations and more than 60% of Americans may be myopic, with epigenetic and environmental factors driving much of this surge. She connects these epidemiologic trends to real-world economic and human costs—from lost productivity estimated at $250 billion globally to the lifelong burden of complications such as retinal detachment, myopic maculopathy, glaucoma, and cataract.

The conversation then moves from population-level data to chairside strategy. Rue argues that clinicians must stop thinking in diopters and start thinking in millimeters, emphasizing axial length as the true determinant of structural risk. Using the analogy of a fitted bed sheet stretching over a mattress to describe the retina under axial elongation, she explains why even small changes in millimeters matter. Shah and Rue dig into practical management: age- and phenotype-based atropine concentration selection, the pitfalls of relying on spectacles that kids won’t wear enough hours per day, and the advantages of dual-focus soft lenses and Ortho-K in real-world adherence. Rue also shares communication strategies for engaging both parents and children in behavior change—especially around device use and outdoor time—and makes a strong case for prophylactic treatment in at-risk 6- and 7-year-olds. The episode closes with a call for more clinicians to build robust myopia management programs, charge for their expertise, and see myopia control as both a professional responsibility and a key practice growth opportunity.

The paper inspiring this discussion is "Myopia Progression Management: Current Trends and Future Directions" by Zhang and colleagues, published in Clinical & Experimental Ophthalmology.

Do you want to only listen to this episode? Check out the audio player below.

Episode 6 is coming on Monday, August 3, 2026, at 8 AM ET

The sixth episode of From Paper to Clinic will debut in early August and will feature Andrew Dixon, OD, focusing on retinal biomarkers for early Alzheimer disease detection. Listeners are invited to join the conversation as the series explores how evidence moves… from paper to clinic.