Myopia Management Service: How to Set Up in Your Practice

Across East and Southeast Asia, myopia is no longer an occasional finding in a child's eye exam. It is the default. In Singapore, estimates commonly cited in the literature put myopia prevalence at well over 80% among young adults, and rates among primary school children continue to climb. For optometrists and optical shop owners, this creates both a clinical responsibility and a practical question: how do you build a myopia management service that parents trust, that follows the evidence, and that your team can run consistently?

This guide walks through the decisions involved in setting up a myopia management service in your practice, from the clinical foundations and equipment to treatment selection, follow-up schedules, and how to talk about fees. It is written for practitioners in Singapore and the wider region, where parent demand is already high and expectations are rising.

Why Offer a Myopia Management Service at All?

For decades the standard of care was simple: prescribe single-vision spectacles, update them when vision blurred, and move on. That approach corrects the blur but does nothing about the underlying elongation of the eye. Because each additional dioptre of myopia raises the lifetime risk of complications such as myopic maculopathy, retinal detachment, glaucoma and cataract, many clinicians now treat childhood myopia as a progressive condition to be slowed, not merely corrected. The International Myopia Institute (IMI) has published clinical management guidelines that reflect this shift, and it is a useful reference point for building your protocols.

There is also a plain professional reason. Parents in Singapore are well informed. They hear about atropine, orthokeratology and special spectacle lenses from school, from friends and from online searches. If your practice cannot discuss these options with confidence, they will go somewhere that can. A defined service gives you a consistent answer, rather than an ad hoc conversation each time.

Step 1: Establish the Clinical Baseline

A myopia management service begins with measurement. Without a baseline, you cannot show a parent whether treatment is working, and you cannot adjust a plan that is not.

At a minimum, each child enrolled should have cycloplegic autorefraction or subjective refraction, best-corrected visual acuity, binocular vision and accommodation assessment, anterior segment and fundus examination, and keratometry. Where possible, add axial length measurement. Axial length is the most direct indicator of eye growth and is less affected by accommodation and refraction variability than the spectacle prescription. Optical biometers such as the IOLMaster, Lenstar, or more compact myopia-focused devices make it practical to record it at every visit. If you want to explain to parents why this measurement matters, our guide on axial length and myopia is a helpful handout.

Corneal topography is the other key investment if you plan to fit orthokeratology or specialty contact lenses. Many practices start with biometry and a good keratometer, then add topography once demand justifies it.

Step 2: Choose Your Treatment Menu

You do not need to offer every option. A focused menu you can deliver well is better than a long one you cannot support. The main evidence-based categories are as follows.

Low-dose atropine

Atropine eye drops are the most widely studied pharmacological option. The Hong Kong LAMP study found that 0.05% atropine slowed myopia progression and axial elongation over one year compared with placebo, with 0.025% showing a smaller effect and 0.01% a more modest one. Earlier work from Singapore, the ATOM2 trials, established that lower concentrations could retain much of the benefit with fewer side effects than 1%. Side effects of low-dose atropine include photophobia and near blur, which are generally mild at these concentrations. Low-dose atropine is typically compounded in Singapore, so you will need a reliable dispensing arrangement and to confirm what your licence and local regulations allow you to prescribe or supply. For a deeper comparison, see our article on atropine vs orthokeratology.

Orthokeratology

Overnight orthokeratology reshapes the cornea temporarily and has consistently shown a slowing of axial elongation in clinical trials and meta-analyses, commonly in the region of 40-50%, although individual response varies. It requires topography, careful lens fitting, strict hygiene education and regular aftercare, because microbial keratitis, while rare, is the principal safety concern. It rewards practices with strong contact lens skills and good parent communication.

Myopia control contact lenses and spectacle lenses

Daily-disposable soft lenses such as the dual-focus MiSight 1 day have three-year trial data showing reduced progression compared with single-vision lenses. In spectacles, defocus-based designs such as Hoya's MiyoSmart (DIMS) have shown meaningful reductions in myopia progression and axial elongation over two years in a Hong Kong randomised trial. More recent spectacle lens designs have followed. These options are particularly attractive for younger children, or for families who are hesitant about drops or lens handling. See our overview of myopia control glasses and myopia control contact lenses for detail.

Combination and emerging approaches

Many clinicians combine low-dose atropine with optical treatment when progression is fast. Repeated low-level red light therapy has also been studied, mainly in China, but it has raised safety discussions and you should review current regulatory status and evidence carefully before offering it. Our article on red light therapy for myopia control covers this in more depth.

Step 3: Build a Simple Decision Framework

Once you have a menu, write down how your practice chooses between options. Parents appreciate transparency, and a documented framework protects both the family and the practice.

A common approach considers the child's age, current refraction, axial length relative to age norms, rate of progression, family history, lifestyle, and the family's ability to manage drops or lenses. A seven-year-old with a rapidly lengthening eye and two myopic parents is a very different case from a twelve-year-old whose progression has already slowed. Our resources on pre-myopia and myopia progression rate can help you frame these conversations.

Lifestyle advice belongs in every plan regardless of the treatment chosen. Time outdoors is supported by trials in Taiwan, Guangdong and elsewhere as a way to reduce the onset of myopia, and encouraging it is free. We summarise the evidence in outdoor time and myopia prevention.

Step 4: Set a Follow-Up Schedule and Success Criteria

Treatment without follow-up is guesswork. A typical schedule is a review one month after starting treatment to check tolerance and adherence, then every three to six months to measure refraction and axial length. Orthokeratology patients usually need more frequent visits early on.

Decide in advance what counts as success. Axial length growth in children is expected to occur with age, so your target is to slow it relative to expected growth for that age, not to stop it entirely. If progression is faster than expected, your protocol should say what you do next: check adherence, consider increasing the atropine concentration, adding or switching to optical treatment, or referring. Be honest with parents that no treatment works equally for every child, and that stopping treatment abruptly may lead to a rebound in some patients. Our article on myopia rebound is a good reference for those conversations.

A visual explanation helps. The CarrotByte Myopia Progression Calculator lets you and the parent see projected progression from a child's age and current prescription, which makes the case for early intervention far easier to discuss than a table of numbers. Its companion, the Myopia Risk Calculator, can be used for children who are not yet myopic but have risk factors.

Step 5: Price and Communicate Your Myopia Management Service

Myopia management is usually delivered as a programme rather than a single product. Many practices bundle the initial assessment, the treatment product, and a defined number of follow-up visits into a clear annual or semi-annual fee. This avoids surprise charges and aligns the practice with long-term outcomes. Parents in Singapore are generally cost-aware, so transparency matters. Our guide on myopia control cost in Singapore shows what families typically expect to see, which can help you position your pricing.

When you explain the service, lead with the clinical rationale, not the product brand. Use plain language, show the child's own data, and set realistic expectations. Avoid promising cures or specific numerical outcomes for an individual child. Staff training matters just as much: optical assistants, front-desk staff and optometrists should all give the same explanation of what the service is and what it is not.

Step 6: Run Your Myopia Management Service Smoothly

A good clinical protocol can fail on logistics. Three areas are worth planning early.

Records. You need to track refraction, axial length, treatment, compliance and notes over many years for each child. Paper files make it hard to plot growth curves or spot a child who has missed an appointment. A digital record system that stores axial length trends and treatment history makes the service sustainable. See our guide on going paperless in your optical shop.

Recall. Myopia management depends on patients returning every few months. Automated reminders, and a process for following up missed visits, protect both outcomes and revenue. Our patient recall system guide covers the basics.

Compliance and data. You will be collecting health data on minors, so make sure consent, storage and access controls meet the Personal Data Protection Act. Review our PDPA checklist for optometry software and confirm what applies to your specific licence and setup with the relevant authorities.

Common Mistakes to Avoid

The most frequent problem is launching without measuring axial length or any other objective baseline, then being unable to answer a parent who asks whether the treatment is working. A second is offering a treatment the team does not feel confident explaining. A third is treating the service as a product sale instead of an ongoing clinical relationship, which tends to produce poor follow-up and disappointed families. Finally, avoid overstating results in marketing. Claims about myopia control should be consistent with published evidence and applicable advertising rules for optometrists in Singapore.

Putting It All Together

A successful myopia management service does not need a large budget. It needs a clear baseline assessment, a limited and well-understood menu of evidence-based treatments, a documented decision framework, a disciplined follow-up schedule, transparent pricing, and records that let you track each child over time. Start with the options your team can deliver confidently, measure what you do, and expand as you gain experience.

If you are building or refining your service, start by showing parents what is at stake. Try the free CarrotByte Myopia Progression Calculator with your next young patient, and use it to open the conversation about starting a myopia management plan.