Times change, and so must we. While I wish I could accept all insurance plans, many have “challenging” fee schedules. So now, beyond my established insurance-based practice, I am offering an out-of-network option for families seeking convenient, excellent care. After 26 years in practice and caring for thousands of children, I'm confident in the quality of care and attention I provide.
I hope you’ll continue to recommend me, including for families who would be coming out-of-network. Regardless of how they pay, all of your patients will receive the dedicated care and expertise they deserve. Your support keeps my practice independent and solely focused on our patients.
- For out-of-network and uninsured patients
- For non-covered services (like myopia management)
- Direct pay, concierge-level care
- Every visit with Dr. Lichtenstein
For direct-pay patients only: (929) 588-8570
- Insurance-based
- Participating Aetna, Affinity/Molina, Amerihealth, Anthem, BCBS/Superior Vision, Empire Healthplus, Fidelis, HealthFirst, Metroplus, Tri-Care
- In-network helps reduce costs
- Expert care with Drs. House and Lichtenstein leading our Clinical Team
For insurance-based patients: (718) 468-9800
Practice News: Closure of Woodside Office
We’ve officially closed our Woodside office at 53-17 Roosevelt Avenue as of September 12. It’s been a wonderful 21 years serving the community from two locations and welcoming tens of thousands of families. We hope you will refer all patients to our Fresh Meadows location at 192-13 Union Turnpike. We continue to provide the same excellent specialized care and are proud to (still!) be the only independent full-time pediatric ophthalmology practice serving Queens, north Brooklyn, and Long Island.
Myopia Management: What? Why?
Myopia progression (increasing minus lens power) is primarily caused by axial elongation of the eye, which increases the risk of serious conditions like retinal detachment, macular degeneration, and glaucoma in adulthood. The longer the eye, the greater the risk (and, incidentally, the higher the myopia). For most of my 26 years since fellowship, I updated glasses and passively observed myopic progression, but “nothing could be done” about axial growth.
Now, however, we can reduce axial elongation and, we believe, significantly reduce the long-term risk of vision-threatening diseases. Several effective therapies are available to reduce axial elongation. For the past five years, I’ve prescribed low-dose atropine (0.025 to 0.05%) and tracked myopia progression through serial refractions and ultrasound measurements. However, this approach is no longer sufficient; we need more reliable, precise measurements of axial length paired with quality normative data to evaluate risk and treatment outcomes.
Having obtained a top-of-the-line optical biometer in May 2025, my practice measures axial length with exceptional precision, tracking growth to within 1/100th mm. I analyze these measurements, together with accurate refractions, using specialized software that incorporates data from nearly one million individuals. This approach helps me identify good candidates for myopia treatment and to effectively assess therapeutic response.
In summary, managing myopia during childhood helps reduce axial elongation and myopia progression, shifting the risk curve for serious vision-threatening conditions in adulthood. This represents a paradigm shift and is an exciting and relevant development.
Myopia Management Basics
High Myopia Is a Serious Ophthalmic Condition
High myopia—defined as a refractive error of ≥ - 6 diopters (D) or an axial globe length of ≥ 26 mm—is not just a need for stronger glasses. It is a progressive, structural eye disease driven by axial elongation during childhood and adolescence, which significantly increases the risk of irreversible vision loss in adulthood. Early identification and intervention can alter a child’s visual prognosis for life.
The Problem: Excessive Axial Eye Growth
- Myopia results when axial growth of the eye exceeds its focusing power.
- Each 1 mm of axial elongation results in ~ 3 D of myopia.
- Excessive axial elongation stretches and thins the retina, choroid, and sclera. These anatomic changes markedly increase the risks of:
- Retinal detachment
- Myopic macular degeneration
- Subretinal (choroidal) neovascularization
- Glaucoma
- Early-onset cataracts
| The preponderance of evidence is that excessive axial length (and subsequent anatomic change) causes these pathologies. |
Vision Risks Multiply with Each Diopter
| Degree of Myopia | Risk of Myopic Maculopathy | Risk of Retinal Detachment |
| -2 D | 2x | 3x |
| -4 D | 9x | 9x |
| -8 D | 40x | 21x |
- Even moderate myopia (-2 to -4 D) can pose long-term risks.
- Myopic maculopathy is now a leading cause of legal blindness in several countries.
Axial Length Is the Key Predictor of Risk
- The newborn eye is ~ 17 mm in axial length. By 24 months, axial length is ~22 mm. Axial growth usually stops just shy of 24 mm around age 15.
- Most axial growth occurs early in life: note the 5 mm change between birth and 2 years.
- After the age of 2, axial growth greater than 0.2mm/yr is abnormal. The growth rate normally decreases even more during adolescence.
- Axial length (AL) > 26.0 mm is strongly associated with complications regardless of refractive error.
- Monitoring AL growth is essential in assessing response to therapy and true risk of disease during adulthood.
Who’s at Risk?
- Children with early-onset myopia (<6–9 years)
- Children with two myopic parents
- Children living in urban environments with limited outdoor exposure
- Fast progressors: >0.50 D/year or >0.2 mm/year in axial length
Slowing and Reducing Axial Elongation during Childhood: What Works
- Low-Dose Atropine Eye Drops
- Mechanism: Believed to act on muscarinic receptors to inhibit eye growth.
- Dose: 0.025%–0.05% nightly
- Efficacy (from LAMP and ATOM studies):
- 50–60% reduction in progression for ~ 90% of patients
- Slows both refractive shift and axial elongation
- Safety: Excellent safety profile with minimal local side effects
- Duration: Continued until axial growth subsides (often age 14–16)
- Compliance: High satisfaction and ease of use
- MiSight® Soft Contact Lenses
- FDA-approved daily disposable lens for myopia control
- Mechanism: Creates peripheral defocus to slow eye growth
- Efficacy:
- ~59% slower myopia progression over 3 years
- ~52% slower axial elongation
- Age: Well tolerated in children as young as 7–8 years
- Compliance: High satisfaction and ease of use
- Orthokeratology (Ortho-K)
- Mechanism: Rigid contact lenses worn overnight to temporarily reshape the cornea.
- Efficacy: may be as effective as MiSight or low-dose atropine drops in controlling axial elongation. Temporarily reduces the need for glasses or daytime contact lenses.
- Risks:
- Potential for corneal damage or infection.
- Discomfort and/or difficulty adjusting to lenses.
- Limited effectiveness for higher degrees of myopia.
I see no significant advantage to Ortho-K and only greater risk. I have seen patients develop keratitis as well as vascular growth at the limbus (which can make LASIK more challenging later). In my opinion, placing a rigid piece of plastic on the cornea overnight is simply not a good idea when there are safer options.
- Lifestyle and Behavioral Interventions
- Outdoor Time: ≥2 hours per day appears to reduce risk of myopia onset and slows progression.
- Near Work Breaks: Use the 20-20-20 rule: every 20 minutes, take 20 seconds to look 20 feet away from books/tablets, etc.
- Screen Time: Limit prolonged device use; ensure breaks and balanced activities.
The Role of the Pediatrician
- Early Detection
- Vision screening per AAP and AAPOS Guidelines
- Consider referral to pediatric ophthalmology for myopia management if:
- VA <20/40 (under 6) or <20/30 (6+)
- Rapid progression of myopia
- Family history of high myopia
- Family Education
- Explain that myopia is a disease to manage, not just a glasses issue
- Encourage regular follow-up every 6–12 months for treated children
- Reinforce outdoor activity and treatment adherence
Conclusion
High myopia is a chronic, sight-threatening condition rooted in excessive axial elongation during childhood and adolescence. Over the past decade, effective interventions—including low-dose atropine and MiSight contact lenses during the “critical period” of axial elongation—have been demonstrated to substantially reduce axial elongation. Based on all available evidence, such a reduction is believed to lower the lifelong risk of visual impairment. Pediatricians are essential in identifying at-risk children early, advocating for intervention, and supporting long-term eye health.
Other Useful News in Pediatric Ophthalmology: Pediatric Uveitis
Given the potential risks of long-term adalimumab (Humira) immunosuppression, can children with JIA-related uveitis stop treatment at some point? The “common knowledge” amongst pediatric ophthalmologists and rheumatologists has been that we can attempt discontinuance after 24 months of clinical capture, but this is often proved wrong in real life. In July 2025, The Lancet published a good article addressing this dilemma and quantifying what happens.
Here's the “Interpretation” section from the article:
“Discontinuing adalimumab led to higher rates of recurrence of uveitis, arthritis, or both in patients with previously controlled juvenile idiopathic arthritis-associated uveitis. However, all patients who had treatment failure successfully regained control of inflammation by the end of the 48-week study period after restarting adalimumab.”
