At ARVO 2025, Mark Bullimore, MCOptom, PhD, emphasized the need for more accurate, condition-specific tools in evaluating myopic eye growth and treatment efficacy.
At the 2025 ARVO conference in Salt Lake City, Mark Bullimore, MCOptom, PhD, of the University of Houston College of Optometry shared a compelling critique of the current use of centile growth curves for axial length in myopia management. Speaking directly to optometrists, Bullimore emphasized the need for more accurate, condition-specific tools in evaluating myopic eye growth and treatment efficacy.
Centile growth curves—long used in pediatrics to track height and weight—are increasingly being applied to axial length measurements in children. According to Bullimore, this is where the utility of these curves begins and ends in the context of myopia.
"These curves are based on data from all children, not just myopic ones," he explained. "So they substantially underestimate axial elongation in myopic children."
This limitation has two major consequences:
Bullimore also cautioned against relying on axial length alone to predict myopia onset. While it has some predictive value, "cycloplegic refractive error is far more accurate," he said.
To manage myopia effectively, Bullimore recommends using data derived solely from myopic children. This would allow practitioners to assess the expected axial elongation in untreated cases and compare it meaningfully against treated ones.
“What you want is to know how quickly the average untreated myopic child’s eye will grow,” he said. “And ideally, you’d have confidence intervals or centile ranges specific to that population.”
By separating myopic from non-myopic data, clinicians can gain a more realistic benchmark and better evaluate the success of interventions like orthokeratology or low-dose atropine.
Bullimore’s insights at ARVO underscore the importance of precision in pediatric myopia care. As the prevalence of childhood myopia continues to rise, refining the tools we use to monitor progression and assess treatment outcomes is more critical than ever.
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