Given my background in and experience with myopia, I’ve been asked to offer some advice on implementing myopia management into one’s practice. I suggest eight steps to enhance the likelihood of success.
1 GAIN KNOWLEDGE
A wealth of in-person courses, online courses, materials, newsletters and blogs are available to optometrists to learn what is required to offer myopia management. On Facebook, for example, there is an active discussion group called Myopia Profile, where practitioners frequently ask questions about the management of individual patients and receive expert guidance from experienced practitioners who reside around the world. (See: facebook.com/groups/myopiaprofile/ .)
To truly practice myopia management, I believe O.D.s need to offer more than one therapy. To just do orthokeratology or prescribe atropine does not, in my mind, constitute myopia control. As a result, I recommend optometrists acquire thorough education on at least two “arrows” for their quiver. As a bonus, O.D.s may have something else to turn to if their first approach is not working to their satisfaction.
2 INSTRUCT STAFF
Staff buy-in is essential to implement myopia care. Therefore, it is important to get staff on board and up to speed with myopia control. Conventions and online courses are available for staff too. Front desk personnel, for example, should be familiar with the basics of myopia management, so they can answer patient questions and provide brief details about what the practice offers. Something else I recommend is a “closer,” or a trained staff member whose focus is to get patients excited about the myopia management the practice offers.
Additionally, I suggest choosing a staff member who is comfortable with children when delegating contact lens training, for example. After all, the target population for myopia control is 8- to 12-year-olds. These patients can be trained to handle contact lenses, but the training, on average, takes a little longer than it does with adults, so your staff should schedule these training sessions accordingly.1
3 EDUCATE PATIENTS
I suggest optometrists start by having a simple one-page sheet to introduce the topic of myopia management. This could be informational (e.g. myopia definition, patients it effects, treatment options, etc.) to begin the conversation, or it could be a list of frequently asked questions, such as, “Is my child old enough to wear contact lenses?” Ready-made materials can be found online, e.g., myopiaprofile.com/store/ , and patient-friendly content can be found at mykidsvision.org .
Also, some parents appreciate peer-reviewed papers on the benefits of myopia control, the evidence base and/or the safety of soft contact lenses in children.2-4 Parents who are physicians, professors and engineers, in particular, will appreciate this thorough approach, and the literature will help to set reasonable expectations on their part. (A caveat: I recommend that O.D.s avoid waxing on about the increased prevalence of myopia, as parents care most about their own children.)
Regarding expectations, it’s important optometrists are clear with parents and patients that they won’t stop myopia progression in its tracks, explaining that with orthokeratology, for example, the patient will achieve good correction-free vision, but the eye continues to elongate, albeit at a slower rate.
Additionally, O.D.s should set expectations by educating parents that myopia stabilizes by 15 years in 50% of children and by 18 years in 75% of children.5 This way, parents and their children know myopia may progress into adolescence, but that the optometrist will monitor progression carefully so that the decision to end treatment is based on data.
4 PREPARE FOR PARENT/PATIENT QUESTIONS
A common question asked: “Why hasn’t this option been offered before?” Optometrists should be prepared to explain that the field of myopia control has only recently evolved, noting that the FDA approved the first product for myopia management in 2019.6
5 UTILIZE THE NEEDED EQUIPMENT
If O.D.s are managing myopia using dual-focus soft contact lenses or spectacle lenses, no specialized equipment is required. If optometrists are offering orthokeratology, a corneal topographer may be beneficial.
In the coming decade, axial length measurement may become the standard of care for myopia management.4 As such, it may become a technology worth investing in. Among cataract surgeons, optical biometers that use OCT technology or interferometry are the norm for axial length measurement. As a result, optometrists may be able to obtain such measurements from their local cataract surgeon. Regardless of whether the optometrist has an existing co-management relationship, a local cataract surgeon may be willing to have his tech measure a child’s axial length for a nominal fee or, perhaps, even as a professional courtesy. A networking opportunity awaits!
6 START SIMPLE
Optometrists new to myopia control should not perform their first orthokeratology treatment on a -6.00 D myope or a 2.00 D astigmat. As the old idiom goes: “You must learn to walk before you can run.” Therefore, regardless of the modality, I recommend beginning with a straightforward case, preferably a motivated child and a low-maintenance parent. For example, optometrists should start with a 12-year-old –2.00 D myope who desires contact lens wear.
7 SET APPROPRIATE FEES
Optometrists should charge appropriately for their myopia control services. I suggest structuring fees for a program of treatment. I think orthodontics are a great analogy for myopia management in many aspects, including the fees. (For more on this approach, see bit.ly/myopiaoerding .) A parent is not asked to pay for the materials that constitute the braces or retainers. She is asked to pay for the end product — the straightened teeth and a beautiful smile. I recommend adopting the same philosophy when it comes to myopia management.
8 MARKET MYOPIA CONTROL
I suggest optometrists start their marketing efforts via word-of-mouth from satisfied parents or discussing the myopia control treatments offered with a few carefully selected patients and their parents. From there, I recommend O.D.s utilize their patient-facing website and consider community outreach, such as contacting the local PTA about giving a presentation on myopia control.
HELPING IN OTHER AREAS
The greatest weapon in the fight against myopia is delaying its onset. The greatest modifiable risk factor for developing the refractive condition is spending less time indoors. By educating parents and their children about how time spent outdoors lowers the risk of myopia, we’re playing a role in preventing its onset and in preventing other health issues, such as obesity, related to time spent indoors. Why not consider implementing the eight steps above to make a difference in a child’s sight and overall wellbeing? OM
- Walline JJ, Jones LA, Rah MJ, et al. Contact Lenses in Pediatrics (CLIP) Study: chair time and ocular health. Optom Vis Sci. 2007; 84: 896-902.
- Bullimore MA. The Safety of Soft Contact Lenses in Children. Optom Vis Sci. 2017; 94: 638-46.
- Bullimore MA, Brennan NA. Myopia Control: Why Each Diopter Matters. Optom Vis Sci. 2019; 96: 463-5.
- Bullimore MA, Richdale K. Myopia Control 2020: Where are we and where are we heading? Ophthalmic Physiol Opt. 2020; 40: 254-70.
- Myopia stabilization and associated factors among participants in the Correction of Myopia Evaluation Trial (Comet). Invest Ophthalmol Vis Sci. 2013; 54 :7871-84.
- Chamberlain P, Peixoto-de-Matos SC, Logan NS, Ngo C, Jones D4 Young G. A 3-year Randomized Clinical Trial of Misight Lenses for Myopia Control. Optom Vis Sci. 2019; 96: 556-67.