Transforming Optometric Education to Combat Myopia Crisis and Improve Patient Care

Optometric education is experiencing a seismic transformation as institutions rush to address the burgeoning crisis of myopia and elevate the standards of patient care. The initiative “CCS 2025: Preparing Optometric Students for Patient Care and Myopia Management,” as discussed by thought leaders like Mark Bullimore, MCOptom, PhD, Erin Tomiyama, OD, PhD, and Prethy Rao, MD, shines a spotlight on the ever-evolving priorities of the eye care education sector. But what’s truly at stake isn’t just how students learn or even how they practice after graduation—it’s the public health trajectory for millions of children and adults threatened by a myopic future.

Why Myopia Management is a Crucial Educational Frontier​

Myopia—commonly referred to as nearsightedness—has long been considered a routine refractive error, easily remedied by glasses or contacts. However, as outlined in numerous recent reports, including the 2024 National Academies report cited by Bullimore, myopia’s epidemiology has shifted dramatically in its risk profile. No longer simply a benign inconvenience, myopia is now recognized as a disease with significant, long-term health consequences; in the US and globally, it accounts for over a third of cases of uncorrectable visual impairment, primarily due to avoidable complications like myopic maculopathy and retinal detachment.
The vision loss associated with pathological myopia is often irreversible and leads to a cascade of social and personal costs—from reduced academic achievement in children to increased dependency and diminished quality of life in adults. For optometric education, this means the stakes for both clinical skill and prevention have never been higher.

The Surge in Myopia Prevalence: Facts and Forecasts​

The World Health Organization (WHO) projects that by 2050, nearly half the global population will be myopic, with 10% at risk for high myopia—a level that comes with grave sight-threatening complications. In the US, recent survey studies and CDC reports confirm that myopia rates among children and adolescents continue to rise, driven by lifestyle factors such as increased near work and reduced outdoor time. This epidemiological shift represents one of the most pressing clinical challenges facing optometry today.

Management Options: What Students Need to Know​

Modern optometry is no longer limited to correcting vision. Instead, preventive myopia management has become a primary focus, incorporating strategies to delay onset and curb progression. Bullimore points to four principal modalities:

• Pharmacological Intervention: Low-dose atropine eye drops remain one of the most evidence-based and widely studied treatments for slowing myopia progression. Multiple randomized controlled trials (such as ATOM and LAMP) validate its safety and efficacy for children.
• Orthokeratology (Ortho-K): Specially designed rigid contact lenses worn overnight reshape the cornea, providing clear daytime vision and slowing eye growth. Numerous cohort studies and meta-analyses have affirmed ortho-k’s efficacy, though practitioners must be vigilant regarding infection risk.
• Myopia Control Soft Contact Lenses: Multifocal and dual-focus soft contact lenses—such as the FDA-approved MiSight—have shown clear efficacy in RCTs and are increasingly available in the US, albeit with insurance and accessibility limitations.
• Spectacle-Based Treatments: While such lenses have become standard in markets like Canada and Asia, the US still lags in their regulatory and commercial availability, leaving a significant gap in accessible, child-friendly interventions.

It is noteworthy that despite the proven effectiveness of multifocal spectacle lenses for myopia management in markets abroad, their lack of approval or widespread use in the US restricts students’ exposure within clinical training settings.

Adherence and Patient Matching: The Human Factor​

Technological advances aside, the real challenge for myopia management lies in patient adherence. As Bullimore highlights, successful results hinge not only on prescribing the right modality but also on ensuring patient and family buy-in. This is particularly nuanced in populations without a family history of myopia, who may be skeptical of the risks and slow to accept long-term treatment regimens. Effective communication, motivational interviewing, and cultural sensitivity are now as critical as clinical technique.

The Expanding Clinical Curriculum​

Bullimore paints a picture of rapid evolution: Whereas optometry education 40 years ago was dominated by spectacle dispensing, contemporary programs are racing to install dedicated myopia management clinics, didactic content, and structured hands-on rotations. Where ortho-k and myopia care once were fragmented across specialty clinics (contact lens or pediatric services), now forward-thinking programs unify these efforts under a focused myopia management curriculum.
This trend is mirrored in prominent North American optometry institutions, which have scrambled to ensure that all students complete core rotations or residencies in myopia management and pediatric optometry. The 2023-2024 Council on Optometric Education standards now require evidence of clinical exposure to multifaceted myopia management for graduation.

Key Elements in a Modern Myopia Curriculum​

• Didactic Foundation: This includes lectures on epidemiology, physiology, risk factors for progression, and emerging therapeutics.
• Clinical Rotations: Active management of pediatric patients with myopia, including fitting of ortho-k, soft multifocal lenses, and pharmacologic counseling.
• Communication Workshops: Training on how to hold the “myopia talk” with parents, paralleling counseling for conditions like glaucoma or amblyopia, but with even greater emphasis on long-term risks and shared decision-making.
• Interdisciplinary Exposure: Collaboration with ophthalmologists, especially retina specialists, to appreciate and co-manage the retinal sequelae of high myopia.

Retinal Complications and Long-Term Disease Management​

A sophisticated myopia management curriculum cannot ignore the downstream consequences of high myopia. Retinal complications dominate the risk profile for patients with high axial length and include:

• Retinopathy of Prematurity (ROP): A condition once exclusive to premature infants but now increasingly intersecting with early-onset, aggressive myopia.
• Lattice Degeneration and Retinal Detachment: These risks rise sharply with axial elongation and require students to master not only routine screening but also collaborative management with retina specialists.
• Myopic Maculopathy: This blinding complication now warrants consideration for early intervention with anti-VEGF therapies and, where indicated, laser photocoagulation—techniques students should witness if not directly participate in during their training.

Recent advancements, such as AI-driven retinal imaging platforms (e.g., IRIS), further democratize access to early detection, empowering even non-specialists to contribute meaningfully to timely intervention.

Laser and Anti-VEGF Therapies: A Convergence of Specialties​

Bullimore notes the evolution of treatment paradigms, paralleling developments in macular degeneration. Optometry students increasingly collaborate with retina subspecialists to understand referral timing and co-management protocols around therapies that, while not primary optometric procedures, are critical for optimal patient outcomes.

Communicating Risk: The New "Myopia Talk"​

Informing families about the risks of myopia is one of the trickiest components of optometric practice. Bluntly stating, “your child could go blind” is often counterproductive—even traumatic. Instead, educational best practices emphasize a tiered, longitudinal approach:

• Myopic Parents: These families may be more receptive, recognizing inherited risk and potential consequences from personal experience. The practitioner’s task is often to provide hope—outlining how modern interventions can meaningfully alter a child’s outlook compared to past generations.
• Non-Myopic Families: Here, educators advocate a slow, sustained conversation. It may take months or even years for risk awareness and acceptance of long-term management to solidify. This progressive dialogue builds trust and increases adherence compared to fear-based communication.

Role-playing and simulated conversations now form a staple of preclinical education, enabling students to build confidence before facing real-life situations.

Preparing the Next Generation of Optometrists: Opportunities and Obstacles​

Strengths in Today’s Educational Reforms​

• Integrated, Evidence-Based Curricula: By embedding myopia management within foundational optometric studies and requiring clinical rotations, programs are creating a workforce ready to confront a public health crisis.
• Collaborative Care Models: Interdisciplinary teaching with ophthalmology, specifically retina, improves coordination and expands students’ capacity to manage complex disease.
• Patient-Centered Communication: Increased emphasis on shared decision-making and culturally competent care addresses the diverse needs of the population.

Challenges and Risks​

• Limited Regulatory Approval for Modalities: The lack of certain spectacle options in the US stymies both access to care and the real-life training of optometric students, potentially leaving them less prepared than their international peers.
• Variability in Clinical Training: While leading programs have fully embraced myopia management, some lag behind, delivering only fragmented exposure through specialty clinics. This inconsistency risks perpetuating gaps in competence.
• Patient Adherence and Public Perception: Changing long-standing beliefs about the “harmlessness” of myopia remains slow, especially among non-myopic families.
• Retinal Complication Management: The requirement to co-manage serious complications such as lattice degeneration, retinal detachment, or maculopathy may overwhelm some primary care optometrists, underscoring the need for robust referral networks and ongoing professional education.

The Broader Impact: Transforming Eye Care Through Technology and Access​

An additional and often underappreciated layer in modern myopia management is the advent of AI-powered diagnostic platforms and telemedicine. Tools like the IRIS retinal imaging system—which leverages Microsoft Azure’s advanced AI for deep learning analysis—allow for swift detection of retinopathies and other consequential pathologies from a distance.

Advantages of AI-Driven Screening in Myopia Management​

• Enhanced Diagnostic Speed and Accuracy: Automated analysis augments clinician decision-making, reducing the risk of missed early pathology.
• Broader Access: Mobile and cloud-connected platforms can bring high-quality eye screening to underserved communities, reducing disparities in care.
• Standardized Record-Keeping: Seamless integration of imaging and reports into electronic health records (EHRs) fosters a system-wide, data-driven approach to myopia management, supporting both individual patient care and population-level intervention strategies.

Telemedicine: A Paradigm Shift for Optometric Outreach​

Especially in areas with limited access to pediatric or retinal specialists, virtual consultations bridge the gap, allowing optometrists to co-manage complex myopic pathology with academic centers or retina colleagues. Early outcomes from US pilot programs reveal that such models not only reduce patient travel and wait times but also improve detection rates for blinding diseases, further underlining the importance of digital fluency in optometric education.

Looking Forward: Recommendations for Optometric Education​

For Institutions​

• Mandate Rotations in Myopia Management: All students should have structured, supervised exposure to myopia control, including pharmacologic treatments, lens fitting, and patient counseling.
• Invest in Technology: Partnerships with technology firms and teaching hospitals can bring AI-based diagnostic tools and telemedicine platforms into mainstream education, ensuring students graduate with 21st-century skills.
• Standardize Core Competencies: Establishing minimum clinical and didactic standards, as the US accrediting bodies are now doing, can minimize geographic and institutional disparities.

For Practitioners and Students​

• Embrace Lifelong Learning: The landscape of myopia management is evolving quickly; ongoing professional development is essential.
• Prioritize Communication: Mastery of patient education—especially the nuanced delivery of risk information—may be as critical as technical skill.
• Develop Referral and Co-Management Relationships: No optometrist is an island; understanding when and how to refer is foundational for safe, effective care.

For Policy Makers​

• Streamline Regulatory Approval: Fast-tracking spectacle and other modalities, already proven in global markets, could enhance both patient care and workforce readiness in the US.
• Expand Insurance Coverage: Reducing financial barriers would improve adherence and long-term outcomes for pediatric myopia patients.

Conclusion​

The transformation of optometric education around myopia management is not just an academic trend—it’s an urgent public health response. With myopia now formally recognized as a disease and a leading cause of uncorrectable vision loss, the onus is on education leaders to give tomorrow’s practitioners the clinical tools, technological savvy, and communication skills to tackle the crisis head-on. Early evidence from institutions that have adopted integrated curricula and embraced AI-driven technologies is promising: graduates are better prepared, care is more equitable, and patient outcomes are measurably improved.
Yet, significant challenges remain—regulatory barriers, inconsistencies in training, and entrenched myths about myopia's innocuousness still hamper progress. As optometric education continues to evolve, true leadership will require not just curricular tweaks, but a commitment to lifelong learning, cross-disciplinary collaboration, and relentless advocacy for both patients and the profession.
Ultimately, it is this new generation of optometrists—trained not only to correct, but also to prevent, detect, and educate—who will determine whether the looming specter of myopia can be turned from a public health catastrophe into one of medicine’s great success stories.

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Source: Optometry Times CCS 2025: Preparing optometric students for patient care and myopia management