The Myopia Mindset

65 MMP | "We've Lost 40 Years": Why Myopia Management Still Isn't Standard of Care | Myopia Awareness Week Special (Part 2)

It’s Myopia Awareness Week — and we’re releasing the bluntest episode we’ve ever recorded. Awareness weeks tend to be glossy. This one isn’t. Dr. Cary Herzberg has been doing this work for forty-five years, and Part 2 of our panel opens with him asking a question that should sit uncomfortably with the profession: it’s 2026, we have FDA-approved tools, and we’re still trying to convince colleagues to start. What happened to those forty years? We had to split this conversation in two. Part 1 was the toolbox [https://myopiamindset.substack.com/p/inside-the-myopia-toolbox-part-1]. This is the part that got real. In Part 2, Dr. Cary Herzberg lays down four decades of frustration: optometry has had the data, the products, and the patients in the chair since the early 1980s — and is still, in 2026, asking how to get colleagues to start. Dr. David Ng counters with a hopeful sign — parents are now walking into exams asking, unprompted, about their child’s hyperopic reserve. Then he drops a warning that should get every U.S. ECP’s attention: counterfeit “myopia” spectacle lenses are already showing up in Canadian opticals at $100 a pop, with no efficacy data and unidentifiable origin. Inside this episode: – Cary on what optometry has gotten wrong since the 1980s genetics-only era — and what he thinks “real” board certification in myopia would look like – Dave’s red-flag report on counterfeit myopia spectacle lenses showing up in Canada (and why he expects it in the U.S.) – Dr. Jennifer Lyerly on a 2022 Vision Monday survey claim that 70% of U.S. ODs were “doing myopia management” — most of them, somehow, with progressives – The structural problems: 15-minute exam slots, PE-backed practices, debt-loaded new grads, and the national boards as a curriculum gatekeeper – Why ODs still don’t refer to other ODs — and what the AAOMC’s brand-new P2P program is trying to do about it – The closing trio of pitches to new grads: Jennifer’s compassion frame, Dave’s “come spend a day with me,” and Cary’s Newton Wesley line — make a legend of yourself If you missed Part 1, start there — we walk through the modalities, the data, and the “where do I even start” question. [https://myopiamindset.substack.com/p/inside-the-myopia-toolbox-part-1]This is the follow-up. If this episode hit, share it. Myopia Awareness Week is the one week of the year a non-clinical friend or family member might actually click on something like this. Forward it to a parent. Send it to the OD you know who's been "thinking about getting into myopia management" for three years.

64 MMP | Inside the Myopia Toolbox, Part 1: What Works, When, and Who Should Get It

Twenty years ago, the myopia toolbox had one drawer: ortho-K. Today, U.S. optometrists have FDA-approved soft contacts, an approved spectacle lens, off-label low-dose atropine, and a steady drip of next-generation options coming through Health Canada first. So how do you actually decide what to put a kid in? In Part 1 of this two-part panel, Matthew sits down with Dr. Jennifer Lyerly (True Vision Eye Care, Defocus Media), Dr. David Ng (Bayview Vision Care & The Myopia Clinic, AAOMC board member), and Dr. Cary Herzberg (co-founder and past president, AAOMC) to walk through the modern myopia toolbox in real, chair-side terms. What’s inside this episode: – How each panelist actually decides between MiSight, ortho-K, atropine, and Stellest based on lifestyle, age, and progression – The new MiSight IQ data David is watching — and the 100%-control claim coming out of a Malaysian ortho-K + red-light cohort – Why Jennifer says you do not need axial length to get started, and which single piece of equipment actually is non-negotiable (hint: only one modality requires it) – A real cautionary story from a state board complaint filed against an OD who never mentioned myopia management – Cary’s “throw the gauntlet down” pitch for SYD-101 and the case for moving from myopia management to myopia prevention Part 2 drops next week — that’s where things get heated. Becomes a Subscriber on Substack: https://myopiamindset.substack.com/ [https://myopiamindset.substack.com/]

63 MMP | Why the FDA Said No to a Drug That Could Save Kids' Eyes

A Texas ophthalmologist sits down to explain the lifetime risks of myopia to a 6-year-old's mom — and mid-sentence realizes the mom, still in her 20s, has already had retinal detachments in both eyes from her own untreated nearsightedness. That's the gap this episode is about: the gap between what we know myopia does to people, and what the FDA's drug division decided was "not clinically meaningful" when it rejected SYD-101 — Sydnexis's stable, low-dose atropine drop — last fall. Dr. Cary Herzberg, a 40-plus-year ortho-K/myopia management pioneer, walks through the STAR study, the fast-progressor data Sydnexis dropped at AAPOS, and why a drug that's approved in Europe is still locked out of American practices. We get into how the FDA's own request to add older patients dragged the headline numbers down, what 47.9% / 37.6% / 28.0% actually means for a kid, and what an everyday optometrist, ophthalmologist, or parent can do this week to push back. What We Cover In This Episode: Sydnexis & SYD-101 — the company and the 0.01% low-dose atropine drop that this episode is about. https://sydnexis.com/ [https://sydnexis.com/] Sydnexis Press Release Data Presented At AAPOS — https://www.businesswire.com/news/home/20260323823740/en/Sydnexis-Announces-New-Data-from-Phase-3-STAR-Trial-of-SYD-101-Presented-at-2026-AAPOS-Annual-Meeting [https://www.businesswire.com/news/home/20260323823740/en/Sydnexis-Announces-New-Data-from-Phase-3-STAR-Trial-of-SYD-101-Presented-at-2026-AAPOS-Annual-Meeting] The STAR study — Sydnexis’s 3-year, 847-patient pediatric myopia trial across the U.S. and Europe. https://sydnexis.com/resource/evidence-from-the-star-study-a-novel-low-dose-atropine-eye-drop-slows-the-progression-of-pediatric-myopia/ [https://sydnexis.com/resource/evidence-from-the-star-study-a-novel-low-dose-atropine-eye-drop-slows-the-progression-of-pediatric-myopia/] https://iovs.arvojournals.org/article.aspx?articleid=2804883 [https://iovs.arvojournals.org/article.aspx?articleid=2804883] Washington Post article — A drug for myopia could help millions of kids. The FDA is keeping it off the shelves (by David G. Hunter) https://www.washingtonpost.com/opinions/2026/02/10/fda-myopia-drug-trial/ [https://www.washingtonpost.com/opinions/2026/02/10/fda-myopia-drug-trial/] Inside Health Policy article — Pediatric Myopia Drug is Latest In String of Unexpected FDA Rejections (by Jessica Karins) https://insidehealthpolicy.com/inside-drug-pricing-daily-news/pediatric-myopia-drug-latest-string-unexpected-fda-rejections [https://insidehealthpolicy.com/inside-drug-pricing-daily-news/pediatric-myopia-drug-latest-string-unexpected-fda-rejections] American Association for Pediatric Ophthalmology and Strabismus (AAPOS)— https://www.aapos.org/home [https://www.aapos.org/home] The LAMP study — https://pubmed.ncbi.nlm.nih.gov/30514630/ [https://pubmed.ncbi.nlm.nih.gov/30514630/] Stellest spectacle lenses — https://www.essilorluxottica.com/en/newsroom/press-releases/essilor-stellest-fda/ [https://www.essilorluxottica.com/en/newsroom/press-releases/essilor-stellest-fda/] American Academy of Orthokeratology and Myopia Control (AAOMC) — https://aaomc.org/ [https://aaomc.org/] Petition to classify pediatric progressive myopia as a disease — Urgent Call for U.S. Children to Have Access to an FDA-Approved Low-Dose Atropine https://www.change.org/p/urgent-call-for-u-s-children-to-have-access-to-an-fda-approved-low-dose-atropine-68d0a62c-8058-48bb-ab09-9c586d3a3ff6?recruiter=1397201700&recruited_by_id=25f73080-d542-11f0-94d3-2b1ed6b14439&utm_source=share_petition&utm_campaign=petition_dashboard&utm_medium=copylink [https://www.change.org/p/urgent-call-for-u-s-children-to-have-access-to-an-fda-approved-low-dose-atropine-68d0a62c-8058-48bb-ab09-9c586d3a3ff6?recruiter=1397201700&recruited_by_id=25f73080-d542-11f0-94d3-2b1ed6b14439&utm_source=share_petition&utm_campaign=petition_dashboard&utm_medium=copylink] WHO projection — https://www.sciencedaily.com/releases/2016/02/160217113308.htm [https://www.sciencedaily.com/releases/2016/02/160217113308.htm]

62 MMP | pt1 - How a Top Children's Hospital Built a Myopia Program That Treats Every Kid

What does it look like to build a full-spectrum myopia management program inside one of the country’s top pediatric hospitals — and what can every optometrist learn from it? 🔗 Subscribe on Substack [https://myopiamindset.substack.com/] - video podcasts + articles + exclusive bonus content 📸 Instagram [https://www.instagram.com/myopiamindset/] / TikTok [https://www.tiktok.com/@myopiamindset] / Linkedin [https://www.linkedin.com/in/matthew-herzberg-a6a15163] - connect + daily insights In Part 1 of this special episode of the Myopia Mindset podcast, host Matthew Herzberg sits down with Drs. Magda Stec, Noreen Shaikh, and Shelby Johnson from the ophthalmology division at Ann and Robert H. Lurie Children’s Hospital in Chicago [https://www.luriechildrens.org/]. The doctors take us inside a program that’s been building for nearly eight years — starting with low-concentration atropine and evolving into a full toolbox that includes MiSight, Ortho-K, Biofinity toric multifocal, and now FDA-approved Stellest lenses. You’ll hear how Lurie’s philosophy of offering myopia management to every patient — including those on public aid — came together, and how the division created a collaborative culture where ophthalmologists, optometrists, nurses, and pediatricians all speak the same language. The panel also covers what a solid baseline workup looks like, how to approach pediatricians for cross-referrals, and how they navigate the conversion conversation with parents in a time-efficient way. If this episode fires you up about myopia management, subscribe — Part 2 drops soon and covers confidence-building, staff training, and whether Stellest glasses will finally blow open the category for optometrists everywhere.

Episode 61 - SUPPORTERS PREVIEW: Ortho-K Benefits And How To Communicate Them To Parents (Part 2)

Support us on Substack for the full episode here: https://myopiamindset.substack.com/ [https://myopiamindset.substack.com/] Knowing the benefits of Ortho-K is one thing but getting parents to understand and say yes is another. In Part 2 of this Myopia Mindset podcast conversation, Dr. Matthew Martin, Dr. Leah Johnson, and Dr. Cary Herzberg dive into how to communicate Ortho-K effectively to parents, bridging the gap between clinical knowledge and real-world decision-making. This is where many practices struggle, not because Ortho-K doesn’t work, but because the message isn’t landing. In Part 2, we cover: How to frame Ortho-K in a way parents immediately understand The biggest communication mistakes doctors make How to simplify complex concepts like myopia progression Positioning Ortho-K as a necessity, not a luxury Building trust and confidence during the consult If you’ve ever had a parent hesitate or say no; this podcast episode focuses on how optometrists can communicate the value of orthokeratology to parents, improve patient acceptance, and increase success in myopia management through better consultation strategies. How do you engage your parents and increase conversions in your practice? Let us know in the comments!