For decades, single-vision correction has been the default approach for managing myopia in children. But the evidence is now unequivocal: this strategy is no longer defensible as a first-line treatment. While single-vision lenses correct blurred distance vision, they do nothing to address abnormal axial elongation -and in doing so, leave young eyes vulnerable to future vision-threatening complications. Jagrut Lallu explores why the continued use of single-vision correction alone is outdated, the current prevalence and urgency of the issue, and the need for a systematic shift in clinical practice.

WRITER Jagrut Lallu

Despite the availability of clinically proven interventions and a global call to action, most notably the World Council of Optometry’s (WCO’s) endorsement of myopia management as the standard of care,1 many young myopes are still prescribed single-vision lenses instead of evidence-based treatment alternatives.2 This clinical inertia persists, even as the global burden of myopia grows.

If we are to protect the eye health of future generations, the time for change is now.

MYOPIA BY THE NUMBERS

Myopia is no longer a niche concern – it is a rapidly escalating global public health issue. As of 2020, an estimated 2.6 billion people worldwide were affected by myopia, with projections indicating this will rise to five billion by 2050, including nearly one billion with high myopia.3 This growth is not just a statistical trend; it signals a looming burden of ocular disease, reduced quality of life, and increased economic costs through lost productivity and healthcare expenditure.4

Closer to home, Australian data shows that myopia rates in children have doubled over the past decade. Approximately one in four children aged 12 is now myopic, rising to nearly 40% by age 17.2

Australian Institute of Health and Welfare data confirms similar trends, particularly among urban populations, where children are experiencing earlier onset and faster progression.5

Despite these numbers, many children do not receive active myopia management.

The Brien Holden Vision Institute’s global prevalence maps and Myopia Calculator paint a sobering picture of what lies ahead. Without a profession-wide shift in clinical practice, we face an avoidable epidemic of vision impairment in future generations.

THE PROBLEM OF CLINICAL INERTIA

If the data is clear and the risks well documented, why do most children with myopia still receive single-vision correction as the default, particularly in the early stages of progression when the rate of change is often greatest? Changing that default requires more than clinical knowledge – it demands a shift in mindset, workflow, and often patient/ parent communication.

In my opinion, barriers to adopting myopia control strategies include a lack of practitioner confidence, limited patient or parent awareness, concerns about treatment costs, and perceived complexity in managing ongoing care. In markets where interventions such as myopia control contact lenses or atropine are accessible, uptake remains modest.

As a WCO Ambassador I have observed in my own clinical work in New Zealand, that many optometrists remain unsure how to initiate conversations about myopia management – especially with parents who view glasses as a simple solution. There’s a need for structure and confidence; we’re not just correcting vision anymore – we’re managing a disease. That’s a different mindset.

Until the profession fully embraces that shift, and the systems around it support active myopia management as standard care, many children will continue to receive outdated care for a condition that deserves a far more proactive approach.

THE RISKS OF DOING NOTHING

Myopia is a progressive disease with serious long-term consequences. As axial length increases, so too does the risk of irreversible vision impairment. The concern is not just blurred vision in childhood, but the potential for sight-threatening pathology later in life.

Every additional dioptre of myopia increases the likelihood of complications such as myopic macular degeneration, retinal detachment, glaucoma, and cataracts.6 Even low levels of myopia carry elevated risk, and that risk escalates steeply with higher degrees. For example, a child who becomes highly myopic may be up to 40 times more likely to develop myopic maculopathy compared to a non-myopic peer.7

These are not theoretical risks. According to the World Health Organization (WHO), uncorrected or under-managed myopia is already one of the leading causes of vision impairment globally – and is projected to become the single biggest cause of permanent blindness in some regions by 2050.8

For individuals, this can mean years of vision loss, reduced independence, and lower quality of life. For health systems, it translates to escalating costs in eye care, rehabilitation, and aged care. And for society, the cost of inaction is a preventable burden on productivity and wellbeing.

The case for intervention isn’t just clinical – it’s economic, ethical, and urgent. Doing nothing is not a neutral act; it’s a choice with measurable consequences.

OPTIONS BEYOND SINGLE-VISION

The clinical consensus is now clear: myopia is a condition that must be managed, not merely corrected. Single-vision lenses are no longer an appropriate first-line option for children with progressive myopia.

A growing body of high-quality evidence supports several interventions that do reduce the rate of myopia progression. Certain specially designed soft contact lenses and spectacles, orthokeratology (OK), and lowdose atropine eye drops, are among the most widely studied and clinically validated options. For example, a three-year study showed that children wearing dual-focus daily disposable contact lenses experienced significantly slower progression than those in single-vision lenses.9

Orthokeratology has also shown comparable levels of efficacy in controlling axial length growth, particularly when prescribed early in the progression curve. Meanwhile, lowconcentration atropine (0.01%–0.05%) has emerged as a viable pharmacologic option with minimal side effects and strong longterm results.10

Spectacle-based options, such as defocus incorporated multiple segments (DIMS) lenses, have shown sustained effectiveness over the long term. In an eight-year followup study, children who wore DIMS lenses continuously experienced significantly less myopia progression (−0.44D) and axial elongation (0.46 mm) compared to those with shorter wear durations, highlighting the long-term benefits of consistent use.11

At the time of writing, we are awaiting the publication of updated data from Australian optometrist and researcher Tim Fricke, intended as a follow-up to the earlier Brien Holden Vision Institute paper,3 which is expected to provide further insights into the evolving landscape of myopia management.

BARRIERS TO CARE

One of the most common barriers for practitioners offering myopia management is cost. This often reflects a deeper issue: uncertainty about the value of treatment. When confidence in the evidence or communication is lacking, it’s easy to default to what’s perceived as affordable rather than what’s clinically appropriate.

Myopia management helps reduce the risk of serious complications, making its value clear. Parents who are highly myopic rarely question the investment because they understand the long-term risks. Our role is to help all families see myopia as the progressive disease it is and to support early, proactive care.

Building this confidence starts within the profession. Mentorship is key. For those unsure where to begin, tools like the WCO Myopia Management Navigator and Myopia Profile offer practical guidance, resources, and real-world case examples.

Global standards are catching up. The World Council of Optometry’s Myopia Management Standard of Care1 outlines a three-part framework: ‘Mitigation, Measurement, and Management’, all of which underscore the need to move beyond single-vision correction. The International Myopia Institute has also published detailed classification and treatment guidelines that call for active intervention in cases of progressive childhood myopia.12

The evidence is robust, the tools are available, and the professional guidance is aligned. What’s needed now is broad, consistent implementation, so that every child with myopia receives the care their long-term eye health deserves.

THE WAY FORWARD

Optometrists are uniquely positioned to lead the shift to active management of myopia, but this requires a fundamental rethink of clinical pathways. Every child eye exam and initial myopia prescription is an opportunity to assess risk, educate families, and intervene early.

Early intervention makes a measurable difference – and optometrists must be equipped and empowered to act decisively at the first signs of progression.

All of the profession must now move from knowing to doing. The opportunity is in your consulting room and the time to act is now.

Jagrut Lallu BOptom MSc is the World Council of Optometry Myopia Ambassador for Asia Pacific and the International Myopia Institute Ambassador for Myopia in New Zealand. He is a practising optometrist at Rose Optometry in Hamilton, NZ.

References

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