The untapped partnership between retinal specialists and optometrists in myopia care

The relationship between optometrists and retinal specialists has long been one of the strongest collaborative partnerships in eye care. Every day, optometrists refer patients with retinal tears, retinal detachments, macular degeneration, diabetic retinopathy, epiretinal membranes, lattice degeneration, and countless other retinal disorders for specialized diagnosis and treatment. These referral pathways are well established and have benefited patients for decades.

Yet one opportunity remains largely untapped.

As the worldwide prevalence of myopia continues to rise, retinal specialists occupy a unique position in identifying families at increased risk for progressive myopia and encouraging early intervention for younger relatives. Rather than focusing solely on the complications of myopia after they develop, retinal specialists and optometrists can work together to reduce the future burden of vision-threatening disease.

This shift represents an important evolution—from treating the consequences of high myopia to helping prevent them.

The growing burden of myopia

Myopia has become one of the most significant public health challenges in eye care.

Over the past 5 decades, the prevalence of myopia has increased dramatically around much of the world. In the United States, approximately 40% to 45% of adults are myopic, while in several East Asian countries, rates among adolescents and young adults have reached 80% to 95%. Globally, more than 2.6 billion people currently have myopia, and projections suggest that by 2050, nearly half of the world’s population—approximately 5 billion people—may be affected. Of even greater concern, nearly 1 billion individuals are projected to have high myopia, placing them at substantially increased risk for vision-threatening complications.¹

These projections have transformed myopia from a routine refractive condition into a major public health concern.

The landmark analysis by Holden and colleagues in Ophthalmology highlighted the dramatic projected increase in myopia prevalence worldwide and emphasized the growing burden of high myopia and its associated complications.¹

The increasing prevalence of myopia cannot be explained by genetics alone. Although genetic susceptibility plays an important role, environmental influences—including prolonged near work, increased educational demands, greater use of digital devices, urbanization, and reduced time spent outdoors—are believed to contribute to excessive axial elongation during childhood.

Research consistently demonstrates that increased outdoor exposure is associated with a lower risk of developing myopia. Current understanding of myopia development and management is summarized in the International Myopia Institute white papers, which provide evidence-based guidance for clinicians involved in myopia prevention and treatment.²

Several evidence-based interventions have also demonstrated the ability to slow myopia progression once it begins.

Why high myopia matters

The importance of slowing childhood myopia extends far beyond reducing dependence on thicker eyeglass lenses.

As axial length increases, so does the lifetime risk of retinal tears, retinal detachment, myopic macular degeneration, glaucoma, and earlier cataract formation. These risks rise progressively with increasing myopia, particularly when refractive error reaches approximately −5.00 to −6.00 D or greater.

The relationship between increasing myopia and ocular morbidity is substantial: Each additional diopter of myopia is associated with an increased risk of several potentially vision-threatening conditions (Table).

Retinal specialists witness these complications throughout their careers. They manage retinal detachments, myopic macular degeneration, tractional changes, and peripheral retinal pathology that represent the downstream consequences of excessive axial elongation. Their practices provide a daily reminder that high myopia is not merely a refractive condition; it is a disease process with lifelong ocular consequences.

Fortunately, myopia management has changed dramatically during the past decade. Numerous clinical trials have demonstrated that interventions, including low-dose atropine, multifocal soft contact lenses, orthokeratology, specialized spectacle lens designs, and increased time spent outdoors, can slow myopia progression in many children. Although these approaches do not completely eliminate progression, reducing axial elongation during childhood may substantially decrease the risk of future ocular pathology.

Evidence supporting these interventions includes the Low-Concentration Atropine for Myopia Progression (LAMP) study and the Bifocal Lenses In Nearsighted Kids (BLINK) randomized clinical trial of multifocal contact lenses.^4-6

An overlooked opportunity

Every retinal specialist manages a wide range of retinal diseases, including many that are directly or indirectly related to high myopia.

Although many patients are beyond the age when myopia-control interventions are likely to provide meaningful benefit, they frequently have children, grandchildren, nieces, nephews, or other younger relatives who may already be developing myopia or who may have an increased genetic susceptibility.

This creates an important opportunity for prevention.

A retinal consultation is often a moment when patients and families are especially receptive to discussions about ocular health. Beyond addressing the immediate diagnosis, retinal specialists can ask a simple but important question: “Do you have children or grandchildren who are becoming nearsighted or whose prescriptions are increasing rapidly?”

That brief conversation may identify younger family members who would benefit from an evaluation by an optometrist experienced in myopia management.

The retinal specialist’s role is not to provide myopia management. Rather, it is to recognize risk, educate families, and facilitate timely evaluation. Their unique perspective comes from seeing firsthand the consequences of progressive axial elongation: retinal detachments, myopic macular degeneration, tractional changes, and other complications that can threaten vision later in life.

The patient sitting in the retina chair may not benefit from myopia management—but their children and grandchildren may.

By helping families understand that childhood myopia can have lifelong consequences, retinal specialists can transform a discussion about existing retinal disease into an opportunity for prevention.

Strengthening an existing partnership

The collaboration between optometrists and retinal specialists already functions exceptionally well.

Optometrists routinely identify retinal pathology, provide timely referrals, and participate in long-term comanagement following treatment. Myopia management represents a natural extension of this established partnership rather than the creation of an entirely new referral pathway.

Equally important, many retinal specialists completed their training before the rapid expansion of evidence supporting myopia-control therapies. The field has evolved significantly, and some clinicians may be less familiar with current approaches than those who provide daily myopia management.

This presents an opportunity for professional collaboration and education. Optometrists can share current evidence, clinical guidelines, and treatment approaches with their retinal colleagues, while retinal specialists can help identify families that may benefit from early intervention.

Both professions bring complementary expertise, united by a common goal: preserving vision throughout life.

Looking beyond today's patient

Perhaps the greatest opportunity lies not with the patient sitting in the examination chair, but with the next generation.

A patient receiving treatment for complications of pathologic myopia cannot reverse the excessive axial elongation that has already occurred. However, that patient’s 8-year-old granddaughter or 10-year-old grandson may still benefit from evidence-based interventions that slow myopia progression while the eye is actively growing.

The concept is straightforward: Treat today’s retinal disease while helping prevent tomorrow’s.

This preventive approach mirrors successful strategies used throughout medicine. Cardiologists counsel families about inherited cardiovascular risk. Oncologists recommend evaluation when hereditary cancer syndromes are identified. Retinal specialists have a similar opportunity: recognizing families at increased risk for progressive myopia and encouraging timely evaluation of younger relatives.

No clinicians witness the lifelong consequences of progressive myopia more frequently than retinal specialists. Every retinal tear, retinal detachment, myopic maculopathy, and tractional complication serves as a reminder that childhood refractive progression can become adult retinal disease. Their perspective gives unusual credibility to conversations about prevention.

A shared responsibility

The growing burden of myopia demands collaboration across the eye care community.

A partnership of professions can address this challenge together. Optometrists, pediatric ophthalmologists, comprehensive ophthalmologists, retinal specialists, pediatricians, family physicians, school personnel, and parents all have important roles to play.

For retinal specialists, the opportunity is especially compelling. They understand better than anyone the devastating consequences that high myopia can produce later in life. By encouraging early identification and referral of at-risk children, they can reduce their future burden.

The strongest referral relationships have always been built on a shared commitment to patient care. Myopia management offers an opportunity to strengthen an already successful partnership between optometry and retina. By strengthening collaboration between optometrists and retinal specialists, lifelong visual outcomes for patients and their families can be improved.

As the prevalence of myopia continues to rise worldwide, preventing vision-threatening complications before they occur may become one of the most important collaborative efforts in modern eye care.

References

1. Holden BA, Fricke TR, Wilson DA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036-1042. doi:10.1016/j.ophtha.2016.01.006

2. IMI white papers and clinical summaries. International Myopia Institute. Accessed October 16, 2026. https://myopiainstitute.org/imi-white-papers-clinical-summaries/

3. Bullimore MA, Ritchey ER, Shah S, Leveziel N, Bourne RRA, Flitcroft DI. The risks and benefits of myopia control. Ophthalmology. 2021;128(11):1561-1579. doi:10.1016/j.ophtha.2021.04.032

4. Yam JC, Jiang Y, Tang SM, et al. Low-Concentration Atropine for Myopia Progression (LAMP) study: a randomized, double-blinded, placebo-controlled trial of 0.05%, 0.025%, and 0.01% atropine eye drops in myopia control. Ophthalmology. 2019;126(1):113-124. doi:10.1016/j.ophtha.2018.05.029

5. Walline JJ, Walker MK, Mutti DO, et al; BLINK Study Group. Effect of high add power, medium add power, or single-vision contact lenses on myopia progression in children: the BLINK randomized clinical trial. JAMA. 2020;324(6):571-580. doi:10.1001/jama.2020.10834

6. Gifford KL, Richdale K, Kang P, et al. IMI - Clinical Management Guidelines Report. Invest Ophthalmol Vis Sci. 2019;60(3):M184-M203. doi:10.1167/iovs.18-25977