Myopia Management: Prioritizing Axial Length Measurement Over Refractive Error
Overview
Experts at the 2026 Global Specialty Lens Symposium emphasized the critical role of axial length (AL) measurement in managing myopia progression, rather than relying on refractive error alone. Establishing a baseline AL and monitoring it regularly allows for timely intervention and better risk assessment of associated eye diseases.
Background
Myopia progression is linked to the elongation of the eye, which can increase the risk of serious ocular conditions such as glaucoma and retinal detachment. While choroidal volume at ages 12 to 14 is theoretically the best predictor of future myopic complications, it is difficult to measure clinically. Axial length measurement offers a practical and reliable alternative to track eye growth and guide management decisions. Treatment strategies must be tailored to individual patient responses and pupil characteristics to optimize outcomes.
Data Highlights
| Age Group | Target Axial Length Progression | Atropine Dose | Pupil Coverage by Defocus Optics |
|---|---|---|---|
| <10-12 years | <0.2 mm/year | 0.05% | 50-60% minimum |
| 12-16 years | <0.1 mm/year | 0.025% | 50-60% minimum |
| >16 years | No progression | Not specified | 50-60% minimum |
Key Findings
- Axial length measurement is a superior predictor of myopia progression and related risks compared to refractive error.
- Baseline AL should be established at the first visit and monitored every 6 months or sooner for rapid progressors.
- Effective myopia control requires covering at least 50-60% of the pupil with defocus optics; pupil size influences lens choice.
- Higher defocus doses and atropine (0.05% for <12 years, 0.025% for >12 years) improve control, especially in younger children.
- Monitoring AL is essential as refractive error may remain stable despite ongoing axial elongation.
- Binocular vision assessments and lifestyle modifications are important adjuncts to myopia management.
Clinical Implications
Clinicians should prioritize axial length measurement over refractive error to accurately assess myopia progression and adjust treatment strategies accordingly. Regular AL monitoring enables early detection of uncontrolled eye growth, allowing timely intervention with optical or pharmacological methods. Individualized treatment plans considering pupil size, patient age, and binocular vision status optimize myopia control outcomes.
Conclusion
Axial length measurement is the key metric for effective myopia management, guiding clinical decisions and reducing the risk of long-term ocular complications. Integrating AL monitoring with tailored interventions and lifestyle advice enhances patient care and myopia control success.
References
- Michaud, Marcote-Collard, Simard 2026 -- Myopia Management: Focus on Axial Length Measurement, Not Refractive Error
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