Myopia management position statement: September 2025

Myopia (or short-sightedness) is a global epidemic wherein the refractive components of the human eye are too strong, or the axial length too long, to provide clear vision. The refractive prescription of an individual is a measure of the severity of their ametropia or refractive “error”. Severe myopic refractive error is a form of visual impairment, the prevalence of which is increasing significantly across both Wales and the wider world. In 2016, Holden, B. et al. estimated 22.9% of the global population was myopic in the year 2000, extrapolating that 34% of the global population would by myopic by 2020. Updated literature suggests this is on trend, quoting a global prevalence of myopia at 35.81% in 2023 (Liang et al., 2024).

The Welsh Optometric Committee (WOC) has gathered research towards a proposal of an All-Wales Myopia Management service, wherein individuals at risk of developing myopia and myopic progression were counselled, examined, and treated within state-funded healthcare. Myopia cannot be ‘reversed,’ and this paper is to outline the consideration of managing myopia, not curing it.

Whilst global research exists in concerning efficacy of various treatments towards myopia management (within academic/corporate trials and individual clinics), at the time of writing this SBAR, only one country has offered myopia management outside of private arrangement: In June 2025, France announced a reimbursement scheme to help support and treat patients with “rapidly progressing” myopia (Haute Autorité de Santé, 2025), a major milestone for equity of access to myopia management.

This paper scopes the importance of, and suggests an approach to facilitate, myopia management in Wales.

There are both genetic and environmental factors influencing the prevalence of myopia and its’ severity. Flitcroft et al. (2019) define ‘high’ myopia as a spherical equivalent of more than -6.00D, a figure now adopted by the International Myopia Institute (IMI) and the UK College of Optometrists (CoO). An individual with myopia will be blurred for both distance and (for high myopia) near vision. Whilst uncorrected myopia is a visual impairment, more importantly the myopic eye is anatomically altered and carries higher risk of co-pathology; higher levels of myopia have been shown to correlate with an increased risk of glaucoma, cataract, retinal detachment and myopic macular degeneration (Annechien, E. G. et al. (2020), Ikuno, Y. (2017). This list is non-exhaustive, and such pathologies carry increased and ongoing costs (financial, socioeconomic, and emotional) to support individuals with sight loss (Rose et al., 2000).

An estimated 938 million people across the world will have ‘high’ myopia by 2050 (Holden, B. et al., 2016), approximately 9.8% of the 2050 global population. The proportion of myopes in the UK has more than doubled over the last 50 years in children aged between 10 to 16 years and children are becoming myopic at a younger age (McCullough et al. 2016).

Currently, upon detecting and diagnosing myopia in a juvenile patient (under 19 years of age), an optometrist or ophthalmic medical practitioner within Wales practising under the Welsh General Ophthalmic Services (WGOS) may provide; an eye examination comprising of a Sight Test (as defined by the Opticians Act 1989), with embedded prevention and well-being provision to create a Patient Management Plan (PMP) specific to the patient, and provision of NHS Wales funded optical appliances, supported by WGOS Optical Vouchers (Accessed from WGOS1 Clinical Manual, updated February 2025).

The mechanism of action for progression of myopia (increase in spectacle prescription) in a vast majority of individuals, is axial length growth. There is a very small minority where other ocular and genetic conditions cause myopia as a co-pathology; however, they fall outside of the scope of this paper to discuss. Juvenile myopic progression is the increase in refractive error of a patient during a child’s developmental years (no fixed ‘start’ or ‘end’ age). Myopia management as an intervention, is to reduce the rate of axial growth during this period allowing their prescription to stabilise in young adulthood with a lower final refractive prescription than they would have without myopia management.

Conventionally, childhood myopia is corrected with either spectacle or contact lenses. These measures allow the patient to see clearly; however, they do not influence the progression of the myopia. Children with myopia require repeat eye examinations, updated lens powers, and are at greater risk of myopic co-pathology in later life due to their prescriptions (Annechien, E. G. et al. (2020), Ikuno, Y. (2017). Their general risk is proportional to the severity of their myopia.

Myopia management is a term used to describe interventions initiated to reduce myopia progression (College of Optometrists, 2022), delivered to a patient who is deemed at risk, most commonly juveniles and children whose eyes are still developing. Practitioners in Wales (Surveys by Britton, 2022, 2024), the wider UK, and globally are starting to prescribe myopia management as part of their daily practice. 

There currently does not exist a comprehensive standard operating procedure or guidance for best practice of myopia management from a UK health organisation, such as NICE, SIGN or otherwise. However, the World Council of Optometry in 2021 advised “optometrists to incorporate the standard of care for myopia management within their practice” and the College of Optometrists have developed guidance for practitioners managing children with myopia, emphasising that  “all practitioners should be able to discuss the risks and benefits of myopia management even if they are not delivering the intervention themselves” (CoO, 2022). In addition, The Association of British Dispensing Opticians have advised that contact lens opticians and dispensing opticians have a professional responsibility to inform patients and parents about myopia management options (ABDO, 2022).

The forms of myopia management and intervention briefly comprise:

• patient education
• soft contact lens options
• Orthokeratology
• spectacle lens options
• atropine and other pharmaceutical options

The most effective form of myopia management is education and prevention of onset. Research suggests that time outdoors is effective in delaying myopia onset in children (Cao et al., 2020) however, is not statistically significant in slowing progression in children who are already myopic (Xiong, S. et al., 2017, Ho, C.L. et al., 2019).

In 2022, myopia management was submitted as a topic to Health Technology Wales (HTW) by NHS clinical advisors, for their appraisal of available evidence. Their results published in May 2023 concluded: "economic modelling estimates that orthokeratology and multifocal soft contact lenses may be cost effective compared with single-vision correction, driven by the assumption of quality-of-life gains from a reduction in long-term myopia progression and its complications" (HTW, 2023). 

Further data relating to other interventions is becoming available at pace; notably, the living Cochrane review (Lawrenson et al., 2023) on myopia management. Research suggests topical antimuscarinic agents and orthokeratology currently appear to be the most effective treatments for slowing childhood myopia progression, however the field is constantly evolving.

The National Centre for Care and Health Excellence are currently reviewing the viability of topical anti-muscarinic drops for children aged 3 to 14 (NICE, 2025).

To note, a minority of individuals, due to specific ocular, congenital or systemic conditions develop high levels of myopia at young ages regardless of other factors, for example those with Marfan Syndrome, or Retinopathy of Prematurity (Whitmore, W. (1992) and Logan, N.S., et al. (2004)). In these cases, there is no substantive research to support the use of myopia management to limit the extent of refractive error, and interventions are less likely to provide a benefit. This does not necessarily mean the patient should not be offered the treatment in the interest of equitability; however, this would not be conventional case finding. 

This SBAR relates to interventions against axial length elongation, and the resultant increase in refractive error, in acquired childhood myopia. It is the intention of WOC to publish further statements into the future, as research evolves. 

Myopia management has been delivered in some form, within private practices in Wales, for at least the last 10 years. Optometrists and dispensing opticians are ideally placed in a primary care setting to educate, initiate, and evaluate myopia management, with recent workforce surveys suggesting at least half of practices in Wales currently offer myopia management in some form (Britton, 2022, 2024). There are variations in habits of practitioners, driven by confidence, knowledge, and availability of equipment, but also the financial freedom of the patient and their family to invest in private treatments.

WOC believes that there are interventions presently available which should be considered financially viable options for myopia management by those involved in a patient’s care. This is with due consideration given to availability of equipment across the country to deliver each given intervention, and the individual patient’s suitability. Research based in Wales by Bennett et al. (2025) concluded that options to slow the progression of myopia are cost-effective and viable treatment considerations for adolescent myopes.

There is substantial argument for Wales to adopt a myopia management policy to support its practitioners and population. In principle, the World Council of Optometry “3Ms” policy could be interpreted in Wales as:

• Mitigation
  • Clear, written public health campaigns, displayed in primary care and educational settings (not limited to optometric practices), on lifestyle factors to prevent or delay the onset of myopia
  • comprehensive public education of the importance of regular eye examinations in children (benefits stretching beyond myopia) wherein,
  • children who are of the typical age of myopia onset should be signposted to optometry services.
  • pre-existing contractual requirements such as a tailored “Patient Management Plan” are utilised following each WGOS eye exam: optometrists and dispensing opticians adequately equipped to educate parents and children on myopia onset and management
• Measurement
  • healthcare professionals evaluating the status of a myopic patient during regular comprehensive vision and eye health exams, (for example, refractive error and axial length measurement whenever possible) and providing epidemiological data on Welsh prevalence and impact of intervention, to further inform future service delivery
• Management
  • refractive correction of all myopic patients, via the method best suited to their individual needs
  • provision of evidence-based myopia management interventions, without financial barrier to the patient at point of delivery, to ensure an equitable access to best-practice healthcare

Annechien, E. G., Haarman, C. A., Enthoven, J., et al. (2020) The Complications of Myopia: A Review and Meta-Analysis. Investigative Ophthalmology and Vision Sciences Vol 61 (4) 49 doi: https://doi.org/10.1167/iovs.61.4.49.

Association of British Dispensing Opticians (ABDO), 2022, Position Statement: https://www.abdo.org.uk/wp-content/uploads/2022/08/224743-Position-on-Myopia-ABDO-Policy-Doc-JUL22-i.pdf.

Bennett, H., Britton, A., O’Sullivan, D. et al. (2025) Cost-effectiveness of myopia-control spectacles and contact lenses for children and adolescents in Wales. Cost Effectiveness and Resource Allocation Vol 23, 26. https://doi.org/10.1186/s12962-025-00632-w

Cao, K. et al. (2020), Significance of Outdoor Time for Myopia Prevention: A Systematic Review and Meta-Analysis Based on Randomized Controlled Trials Ophthalmic Research 63(2), pp. 97 to 105. Available at: https://www.karger.com/Article/FullText/501937

College of Optometrists (2022) https://www.college-optometrists.org/clinical-guidance/guidance/knowledge,-skills-and-performance/assessing-and-managing-children-with-myopia

Britton, A. (2022, re-circulated 2024). Surveys of the Welsh optometric profession concerning myopia management in primary care practice.

 Flitcroft, D.I., He, M., Jonas, J.B. et al. (2019) IMI: Defining and classifying myopia: A proposed set of standards for clinical and epidemiologic studies The Association for Research in Vision and Ophthalmology Vol 60 (3) pp. 20to 30.

Health Technology Wales. Myopia-control contact lenses and spectacles to slow the progression of myopia in children and adolescents 2023 [06 Nov 2023]. Available from: https://healthtechnology.wales/reports-guidance/cont rol-contact-lenses-and-spectacles/ 

Haute Autorité de Santé report, leading to 2025 pilot funding: https://reviewofmm.com/france-to-reimburse-hoya-miyosmart-lenses/?uid=%%$md5_email%%&utm_source=WhatCountsEmail&utm_medium=RMM_Review%20of%20Myopia%20Management%202025&utm_campaign=RMM_250619_NB_HOYA

Ho, C.L., Wu, W.F., Liou, Y.M. (2019) Dose-Response Relationship of Outdoor Exposure and Myopia Indicators: A Systematic Review and Meta-Analysis of Various Research Methods International Journal of Environmental Research and Public Health Jul 21;16(14):2595. doi: 10.3390/ijerph16142595 

Holden, B.A., Fricke, T.R., Wilson, D.A. et al. (2016) Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology. Vol 123(5) pp. 1036 to 1042. doi: 10.1016/j.ophtha.2016.01.006

Liang, J., Pu, Y., Chen, J. et al. (2025) Global prevalence, trend and projection of myopia in children and adolescents from 1990 to 2050: a comprehensive systematic review and meta-analysis British Journal of Ophthalmology 2025;109:362 to 371 https://doi.org/10.1136/bjo-2024-325427.

Logan, N.S., Gilmartin, B., Marr, J.E., et al. (2004) Community-Based Study of the Association of High Myopia in Children with Ocular and Systemic Disease. Optometry and Vision Science Vol 81 (1) pp. 11 to 13.

McCullough. S.J., O’Donoghue, L. and Saunders, K.J. (2016) Six Year Refractive Change among White Children and Young Adults: Evidence for Significant Increase in Myopia among White UK Children PLoS ONE 11(1) https://doi.org/10.1371/journal.pone.0146332.

National Institute for Health and Care Excellence, NICE (in development) Low-dose atropine eye drops for treating myopia in people 3 to 14 years [ID6517] https://www.nice.org.uk/guidance/indevelopment/gid-ta11669.

Rose, K., Harper, R., Tromans, C., et al (2000) Quality of life in myopia. British Journal of Ophthalmology Vol 84(9):1031 to 1034.

Whitmore, W. (1992) Congenital and developmental myopia. Eye Vol 6, pp. 361 to 365. 

World Health Organization - Brien Holden Vision Institute. The Impact of Myopia and High Myopia. Report of the Joint World Health Organization–Brien Holden Vision Institute Global Scientific Meeting on Myopia. Available at: https://www.visionuk.org.uk/download/WHO_Report_Myopia_2016.pdf.

Xiong, S., Sankaridurg, P., Naduvilath, T. et al. (2017) Time spent in outdoor activities in relation to myopia prevention and control: a meta-analysis and systematic review. Acta Ophthalmologia Vol 95 (6) pp. 551 to 566. doi: 10.1111/aos.13403.

Yashushi, I. (2017) Overview of the complications of high myopia Retina (Philadelphia, Pa.), Vol.37 (12), pp.2347 to 2351.