Practical tips and tricks: Advice for peers when treating the myopic pediatric patient

As myopia management becomes a standard part of pediatric eye care, clinicians are often faced with nuanced decisions that extend beyond simply prescribing treatment. Questions around when to intervene, how to explain long-term risks to parents, and how to measure success can make managing younger patients especially complex—particularly in cases of slow or seemingly minimal progression. In this Q&A, Jeffrey J. Walline, OD, PhD, shares practical perspectives on counseling families, selecting treatment options based on lifestyle and compliance, and avoiding common misconceptions that can shape expectations around myopia control outcomes.

Transcript

Edited lightly for clarity and length.

Jordana Joy: How do you approach the “borderline” child with slow progression—treat or wait?

Jeffrey J. Walline, OD, PhD:Past progression does not predict the rate of future progression at all, so I strongly believe that the parents of all myopic children younger than 16 years (the typical age myopia progression ends) should at least be educated on the benefits of myopia control.

Joy: What language or visuals help parents understand long-term risks (ie, retinal detachment, myopic maculopathy)?

Walline: The most basic message to tell parents is, “Reducing the amount of myopia as an adult reduces the chance of having poor vision even when wearing glasses or contact lenses.” From there, you can tailor the message for the individual, depending on their level of understanding and expertise.

Joy: How do you interpret variability in refraction or axial length over time?

Walline: I tell parents that on average children progress faster in the winter and slower with age, but it is impossible to predict how fast a child will progress or even know how well the treatment is working for an individual child. All we can say is that on average, this treatment is expected to slow myopia progression or eye growth by a given percentage and that none of them really work meaningfully better than another.

Joy: How would you suggest ODs choose between atropine, orthokeratology, soft multifocal lenses, or spectacle options?

Walline: We can’t predict which treatment will work the best for any individual child, but we know that the treatment is only effective if the child uses it. The choice of treatment should be made based on the treatment that best fits the child’s lifestyle and improves compliance.

Joy: For ODs that have myopia management programs, what would metrics would you suggest to be used to define “success”?

Walline: Based on what we know today, it is impossible to determine the effectiveness of a treatment for any given individual patient. Therefore, success should be defined by the patient’s compliance and comfort with the treatment regimen.

Joy: What’s a common mistake clinicians make when starting myopia management?

Walline: The most common mistake for clinicians starting myopia management is to believe that success is defined by stopping eye growth. Even emmetropic eyes grow in a coordinated fashion, so we must realize that all we can do is provide a treatment and encourage compliance for best results.