The Myopia Mindset

Here’s a question Dr. Cary Herzberg wants every optometrist to ask in the mirror: if you dropped every vision care plan tomorrow, could your practice survive?

For most young ODs, the honest answer is no. Not because they aren’t great clinicians — optometry school made sure of that — but because, as Cary puts it, “they don’t teach you how to make a living.”

Cary has spent 50+ years in myopia management, pioneered modern ortho-k, and mentored countless successful specialty docs. Together we’re mapping out how the modern OD can take back control of how they practice and do business — starting with step one: becoming the decision maker.

Subscribe on our substack to further explore how optometrists can reclaim control of their careers in a profession increasingly shaped by vision plans, online retailers, private equity, and high patient volumes. Cary Herzberg argues that becoming the "decision maker" doesn't require owning a practice—it requires taking ownership of the value you bring, whether you're an associate or practicing in a corporate setting. We discuss why informing patients about myopia management isn't "selling," but a professional responsibility, and how today's concerns over children's screen time create an opportunity for optometrists to become trusted advocates for families. Cary outlines a five-step framework for building a fulfilling, specialty-driven career: redefine your professional identity, embrace patient education, choose a specialty, create long-term care plans, and make a compelling business case for the resources you need. The reward is greater professional autonomy, a loyal patient base built on relationships rather than insurance plans, and the freedom to practice on your own terms.

This month’s Myopia News Monthly brings Dr. Andrew Brauer and Dr. Priscilla Chang to the table for three stories — and one genuine disagreement.

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For all the noise around artificial intelligence, the most useful question for a myopia practice isn’t “Will this replace me?” It’s “Can this help me do the work I already know I should be doing?”

That’s the premise of this week’s episode. I sat down with my friend Louise Curcio — a fractional marketing director with a focus on AI-augmented marketing, and formerly the director of myopia management marketing at CooperVision — to walk through a practical list of marketing moves for the myopia practice. None of these are exotic. Most are fundamentals that strong practices have used for years. What’s changed is that AI now makes each one faster, cheaper, and easier to execute, often in the time it takes to listen to this episode.

Contact Louise Curcio on Linkedin

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Welcome back to Myopia News Monthly, where we cover the top stories in the myopia management industry so you can grow organically into the expert you were always meant to be.

This month’s panel: returning guests Dr. Andrew Brauer, Dr. Cary Herzberg, and Josh Martinez of Doctor’s Own Design/Aurora GP Lab, Inc.

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This Month’s Stories

1. HHS and the Surgeon General issue a warning on children’s screen use.

2. The FDA rejects Sydnexis’ SYD-101 — despite the STAR trial meeting its primary endpoint.

3. Hoya’s MiYOSMART iQ posts some of the strongest myopia control data ever reported.

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Building a myopia management referral network sounds simple on paper: introduce yourself, explain what you do, and ask other ODs to send you their myopic kids. In practice, it's a grind — cold calls that go nowhere, front desks that don't pass the message, colleagues who don't see myopia management as standard of care yet, and doors that get slammed, sometimes multiple times in a row.

Dr. Marie Palladino has been through all of it. In this bonus segment, she shares the unfiltered version of how she built her referral base from zero — including what she brought to offices (food helps), what she said to convince ODs she wasn't going to poach their patients, and how she used the mutual-referral framework (offering to take their glaucoma or dry-eye cases in exchange) to turn a one-sided ask into a real partnership.

She also gets into the mindset side: how she stayed motivated through repeated rejection, why she shoots for small wins instead of big asks, and the personal connection strategy she used to open doors that the myopia conversation couldn't open alone.

If you're trying to grow a referral pipeline — or you've already tried and hit a wall — this is the conversation you needed to hear.

Every month there’s more happening in myopia management than any one clinician can keep up with — new studies, new products, new debates. That’s exactly why we built this series.

In this episode, I sit down with two practitioners who’ve been in the trenches of myopia management: Dr. Andrew Brauer of Eye Care Center of DuPage and Dr. Cary Herzberg, with 40+ years of myopia management experience. We go through the five most important stories from Q1 2026 — and we don’t hold back on the disagreements.

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In this episode:

LAMP Study (8-year follow-up): The data is in — tapering atropine before stopping leads to less rebound than abrupt cessation. But is a quarter-diopter reduction enough to change how you manage discontinuation? And should we even be framing myopia management as something that ends? | Eight-Year Results of the LAMP Randomized Clinical Trial

https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2846905

Essilor Stellest 2.0: More plus, potentially twice the efficacy of the original. Andrew raises the concern nobody wants to say out loud about spectacle-only practices. | Next-Generation Spectacle Lens Aims to Strengthen Myopia Control in Children

https://theophthalmologist.com/issues/2026/articles/march/next-generation-spectacle-lens-aims-to-strengthen-myopia-control-in-children/

Contrast Theory of Myopia: Dr. Ashley Tucker’s piece in Review of Myopia Management ties color vision research to myopic defocus. Is this a new mechanism — or just a new way of describing the one we already know? | When Color Vision Research Meets Myopia Control

https://reviewofmm.com/when-color-vision-research-meets-myopia-control/

Sight Glass DOT Lenses at NCC 2026: New data, 20% African American representation in the study, and the astigmatism question finally answered. | SightGlass Vision Presents Latest Findings on DOT Spectacles at NCC 2026

https://reviewofmm.com/sightglass-vision-presents-latest-findings-on-dot-spectacles-at-ncc-2026/

European Delphi Consensus: Should myopia be classified as a progressive disease? Some colleagues still push back. Andrew and Cary explain why it’s not a question worth arguing. | Consensus on Evidence Gaps and Unmet Needs in Childhood Myopia

https://reviewofmm.com/consensus-on-evidence-gaps-and-unmet-needs-in-childhood-myopia/

Whether you’re deep into myopia management or just building your program, this panel is your monthly check-in.

🎧 Listen now — and if you’re a paid subscriber, stay tuned for the bonus segment coming later this week. https://myopiamindset.substack.com

The Myopia Mindset is a weekly podcast for optometrists, ophthalmologists, and eyecare professionals devoted to myopia management. New episodes every week.

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. 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. 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.

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.

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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/

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

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://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/

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

American Association for Pediatric Ophthalmology and Strabismus (AAPOS)— https://www.aapos.org/home

The LAMP study — https://pubmed.ncbi.nlm.nih.gov/30514630/

Stellest spectacle lenses — https://www.essilorluxottica.com/en/newsroom/press-releases/essilor-stellest-fda/

American Academy of Orthokeratology and Myopia Control (AAOMC) —

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

WHO projection — https://www.sciencedaily.com/releases/2016/02/160217113308.htm