Setting up Your Practice for Myopia Management

Myopia prevalence is increasing across Canada,¹ making myopia management an integral part of contemporary optometric practice. With the population growing by nearly 3 million people every decade—primarily due to immigration from regions with high myopia rates such as East Asia, and also Europe—the number of myopic patients that will be seen in practice is expected to rise.²

Ensuring that your practice is well set-up to meet this expected rise is crucial. Preparing a practice for myopia management involves investing in the right tools, structuring appointments to support ongoing treatment, and ensuring staff are knowledgeable about available interventions. Communicating effectively with patients and their families—both in person and through digital channels—helps to improve awareness and encourage engagement with myopia control strategies. This article will go through how to set up your clinic up for myopia management and will explore equipment, appointments, and providing information to your patients.

Essential Equipment for Myopia Management

For optometrists looking to integrate myopia management into their practice, it is important to first understand the essential components of a comprehensive eye examination before selecting the necessary equipment. Core components of a myopia assessment, as described by the International Myopia Institute (IMI) Clinical Management Guidelines,³ are as follows, alongside typical equipment utilized in each.

1. Refraction and Acuity Measurement

A precise refraction is the foundation of myopia management, not only to prescribe appropriate correction but also to identify early risk factors for myopia development. Young children with less hyperopia than expected for their age (e.g. +0.75D or less at age 6–7)⁴ are at increased risk for developing myopia. Cycloplegic refraction can be useful in certain cases to fully assess refractive error and accommodation. While not necessary for every myopic child, it is recommended when fluctuating refractions or pseudomyopia is suspected.³ Essential equipment includes:

• Pediatric-friendly acuity chart: With myopia developing at younger ages,⁵ some children may not yet recognize letters, making age-appropriate acuity charts essential.
• Retinoscope: this is preferred over autorefractors for younger children, to improve accuracy in non-cycloplegic refraction.

For support in pediatric refractions, check out the Myopia Profile article How to achieve accurate refractions for children.  

2. Binocular Vision Assessment

While there is no universal standard for measuring binocular vision, certain accommodative and vergence abnormalities have been linked to myopia onset and progression, making their assessment an important part of myopia management.³ Poor accommodative responses at near and increased accommodative convergence (AC/A ratio) are associated with myopia.^6-8 Equipment that addresses accommodation and vergence assessment includes:

• Retinoscope: This will help you assess for accommodative lag or lead.
• Plus/minus flippers: This will allow for accommodative facility testing.
• Prism bar: This will allow for heterophoria and fusional reserves assessment.

Read the Myopia Profile article Four reasons why binocular vision matters in myopia management to learn more, and for links to articles and technique videos on binocular vision assessment on Myopia Profile’s YouTube channel.

3. Retinal Examination and eye health

High myopia increases the risk of retinal complications, including myopic maculopathy and retinal detachment.⁹ Regular retinal evaluations, particularly for patients with high myopia (-5.00D or more), help in early detection and monitoring of retinal changes. Key equipment includes:

• Indirect ophthalmoscope: This will allow you to assess the far peripheral retinae for any myopic changes.
• 90D or 78D fundus lens: This will allow detailed assessment of the posterior pole.

Optional Advanced Equipment in Myopia Management

While core clinical tools are essential for myopia examinations, certain advanced instruments can enhance your practice for myopia management. If access to these tools is limited, referral and co-management pathways with well-equipped colleague optometrists or ophthalmologists can help ensure comprehensive patient care. These tools include:

• Optical Biometry: Myopia can be managed using refraction alone; however, axial length measurement is a highly precise tool for tracking progression, with optical biometry methods offering up to 10 times greater accuracy than refraction. Ultrasound measurement, by comparison, has a similar resolution and repeatability to refraction.¹⁰ A single measurement can help assess long-term myopia risk, with an axial length over 26mm linked to higher ocular complication risks.¹¹ Ongoing monitoring allows clinicians to track normal versus progressive axial elongation and refine risk assessment.
• Corneal Topography: Corneal topography is valuable for assessing anterior eye health and for contact lens fitting, especially for orthokeratology. In progressive myopia, corneal curvature measurement can ensure that increased myopia or astigmatism is not indicative of ectasia. A keratometer or topographer provides corneal shape data, aiding lens selection, with referral pathways recommended if this equipment is unavailable.
• Retinal imaging: The IMI Clinical Management Guidelines recommend an annual retinal examination through dilated pupils for high myopes (-5.00D or more) and as indicated for others, with OCT or fundus photography used to document any abnormalities.³

Structuring Myopia Management Appointments

Myopia management appointments can require more time and planning than a standard eye exam. You’ll need to schedule initial consultations and follow-ups to monitor progression and adjust treatments. Here are suggestions on how to structure these visits.

Initial consultation

The initial consultation for a pediatric patient should be comprehensive, incorporating a detailed history, risk assessment, clinical testing, and treatment discussion. The Canadian Association of Optometrists (CAO) recommends the following eye examination schedule for children:¹²

• Infants and Toddlers (Birth to 24 months): First eye examination between 6 and 9 months of age.
• Preschool Children (2 to 5 years): At least one eye examination between ages 2 and 5.
• School-Age Children (6 to 19 years): Annual eye examination from ages 6 to 19.

Even in the absence of symptoms, children should have regular eye exams, as they may not recognize or report vision problems. Ensuring that practice staff are well-informed about these guidelines is essential for effective myopia management. As the first point of contact, front-of-house staff often play a key role in scheduling appointments and guiding patients. Their understanding of recommended examination intervals allows them to confidently advise parents on when their child should have an eye exam.

Follow-up visits and monitoring schedule

Follow-up visits and monitoring schedules should be tailored to a child’s myopia risk, rate of progression (for existing myopes), and chosen treatment approach. According to the IMI Clinical Management Guidelines, children undergoing myopia management or identified as pre-myopic should be monitored at least every six months to track progression and, where available, measure axial length changes.³

The frequency of follow-up visits also depends on the selected treatment modality:

• Spectacles: Follow-ups at 1 month and 6 months.
• Soft Contact Lenses: Follow-ups at 1 month and 6 months.
• Orthokeratology: Follow-ups at 1 day, 4-7 days, 1 month, 3 months, and every 6 months.
• Atropine: Follow-ups at 1 month and every 6 months.

These intervals help ensure treatment compliance, suitability for the patient, monitoring for potential side effects, ensuring efficacy, and making timely adjustments when necessary. For an infographic representation of follow-up schedules, you can download the Myopia Profile Managing Myopia Guidelines Infographics here.

Providing Patients with Myopia Information

Educating patients and their families about myopia is essential for informed decision-making and treatment adherence. A multi-channel approach can help reinforce key messages and provide easy access to reliable resources. This could include creating a website for your practice, social media platforms, and printed materials.

• Your practice website: Creating a website or adding a dedicated myopia management section allows parents and patients to access accurate, evidence-based information at any time. This section can outline available treatment options you provide, their benefits, and also the importance of early intervention. Read more in our article What to add to your website on myopia management.
• Social media platforms: Using social media to share educational content, patient-friendly explanations, and updates on myopia management helps increase awareness and engagement. Short videos and success stories can effectively convey information in an accessible and relatable way. Facebook and Instagram are commonly used by parents of young children. Make sure your office culture shines through – show that your clinic is kid-friendly and parent-friendly.
• Referring patients to further information: Directing patients and parents to MyKidsVision.org provides them with evidence-based information on myopia and its management. To simplify access, a QR code sheet is available for download on MyopiaProfile.com, which allows patients to scan and instantly access relevant articles and resources.

Key Takeaways

Successfully integrating myopia management into clinical practice requires a combination of the right diagnostic tools, structured appointment schedules, and effective patient education. By following evidence-based guidelines, such as those from the IMI and CAO, Optometrists can provide proactive care to slow myopia progression and reduce long-term ocular health risks. As myopia rates continue to rise in Canada, implementing a comprehensive myopia management approach positions Optometrists at the forefront of this evolving field, helping you grow your practice while also providing the highest standard of care.

References

1. Yang M, Luensmann D, Fonn D, Woods J, Jones D, Gordon K, Jones L. Myopia prevalence in Canadian school children: a pilot study. Eye (Lond). 2018 Jun;32(6):1042-1047.
2. Statistics Canada. Population growths in Canada: From 1851 to 2061 http://www12.statcan.gc.ca/census-recensement/2011/as-sa/98-310-x/98-310-x2011003_1-eng.cfm. Accessed 18 March 2025.
3. Gifford KL, Richdale K, Kang P, Aller TA, Lam CS, Liu YM, Michaud L, Mulder J, Orr JB, Rose KA, Saunders KJ, Seidel D, Tideman JWL, Sankaridurg P. IMI – Clinical Management Guidelines Report. Invest Ophthalmol Vis Sci. 2019 Feb 28;60(3):M184-M203. 
4. Zadnik K, Sinnott LT, Cotter SA, Jones-Jordan LA, Kleinstein RN, Manny RE, Twelker JD, Mutti DO, Collaborative Longitudinal Evaluation of E, Refractive Error Study G. Prediction of Juvenile-Onset Myopia. JAMA Ophthalmol. 2015;133:683-689.
5. McCullough SJ, O’Donoghue L, Saunders KJ. Six Year Refractive Change among White Children and Young Adults: Evidence for Significant Increase in Myopia among White UK Children. PLoS One. 2016 Jan 19;11(1):e0146332. 
6. Mutti DO, Jones LA, Moeschberger ML, Zadnik K. AC/A Ratio, Age, and Refractive Error in Children. Invest Ophthalmol Vis Sci 2000;41:2469-2478.
7. Gwiazda J, Bauer J, Thorn F, Held R. A dynamic relationship between myopia and blur-driven accommodation in school-aged children. Vision Res 1995;35:1299-1304.
8. Gwiazda J, Thorn F, Held R. Accommodation, accommodative convergence, and response AC/A ratios before and at the onset of myopia in children. Optom Vis Sci 2005;82:273-278.
9. Bullimore MA, Ritchey ER, Shah S, Leveziel N, Bourne RRA, Flitcroft DI. The Risks and Benefits of Myopia Control. Ophthalmology. 2021 Nov;128(11):1561-1579.
10. Wolffsohn JS, Kollbaum PS, Berntsen DA, Atchison DA, Benavente A, Bradley A, Buckhurst H, Collins M, Fujikado T, Hiraoka T, Hirota M, Jones D, Logan NS, Lundström L, Torii H, Read SA, Naidoo K. IMI – Clinical Myopia Control Trials and Instrumentation Report. Invest Ophthalmol Vis Sci. 2019;60(3):M132-M160.
11. Tideman JW, Snabel MC, Tedja MS, van Rijn GA, Wong KT, Kuijpers RW, Vingerling JR, Hofman A, Buitendijk GH, Keunen JE, Boon CJ, Geerards AJ, Luyten GP, Verhoeven VJ, Klaver CC. Association of Axial Length With Risk of Uncorrectable Visual Impairment for Europeans With Myopia. JAMA Ophthalmol. 2016;134(12):1355-1363.
12. Canadian Association of Optometrists. Recommended frequency of eye examinations for children in Canada. Comprehensive Pediatric Eye and Vision Examination: Evidence-Based Clinical Practice Guideline. 2017.