Does Myopia Prevention Exploit Your Anxiety?

Does Myopia Prevention Exploit Your Anxiety?

by Brian Chou, OD, FAAO, FSLS

  • September 19, 2023

Have you noticed more eye care practices advertising myopia prevention? This emerging service is also called “myopia control” and “myopia management”. The longstanding treatment for myopia improves vision using traditional glasses and contact lenses, or laser vision correction. Myopia prevention goes one step further, attempting to also slow the expected progression of myopia in children.

Today, about 42% of the U.S. population is nearsighted, or myopic, representing a significant increase from 25% in 1971. Multiple explanations abound, but no one really knows for sure why. Myopia is correlated with intelligence, and a higher rate of problems with the retina, the sensitive lining inside the eye. Bear in mind, correlation does not mean causation.

Common Treatments for Myopia Prevention

Myopia prevention usually comprises of low-dose atropine eye drops, corneal reshaping lenses, and/or a specific type of soft multifocal design such as MiSight and Abiliti. There are also proprietary eyeglass lenses designed to slow nearsighted progression in kids, including SightGlass Vision DOT, Zeiss Myopia Management lenses, Essilor Stellest, and Hoya MiYOSMART. Finally, since several studies have associated greater outdoor sunlight exposure with less nearsighted progression, so some myopia prevention programs encourage outdoor activities even though a causal relationship between sunlight exposure and myopia prevention is not yet definitive.

The Marketing Push for Myopia Prevention

Why all the recent attention to prevent childhood myopia? Historically most optometric practices make 65% of their revenue from selling eyeglasses and contact lenses. Yet online disruptors, like Warby Parker and Vision Direct, have taken a chunk of these product sales away. That is why more optometric practices are looking for replacement revenue. The ophthalmic industry has identified myopia management as one of these areas.

While there is organic demand for myopia control, the myopia prevention stakeholders are taking a page out of the playbook from the pharmaceutical industry, referred to as “diseasification”, where a common condition is elevated to the level of disease to sell treatment. While this does not diminish how myopia is a risk factor for retinal disease, the tendency is for marketing to over-amplify this concern. To understand how the amplification is outsized, we can look to the counterpart of myopia: hyperopia, or farsightedness. Hyperopic patients are also at greater risk for vision loss due to accommodative esotropia, narrow angle glaucoma, and acute angle closure glaucoma. But there is relatively scant alarm sounded by optometric practices about hyperopia. Why is this? It has to do with the monetization of myopia prevention, whereas monetization has not yet occurred with hyperopia. The increased marketing activity behind myopia management seeks to spark generate consumer demand for this emerging service category.

Is Myopia Management Racist?

Most patients undergoing myopia management today are Asian. As an example, in my estimation, roughly 90% of patients in Corneal Refractive Therapy are Asian, of which most are Chinese American.

Why is there so much concern about myopia amongst Chinese Americans? First, there is a much higher rate of myopia among Chinese children. Studies have found upwards of 80% of Chinese 12th graders are myopic. Interestingly, 70% of Chinese parents are unaware of the increased eye health risks associated with myopia. Even so, there is a stigma associated with myopia among the Chinese. In part, this is because since the mid-1960s the Chinese Education Ministry has required all children in its schools to perform eye exercises in an attempt to slow myopic progression. There have also been other interesting attempts in China to minimize myopic progression, including “bright classrooms” where sunlight bathes the learning environment, and even iron bars to prevent children from getting too close to their reading material. With decades of Chinese school children exposed to eye exercises which have not slowed the increasing prevalence of myopia in China, and other seemingly unusual efforts, it is understandable why anxiety surrounds myopia amongst Chinese Americans.

There is no corporate agenda that I am aware of exploiting the sensitivity of Chinese Americans to myopic progression. It’s not to say it can’t exist though. Asian parents are vulnerable to having their hopes and emotions harnessed to sell myopia prevention for their children. Chinese American parents can immunize themselves by realizing that myopia is not necessarily a bad thing. For those over age 40, myopia is helpful in reducing the age-expected need for reading glasses. Yet somehow, the public tends to believe that increasing myopia equates to “worsening”, whereas in fact it means that the near vision is improving. Of course, while low-to-moderate myopia is often helpful later in life, high myopia is usually not helpful.

Myopia Management Today: For the Rich and Anxious

When the FDA approved the first soft lens for myopia prevention in 2019, an annual supply of these lenses was about $2,000. While the consumer cost has since come down, it is still prohibitively expensive for the masses. This is why the early adopters-parents of myopia management tend to have greater disposable income, and/or an elevated level of mental distress about their children becoming more myopic.

Expect that the overall cost of myopia management to come down. More eye care practitioners are mobilizing to offer this service. For the time-being, myopia prevention is still a growing treatment area.


ReVision Optometry is a referral-based practice in San Diego providing scleral contact lens services for patients with keratoconus and other complex eye conditions. If you seek myopia management services, we will direct you elsewhere. To schedule an appointment, request your examination online or call our office at 619.299.6064.