Myopia management isn’t a spectacle lens or a contact lens. Its real value is personalised, predictive and preventative care, delivered consistently over time.

A recent Optometry Today article describes France’s approach to childhood myopia. French clinicians choose from specialist spectacle lenses, myopia-control contact lenses, orthokeratology and low-concentration atropine — tailored to each child’s age, family history, lifestyle, eye growth and ability to manage treatment.

Since June 2025, French national health insurance has funded myopia-management spectacle lenses for around 500,000 eligible children. Treatment no longer depends on what a family can afford.

Why aren’t British children offered the same systematic protection?

The gap in NHS eye care

NHS sight testing is invaluable — it identifies short-sightedness and provides glasses that restore clear vision. But correcting blurred vision isn’t the same as managing myopia.

Glasses help a child see the board today. They don’t address the abnormal eye growth that can make a prescription progressively stronger and raise lifetime risk of retinal detachment, glaucoma, myopic macular disease and other sight-threatening conditions.

England has no routinely commissioned NHS pathway combining early risk identification, cycloplegic refraction, axial-length measurement, evidence-based treatment, atropine prescribing, structured review and escalation.

Building one would be a major undertaking — trained clinicians, equipment, robust recall systems and the capacity to review children every six months, often for years. This isn’t a criticism of NHS clinicians, who deliver excellent care within what’s commissioned. Myopia management is a longitudinal clinical programme, not a product issued once.

Looking before myopia begins

France’s clearest lesson: care can start before a child becomes short-sighted.

At Lynne Fernandes, pre-myopia isn’t an afterthought. We assess age, prescription, family history, ethnicity, visual environment, near-work habits and time outdoors — and, crucially, we measure axial length, the physical length of the eye. Tracking eye growth can reveal a concerning trajectory before the spectacle prescription tells the whole story.

Gerard Fernandes’ postgraduate research focused on pre-myopia: identifying at-risk children, communicating that risk honestly, and building a clinical pathway that acts before the first minus prescription appears.

Leading our clinical pathway

Our myopia and pre-myopia service is led by Sarah Douglas, specialist optometrist and independent prescriber.

Our Optometrists developed the clinical pathway that translates the best available evidence into a practical standard operating procedure that guides how we identify risk, examine and measure each child, explain myopia to parents, select treatment, review eye growth and respond when it isn’t working.

Her role matters because there’s rarely one right answer. A young pre-myope, a sporty ten-year-old with rapidly progressing myopia and a teenager struggling with contact lenses each need a different plan. The best treatment isn’t the most impressive product — it’s the most appropriate, evidence-based option the child can use safely and consistently.

Personalised, predictive and preventative

Personalised

Every child starts from a different place. We consider age, refraction, axial length, rate of eye growth, family history, ethnicity, binocular vision, lifestyle, near-work habits, outdoor time and ability to use treatment reliably.

The product must fit the child — not the other way round.

Predictive

We don’t rely only on whether a child can read the bottom line of a chart, or whether their prescription has changed.

Measuring axial length and comparing it with age-related growth patterns lets us identify eyes growing unusually fast — including in children who aren’t yet short-sighted. That means looking forward, not just recording what’s already happened.

Prediction isn’t certainty, and we’re careful not to present it as such. It simply means better-informed decisions, earlier.

Preventative

Our aim isn’t only clear vision today — it’s reducing or delaying excessive eye growth and, where possible, the level of myopia a child carries into adulthood.

That includes advice on outdoor time, near work, working distance, screen habits and treatment compliance. For some pre-myopic children, the first intervention is lifestyle, not a product — outdoor time is a genuine treatment, not a casual suggestion.

For others, prevention may mean a specialist spectacle lens, contact lens, orthokeratology, atropine, or a considered combination. The decision follows the evidence and the child — not whichever product is easiest to sell.

Our ability to prescribe atropine

At Lynne Fernandes, we can prescribe low-dose atropine eye drops when clinically appropriate.

Atropine is an important additional tool — particularly for younger children, those progressing rapidly, those with a strong family history of high myopia, or those whose eye growth remains excessive despite optical treatment.

We don’t prescribe it automatically. Our Optometrists weighs the child’s age, progression, axial-length pattern, existing treatment, likely benefit, possible side effects and the family’s ability to use drops reliably. It can work alone in selected cases, but its greatest value is often as part of a monitored combination strategy.

Being able to prescribe, monitor and adjust treatment within one joined-up pathway is a real strength of our service.

A new spectacle-lens option

MiYOSMART iQ gives us another valuable option, especially for younger children and families who prefer the simplicity of spectacles.

The design builds on established defocus lens principles, with the treatment area brought closer to the centre and extended across more of the lens. Early findings are encouraging, though as with any new development, we’ll keep watching how trial results translate into everyday practice.

We’re also considering its role for carefully selected pre-myopic children, and we’ll always be clear with parents about where the evidence is established, where it’s still developing, and why we’re making a particular recommendation.

The lens matters. The clinical decisions around it matter more.

Myopia management is not a product on a price list

There’s a real difference between selling a myopia-control product and providing myopia management.

A practice can stock a specialist lens or fit a myopia-control contact lens — good products, well supported by evidence. But supplying one doesn’t, by itself, create a comprehensive clinical service.

Some practices understandably start by adding a myopia-control product to what they already offer. The risk is that management becomes a transaction: spot the short-sightedness, recommend a lens, review the prescription later.

We welcome more opticians talking about myopia management — greater awareness is good for children. But there’s a difference between offering a product and building a genuine clinical discipline.

At Lynne Fernandes, the service is built around mitigation, measurement and management. As much value lies in the personalised, predictive and preventative advice around the product as in the lens, contact lens or medication itself.

The six-monthly review is part of the treatment

Children are typically seen three months after starting treatment, then every six months. At each review we reassess vision, refraction, axial length, treatment use, outdoor activity and near-work habits — and if eye growth stays higher than expected, we review sooner and reconsider the strategy.

That ongoing relationship is where much of the clinical value lies.

A lens can’t tell us it’s been left in a school bag. A contact lens can’t recognise a changed routine. A bottle of atropine can’t decide when treatment needs adjusting. And a product can’t reassure an anxious parent or help a reluctant child understand why treatment matters.

That takes skilled clinicians, time, careful records and continuity.

We audit, review and improve

Our pathway doesn’t stay fixed just because it’s written into a Standard Operating Procedure.

We audit whether risk has been assessed, axial length measured and interpreted, recommendations communicated clearly, and follow-up delivered.

Where we find gaps, we retrain, revise and improve. Research keeps changing what’s understood about pre-myopia, spectacle-lens design, atropine concentration, combination treatment and normal childhood eye growth. Our job isn’t just to read that evidence — it’s to apply it, thoughtfully and consistently.

Experience, clinical skill and compassion

Our myopia service wasn’t created because one new lens arrived.

It’s grown through years of clinical interest, investment and learning. Gerard Fernandes helped establish our early approach and the belief that short-sightedness should be treated as a developing eye-health condition — not just a succession of stronger prescriptions.

That history now sits alongside Sarah’s specialist leadership and the work of our other trained optometrists, who follow the same evidence-based pathway while applying their own clinical judgement.

Together, we’ve now treated and supported more than 300 children.

Behind that number are hundreds of individual stories: anxious parents, children nervous about drops or contact lenses, families worried about fast-changing prescriptions, and young people who simply want to see clearly without feeling their eyes are getting worse every year.

Clinical expertise matters. So does compassion. Parents need honest explanations, not frightening statistics. Children need to feel involved, not treated as passive recipients. Families need to know we’ll notice when something isn’t working — and help them find another route.

What British children deserve

France has shown what’s possible when myopia management is recognised as preventive healthcare, not an optional upgrade to a pair of glasses.

We’d welcome the day every eligible British child can access funded myopia management through a properly designed national pathway.

Until then, we will keep providing the care we believe children should already be receiving: early identification, detailed measurement, access to multiple treatment options, atropine prescribing where appropriate, six-monthly follow-up, and a pathway that’s continually audited and improved.

Because our goal isn’t just to help a child see clearly today.

It is to give them the best possible chance of healthier vision for the rest of their life.