Q&A
Last month, I introduced you to three leaders in the myopia control field. This month, I introduce you to four more.
As with last month’s crew, the depth of this group’s knowledge in myopia control and their commitment to providing a high quality of life to their patients is stellar.
Dr. Aller’s and Dr. Cooper’s respective practice websites illustrate the comprehensive care they provide their myopia patients, as well as the related research they are involved in. (Check out draller.com and coopereyecare.com .)
Dr. Liu is part of an outstanding program at the UC Berkeley School of Optometry, where she not only treats myopia, but also conducts related research and trains new graduates to understand how the scope of our great profession has evolved. (Check out http://bit.ly/2r1WXZw ). Finally, Dr. Gifford has been changing myopia patients lives in Australia for years.
I challenge all of you to develop your own brand of specialty and catapult today’s optometric practice!
Jack Schaeffer, O.D., F.A.A.O.,
Editor-in-Chief
O.D. Scene
MYOPIA CONTROL EXPERTS WEIGH IN . . .
TOM ALLER, O.D.,
JEFFREY COOPER, O.D.,
KATE GIFFORD, O.D.,
& MARIA LIU, O.D., PH.D.
Q: HOW AND WHY DID YOU GET INVOLVED IN MYOPIA CONTROL?
TA: I was an orthokeratology patient at the age of 14. This eventually led to me thinking about optometry as a career. I’m dedicated to testing, refining, designing, researching and advocating for the use of multifocal contact lenses (MFCLs) for myopia management.
JC: In 2000, I had a 4-year-old myope (-4.50 ou) who had a retinal detachment in one eye present to me. The child’s mother asked whether I could do anything to reduce the risk of a retinal detachment in the other eye. I did my due diligence and learned about myopia control.
KG: Right from when I was in optometry school I was equally interested in binocular vision and contact lenses – myopia control is the perfect blend of both.
ML: I have always considered myopia a serious disease rather than simply a benign refractive condition. My many years of experience with orthokeratology in the late ’90s in China and its apparent myopia-controlling effect inspired me to pursue more research and clinical commitments in myopia retardation.
1: Dr. Liu exploring the deep.
2: Dr. Aller and family in Hawaii.
Q: WHAT IS YOUR MOST SUCCESSFUL TREATMENT STRATEGY FOR MYOPIA?
TA: There are known or expected average treatment effects for various treatments. Bifocal glasses may range from 0% to 40% with greater effects for certain subgroups or when the bifocal segment is larger. MFCLs and orthokeratology may have treatment effects from 40% to 80% with an average of around 50%, and atropine may provide around 60%.
JC: Treatment is based upon two variables: (1) rate of progression and (2) child desire. For example, children younger than age 7 who have very progressive myopia (more than 1.50D per year) with one or more parents who have significant myopia are usually started on atropine 1% unless the parent requests a different treatment modality, such as low-concentration atropine.
KG: Given the historical focus on orthokeratology in my practice, and the strength of the research evidence, this is naturally my first choice whenever the patient is suitable.
ML: Data from our clinical patients suggest no significant difference in the efficacy of myopia control between orthokeratology and daytime multifocal contact lenses.
Q: HOW DO YOU PRESENT THE MODALITY TO YOUR PATIENTS?
TA: Typically, myopia management is recommended for any child who has begun myopia or presents with progression in the previous year. To help demonstrate the likely refractive outcomes of standard treatments vs. the various types of myopia control treatments, I use my Myappia app to educate parents that if there is a little bit of myopia progression after one year of treatment, it still is a great victory compared with the likely outcome from standard treatment. It is a powerful tool for parent and patient education.
JC: A quick in-office discussion; then handouts, which review the etiology of myopia; referral to our website for more information;
KG: Positively, and with a focus on the benefits for the child. Much time is spent on educating the parents and pediatric patient, answering their questions and going through information handouts . . .
ML: During our initial myopia control workup and consultation appointment, we take comprehensive baseline measurements and a detailed case history, relevant to myopia control management. We then provide a comprehensive and objective overview of the currently available evidence for myopia treatments, their indications, efficacies, risks of complication, the financial and time investment with each option.
Q: HOW, SPECIFICALLY, DO YOU GENERATE REFERRALS?
TA: I’m not particularly adept at social media, though I have an office Facebook page whose content is managed by a marketing firm, along with Twitter. I have three websites, an all-purpose office website and stopmyopianow for myopia control and reverse myopianow for orthokeratology.
JC: Our website is very important in presenting our practice, as it contains lots of educational material. We get several referrals from ophthalmologists. Our closest relationship is with pediatric ophthalmologists: We receive a lot of referrals for either vision therapy or myopia control. We receive referrals from neuro-ophthalmologists for convergence problems. I get the least number of referrals from optometrists. I see their families, not their patients. Interesting!
KG: My current social media focus is on peer education – my Myopia Profile Facebook group for optometrists now has more than 1300 members, from nearly 20 countries, and active engagement on evidence-based case studies and the latest research. We intend to do more with social media this year for practice marketing, but successful Facebook for business activity doesn’t come free or easily, so our current referrals come from O.D. colleagues or word-of-mouth.
ML: We provide summary letters regarding the nature and likely signs and symptoms associated with each treatment option to patients’ parents, school teachers/nurses and their pediatricians. We try our best to communicate with other O.D.s in co-managing high-risk patients.
1: Dr. Gifford presenting a poster at the 2017 Association for Research in Vision and Ophthalmology.
2: Dr. Cooper and family.
3: Dr. Aller and wife on vacation.
Q: WHAT IS YOUR MOST MEMORABLE MYOPIA CASE AND WHY?
TA: My most memorable case concerns a patient who was -4.00D or -5.00D 30 years ago and under my care has been allowed to progress to -11.00D. In the early days of developing my myopia management protocol, I assumed that MFCLs would only work on eso-fixation disparity at near, and this patient never exhibited that type of binocular dysfunction. By the time other mechanisms had been fairly well-established, it was too late to slow her myopia. She is still married to me, however, presumably happy, but quite a bit more myopic. Guaranteed to be memorable, because she likes to remind me of this treatment failure.
JC: All are memorable in their own right.
KG: Each child who’s gone from spectacle to contact lens wear and returned with parental reports of them being ‘a different child’ – happier and more confident in contact lenses. Practicing myopia management means you have to get comfortable with pediatric contact lens fitting, and these psychological benefits for kids, beyond correcting vision or even myopia control, are the most rewarding.
ML: In general, it is highly rewarding to see children’s eyes lighting up with clear vision without glasses, to see them transform to more confident, self-responsible people and to see parents’ happy faces in knowing that their children’s myopia has been effectively controlled.
Q: WHAT CAN O.D.S DO TO INCREASE AWARENESS OF MYOPIA CONTROL?
TA: Optometrists can support programs, such as Think About Your Eyes, which encourage annual eye examinations. Also, there is a movie in the planning stages called, “Losing Sight – Inside the Myopia Epidemic.” Optometry as a profession, as well as individual optometrists, could help to support this film, just contact me to find out how you can help.
JC: I feel that the AOA should make parents aware of the dangers of progressive myopia and the ability of optometrists to slow progression. This is a task, since treatment is not FDA approved or even universally recognized by either eye profession.
KG: The role starts in the discussions you have with your patients and their parents. To help with these items, we’ve shared my patient communication tool, along with blogs and how-to guides, on myopiaprofile.com. To speak directly to parents about myopia progression risks and control, my optometrist husband Dr. Paul Gifford, Ph.D., and I also developed mykidsvision.org , which can be used on your websites, Facebook pages and even in-office to explain the myopia story.
ML: I feel that working closely with school teachers and nurses, pediatricians, ophthalmologists and developing public campaigns to promote outdoor exposure and limit prolonged use of electronic devices will help raise awareness.
Q: WHO ARE THE MEMBERS OF YOUR FAMILY, AND WHAT DO YOU LIKE TO DO FOR FUN?
TA: I have been married to Virginia for 35 years, or 6.00D of myopia progression. We have three grown children: Kimberly, Brian (developer of myappia) and Theresa. I play handball competitively, and I occasionally play golf, and it tends to be badly done.
JC: My wife, Barbara, and my daughter Alyssa. We love to travel, ski and take advantage of the New York City lifestyle. Also, I love the summer and playing golf with my good friends.
KG: My husband, Paul, and I try not to talk about optometry all the time, although his kids Jack (18) and Rohanne (17) will point out when we’re “nerding out” excessively on the profession! We like to hike and camp as a family, ideally including our 5-year-old miniature schnauzer, Basil, and we like to run, cycle and rock climb.
ML: My husband and I live in East bay, California. We spend lots of time visiting our families, doing fitness, tennis, swimming and playing Xbox games (bad example for kids). Also, I do a lot of traveling and enjoy cooking spicy Chinese food.
1: Dr. Gifford, Paul and practice staff on a “work family” holiday to Cairns, Australia.
2: Dr. Liu doing laps.
3: Coopers at Cape of Good Hope in South Africa.
Q: WHAT IS YOUR FAVORITE BOOK, MOVIE, BAND AND ADULT BEVERAGE?
TA: Book: I tend toward thrillers and political dramas, but according to my Kindle, I like but according to my Kindle, I like authors, such as David Baldacci; Movie: I like the classics (anything with Jimmy Stewart); Band: Tower of Power (a soul band); Adult beverage: Stella Artois, as it seemed to be Brien Holden’s favorite, and it gives me a chance to reminisce about him.
JC: Book: “Exodus;” Movie: “Butch Cassidy and Sundance Kid;” Band: The Rolling Stones; Adult beverage: Dirty Martini
KG: Book: Imajica; Band: I’ve got an eclectic taste from the ’70’s, ’80’s, ’90’s alternative and today’s equivalents brought to us by the kids; Adult beverage: A very hoppy ale, or sparking wine — champagne if possible — on special occasions.
ML: Book: Too many to name; Movie: “Inception;” Band: my favorite western band is U2; Adult beverage: I enjoy a type of oolong Tea called Tie Guan Yin from Fujian province on the Southeast Coast of Mainland China. OM