Myopia Control in Europe: The Case for Upfront Investment in Childhood

A mounting body of evidence supports the clinical efficacy of active myopia management (AMM), but a key question remains: is it cost-effective? New modeling data from France and the United Kingdom suggests the answer is yes, particularly for children at risk for faster myopia progression.

But before we dive into the study and its findings, let’s quickly review how myopia management is evolving.

Beyond Optical Correction: A Shift in Myopia Care

The traditional myopia management (TMM) model, which is comprised of single-vision glasses or refractive surgery, corrects vision but doesn’t slow progression. As a result, children who experience significant refractive shifts face a lifetime of escalating optical, clinical, and quality-of-life burdens.

In fact, higher myopia correlates with increased risk of vision-threatening complications, including glaucoma, retinal detachment, and myopic maculopathy. The long arc of these consequences is where the economic case for AMM becomes compelling—and where this new study comes into play.

Why Lifetime Costs Matter More Than Upfront Price Tags

Using a model that simulated progression in an 8-year-old with −0.75 D, researchers compared TMM and four validated AMM options: low-dose atropine, anti-myopia spectacles, soft contact lenses, and orthokeratology.

Based on the findings, TMM incurred higher lifetime costs than AMM in most scenarios:

• In France, lifetime costs under TMM reached US$32,492 for high-progressors, versus US$19,421 to US$26,295 under AMM.
• In the UK, the same TMM pathway cost US$48,170, while AMM costs ranged from US$24,167 to US$33,015.

For children at higher risk of fast progression, every AMM option delivered cost savings over TMM, with lifetime savings of up to US$24,003 in the UK and US$13,071 in France. These cost savings were driven by the reduced need for complex optical correction, fewer clinical complications, and lower societal costs linked to productivity loss and visual impairment compared to the traditional pathway.

Spectacles and Ortho-K: Leading the Value Curve

Among the four AMM options modeled, anti-myopia spectacles and orthokeratology delivered the greatest economic advantage for fast progressors across both countries, and in France, specifically, they showed cost savings for slower progressors as well. They maintained favorable cost ratios as detailed below, even after adjusting for discounting and sex-based variations in lens use and life expectancy:

• Anti-myopia spectacles delivered cost ratios as low as 0.50 (UK) and 0.60 (France).
• Orthokeratology showed similar ratios (0.55 UK, 0.67 France), providing a viable alternative where contact lens wear is appropriate and well-managed.

By contrast, low-dose atropine and soft contact lenses were more sensitive to pricing and healthcare system dynamics. In France, for instance, higher prices for compounded atropine and ophthalmologist-led contact lens care reduce their cost-effectiveness in slower progressors. Concerns around affordability and accessibility further limit their uptake.

The Role of Risk Stratification

These findings reinforce a practical insight: the economic case for AMM is strongest when it’s targeted to children at higher risk of rapid progression. This underscores the need for early, data-informed risk stratification that uses family history, refractive trends, and biometric markers to guide intervention timing.

But identifying high-risk children is only part of the challenge.

Barriers Beyond Cost: Access, Policy, and Practitioner Roles

AMM uptake is influenced not only by evidence or cost-effectiveness, but also by subsidization policies and provider scopes of practice, which can vary across countries. For example:

• In France, low-dose atropine is fully subsidized, but only ophthalmologists can prescribe it, potentially limiting uptake.
• In the UK, atropine is not subsidized and, in some cases, not within an ophthalmologist’s perceived scope.

Meanwhile, contact lens-based interventions pose their own barriers as they’re more expensive in some settings and require higher levels of compliance and follow-up, potentially making them inaccessible to lower-income families. This raises critical concerns around equity in access to care and disparities in outcomes.

Looking Ahead: From Modeling to Meaningful Care

While cost modeling favors AMM in many scenarios, the clinical rationale goes beyond economics. Children who avoid high myopia report better vision-related quality of life, with fewer cosmetic, psychological, and functional burdens. As AMM treatments evolve and real-world prescribing expands, these broader benefits will matter just as much as dollars saved.

Still, this study offers a clear takeaway: treating early and targeting higher-risk children makes clinical and financial sense. For policymakers, insurers, and clinicians alike, reframing myopia control as preventive care—rather than an optional add-on—is the next key step in reducing its long-term burden.

Reference:

Lee L, De Angelis L, Barclay E, et al. Factors affecting the lifetime cost of myopia and the impact of active myopia treatments in Europe. Am J Ophthalmol. 2025;278;212-221. doi: 10.1016/j.ajo.2025.06.034.