77 MMP | Going All In: Inside the Mighty Eyes Myopia Program

This episode is sponsored by Contamac.The US data on Essilor Stellest is finally in a peer-reviewed journal. A new paper in JAMA Ophthalmology followed 159 children ages 6 to 12 across nine US sites. Over 24 months, Stellest slowed myopia progression by 71% and axial elongation by 53% compared with single-vision lenses.That’s a big deal for US doctors. But our panel noticed something right away: 71% and 53% are not the same number.Dr. Leah Johnson and Dr. Cary Herzberg are back to break down the study. Leah likes what she sees: a well-designed trial, a diverse US population instead of a 95–99% Asian cohort, and strong wear time. She also reminds us that relative percentages can flatter a result, and that the absolute axial length benefit lands about where our other modalities already do. In her words, it’s another lifestyle option, and a good one.Cary zeroes in on the gap between refraction and axial length. If the two measures can be that far apart, he asks, how can anyone tell doctors they don’t need a biometer? That question takes over the episode.Leah compares it to glaucoma. You can manage glaucoma with a pressure-lowering drop and no OCT, but nobody would call that specialty care today. At the same time, she doesn’t want a missing biometer to be the reason a myopic kid ends up in single-vision glasses. Matt brings a lesson from his time as executive director of the AAOMC: when the myopia community came at the rest of optometry too aggressively, it pushed doctors away. His bigger worry is follow-up care, parent education, and the “Stellest is a scam, just go to Target” posts on social media.The panel also covers what happens when kids look through their full distance prescription at near all day, why the 20-20-20 rule may be too short, atropine’s effect on accommodation, and Cary’s story of the $60,000 topographer that paid for itself.In this episode• What the 24-month US Stellest trial in JAMA Ophthalmology actually found• Why 71% (refraction) and 53% (axial length) tell different stories• Relative vs. absolute benefit, and how Stellest compares to ortho-k and soft lenses• The glaucoma analogy: is axial length the OCT of myopia management?• Should a missing biometer ever stop a doctor from treating?• What the myopia community got wrong by pushing too hard on the rest of optometry• Near work through a distance prescription, screen time, and the 20-minute timer• Low-dose atropine, accommodation, and patients who forget to mention their drops• Pricing myopia management to the level of care you provide• Why new technology tends to sell itselfSUBSCRIBE ON SUBSTACKhttps://myopiamindset.substack.com/This week’s sponsor is Contamac.Learn more about Optimum Infinite Ortho-K from Contamac →

Dr. Leah Johnson and Dr. Cary Herzberg react to new research where indigo light prevented myopia in tree shrews, and explain why they still tell parents to send kids outside.This is a preview to one of our subscriber only episodes on Substack.Get the full episode here: https://myopiamindset.substack.com/Substack Subscribers get an inbox update when we post a new episode, early episodes, a weekly newsletter - PLUS bonus content for paying subscribers.

After ten years building Treehouse Eyes, Matt Oerding says the practices that succeed at myopia management aren't the ones with the best story. They're the ones with a system, a doctor with convictionGet the full episode here: https://myopiamindset.substack.com/Substack Subscribers get an inbox update when we post a new episode, early episodes, a weekly newsletter - PLUS bonus content for paying subscribers.

Why a lens-design software company opened its own lab, and how they get new fitters to a first-fit win.Get the full episode here: https://myopiamindset.substack.com/Substack Subscribers get an inbox update when we post a new episode, early episodes, a weekly newsletter - PLUS bonus content for paying subscribers.Mark Cosgrove, Dr. Sukh Gill and Josh Martinez. You may know them from Doctor’s Own Design. Today they’re Aurora GP Lab Inc., and this episode is all about why.

If there’s ever a Mount Rushmore of myopia management, Dr. Thomas Aller is on it.His work shaped where this field is today, and most are using a version of it every week, whether we know it or not. So I wanted to hear how it actually started. The answer: frustration, a payphone, and a lot of stubbornness.Get the full episode here: https://myopiamindset.substack.com/Substack Subscribers get an inbox update when we post a new episode, early episodes, a weekly newsletter - PLUS bonus content for paying subscribers.

This is a preview to one of our subscriber only episodes on Substack.Get the full episode here: https://myopiamindset.substack.com/Substack Subscribers get an inbox update when we post a new episode, early episodes, a weekly newsletter - PLUS bonus content for paying subscribers.This month’s question came from Dr. Andrew Brauer, by way of a text he sent Cary. Andrew had heard Cary say something on a previous episode — an idea Cary traces back to his own mentor — about how sometimes the profession needs to stop trying to convince the doctors and just take the message straight to the patients who need to hear it. Andrew couldn’t shake it. So he sent Cary a text, Cary said we should do this on the show, and that’s how we ended up here.

Dr. Matthew Martin on front-loading the hard part of ortho-K so the next ten years mostly run themselves, and why doctors who keep redesigning happy patients are making their own work.This is a preview to one of our subscriber only episodes on Substack.Get the full episode here: https://myopiamindset.substack.com/Substack Subscribers get an inbox update when we post a new episode, early episodes, a weekly newsletter - PLUS bonus content for paying subscribers.

Dr. Shefali Miglani is one of the most successful myopia management doctors I know. She's also the only guest who opened by telling me she failed. She had the lens, the technology and the topography map, and parents still nodded politely and walked out without signing up.When she figured out why, it changed everything. She'd been talking about her technology, her training and herself, and the parent in the room had no idea where they fit in.We cover why information doesn't convert, why the scare-tactic opener costs you the parent in seconds, what "calm certainty" sounds like, and her reframe on who the hero in your exam room really is. She also talks openly about masculine and feminine energy in practice, and what changed when she stopped bringing a warrior energy into the room that wasn't hers.If you've ever watched a parent say thank you after a great consult and never come back, this one's for you.For the full episode breakdown, read the companion piece on The Myopia Mindset Substack: https://myopiamindset.substack.com/p/why-parents-say-no-to-myopia-management

Dr. David Ng went inside Vision China 2026 — AI risk models trained on more than a million records, ten-year axial trajectories predicted from a single retinal photograph, and a national approach to childhood myopia that makes ours look accidental. Dr. Cary Herzberg, Dr. Andrew Brauer and Dr. Priscilla Chang break down what it means for the rest of us.This is the third story from this month's Myopia News Monthly. The full episode also covers a study where 24.5% of non-myopic high school students became myopic in three years, and a new randomized trial on repeated low-level red light therapy — plus twenty minutes of the panel arguing about whether myopia management is specialty care or primary care.Full episode and every month's breakdown: myopiamindset.substack.com#myopia #myopiamanagement #optometry

Dr. Jennifer Lyerly walks through the STAR study numbers, the parents who just want the glasses, and the 25-year-old nobody knows what to do with.Join Us on Substack: full podcast + articles + bonus contentmyopiamindset.substack.com