Vision Expo 2026: Behavioral modifications and the long game in pediatric eye care, with Sheila Morrison, OD, MS

In a follow-up discussion tied to her presentation "Dry Eyes & Myopia Management: When Kids Win and Lose" at Vision Expo 2026, held March 11-14 in Orlando, Florida, Sheila Morrison, OD, MS, shifted the conversation from the clinical intersection of dry eye and myopia control to the behavioral, preventive, and compliance-related dimensions of managing these conditions in young patients—and makes a case that the stakes of getting them right extend far beyond any single office visit.

Morrison opens with a point that carries important nuance for how clinicians counsel families about screen time: regarding myopia risk, the evidence does not cleanly indict screens over books. Near work broadly—sustained close-distance visual tasks regardless of medium—is the established driver of myopic progression, a finding supported by a 2023 meta-analysis in the International Journal of Environmental Research and Public Health encompassing more than 254,000 participants, which found that exposure to near work increased the odds of myopia by 31% in children.¹ A 2025 systematic review and dose-response meta-analysis published in JAMA Network Open further characterized the relationship, finding that myopia risk increased significantly with screen time from 1 to 4 hours per day before rising more gradually thereafter.²

This does not mean screens are equivalent to books in every respect—Morrison was careful to note that backlit screens do produce measurably different effects on blink rate and ocular comfort than print reading, a distinction that matters considerably when the goal is also managing dry eye alongside myopia. But from a refractive standpoint, the near work burden itself is what matters, and the practical implication for families is actionable: maximize viewing distance where possible, shift screen-based tasks to larger monitors positioned farther away when feasible, and build in regular breaks.

On the dry eye side, Morrison returned to a theme she emphasizes throughout her presentation: the clinical signs are arriving earlier than practitioners may expect, and children are not reliably reporting them. Meibomian gland loss in teenagers exceeding that seen in many adults is a pattern documented in the literature and observed firsthand in Morrison's own clinic. A child presenting today with measurable meibomian gland atrophy is, by definition, already on a trajectory. Without intervention, the cumulative toll over decades could be substantial. The problem is compounded by the fact that children's symptom reporting is unreliable; they often tolerate ocular surface compromise silently until a device—most commonly a contact lens—amplifies the discomfort enough to register as a complaint. By that point, the window for quiet, low-burden prevention has already closed.

This leads to what Morrison identified as one of the most clinically high-yield habits a practitioner can build. That is asking at every visit, explicitly and specifically, what the patient is doing and how. What solutions are they using? How are they using them? What does their dry eye management routine look like today, not 6 months ago? Morrison's observation that treatment drift is common even in long-established patients is well-founded, and her point about the developmental transition from supervised childhood to more autonomous adolescence is particularly practical. Parents who were diligent monitors at age 8 are often far more hands-off by age 15, and that gap—well-intentioned but real—is where compliance quietly erodes.

Her prescription for managing this is straightforward: do not assume. Do not presume that a patient who was doing everything correctly at their last visit is still doing so now. Talk about it at every encounter, normalize the conversation, and keep solutions and contact lens handling squarely in the differential when something is not working. The failures that look like treatment resistance are often failures of routine, and those are fixable, but only if the clinician asks.

REFERENCES

1. Dutheil F, Oueslati T, Delamarre L, et al. Myopia and near work: a systematic review and meta-analysis. Int J Environ Res Public Health. 2023;20(1):875. doi:10.3390/ijerph20010875.

2. Ha A, Kim YK, Jung JH. Digital screen time and myopia: a systematic review and dose-response meta-analysis. JAMA Netw Open. 2025;8(2):e2461557. doi:10.1001/jamanetworkopen.2024.61557.