Personalizing Myopia Management

While the science behind each myopia management tool plays a significant role in determining which is the best to prescribe, it’s no secret that their real-world success also depends on child adherence. In my practice, I have found that assessing three nonvisual characteristics has enabled me to determine treatment compliance and, therefore, the best myopia treatment per individual child: (1) child comfort, (2) autonomy, and (3) lifestyle (see “What About Atropine?”).

COMFORT

When a child flinches during dilation drop instillation and/or becomes anxious to place their chin in the slit lamp’s chinrest, I have found that this child is likely not going to be amenable to contact lens wear to treat their myopia (Figure). This is because they are obviously not comfortable with any objects coming toward their eyes.

Spectacles tend to be the way to go for these children because they can provide effective myopia control without introducing fear or discomfort into the treatment plan. In September of 2025, the FDA approved a spectacle lens (Stellest, Essilor) to help with myopia management. I have found that these lenses are cosmetically approved by children since they don’t have any obvious lens abnormalities. While microlenslets appear to provide myopic defocus, it’s almost impossible for an untrained eye to notice them.

• Pro Tip.As the child matures, we can revisit contact lens wear for their myopia management, if applicable.

AUTONOMY

Some children are incredibly responsible. Specifically, they follow routines and can reliably wash their hands appropriately. Given their ability to make soft contact lens wear both a safe and effective treatment, these children are often excellent candidates for this myopia management tool. Other children, however, are less consistent with routines and have not mastered washing their hands appropriately or regularly.

Spectacles are often the best choice for these children because this management tool removes the burden of hygiene, while still providing strong myopia management.¹

All that said, if the child’s parent is willing to oversee a treatment, such as contact lens wear, and the child is agreeable, that should play a role in the treatment decision as well.

LIFESTYLE

For active children, especially those involved in sports, soft contact lenses or orthokeratology are often ideal. A great example of when orthokeratology lenses may make an ideal choice is if the child is involved in water sports, such as swimming. On the other hand, spectacles can slip, fog, and pose a risk of breakage during sports, making them less likely to be worn by these children. With the peripheral defocus that myopia management lenses have, I typically don’t require my patients to wear these myopic defocus spectacle lenses while playing sports. A pair of sport goggles with polycarbonate lenses has been more useful, especially since active pediatric patients are participating in distance activities.

In contrast, a child less active or primarily engaged in stationary indoor activities, such as reading, may do well with spectacles.

NOT JUST THE DISEASE

Ultimately, choosing the best myopia treatment is about more than just refractive error and axial length; it’s also about the specific nonvisual characteristics of each child. This is because, as illustrated, these characteristics affect treatment compliance. Therefore, when deciding to prescribe contact lenses, spectacles, and/or atropine, I suggest asking the child and their parent the following questions:

• Can this child handle the responsibility of contact lenses?
• What does their daily life look like?
• Are they comfortable with eye-related procedures?
• How involved are their parents?

The answers to these questions have enabled me to confidently match the right technology to the right child, ultimately improving both compliance and outcomes. Remember: In myopia management, the best treatment is the one the child will actually use.