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progression is rare. Studies show increases of 0.50DC or more over three years in children aged 6-12 are unusual. If observed, keratometry or corneal topography is vital to rule out corneal ectasia. An irregular corneal reflex in Retinoscopy signals further corneal examination, as retinoscopy is highly sensitive to early keratoconus detection. Equipment you need: a way to measure corneal curvature and shape where indicated - for orthokeratology and/or contact lens fitting, in cases of progressive astigmatism or where an irregular retinoscopy reflex is noted. If access to this equipment is limited for you, consider referral and co-management pathways with primary eye care colleagues and/or ophthalmologists. growth is about 0.1 mm/ yr, while 0.2 to 0.3 mm/yr suggests myopia progression. Future assessments may involve percentile growth charts, comparing a child's measurement to age-specific data. Those in the 75th percentile or higher face heightened myopia risk. A decrease in percentile indicates successful myopia management. Understanding axial length dynamics aids proactive myopia strategies and lifelong eye health management. Equipment you need: ideally, a way to access axial length measurement for your myopic patients, and non- contact (interferometry) methods are most accurate. Consider co-management with suitably equipped colleagues and/or ophthalmologists to gain measurements, even if only annually, as this extra data can indicate long-term eye health risk and influence management. RETINAL EXAMINATION AND IMAGING Annual retinal examination, particularly for high myopes and as needed for others, is crucial, conducted through dilated pupils. Optical coherence tomography (OCT) or fundus photos are used to objectively document retinal features or abnormalities when findings emerge. In countries where this technology is commonplace, it might be deemed the standard for myopia care, advocating for annual eye health AXIAL LENGTH MEASUREMENT Axial length measurement is pivotal in myopia control research, with interferometry being 10 times more accurate than refraction for tracking myopia progression. While not widely adopted in primary eye care, newer instruments and research suggest its potential as a standard. Measurements, especially with noncontact devices, are recommended, and an axial length beyond 26mm indicates increased risk. As a relative measure, normal ANNUAL RETINAL EXAMINATION, PARTICULARLY FOR HIGH MYOPES AND AS NEEDED FOR OTHERS, IS CRUCIAL, CONDUCTED THROUGH DILATED PUPILS 40 VISION PLUS ARABIA EDITION