August 24, 2026
By Malinda Pence, OD
The staff of Madeira Optical; photo provided by Dr. Pence
My interest in eyecare began with a very personal experience: my grandmother became blind from macular degeneration at the age of 67.
My mother was a nurse, so I already had a health care influence, but I always felt that if I got into optometry, I wanted to do something to help patients like my grandma. Her vision declined before treatments for macular degeneration were available, and I watched helplessly as her vision worsened. Now, with patients I’ve seen for 15 to 20 years who are near and dear to my heart, I am grateful that we can offer them treatments that provide increased vision.
This personal experience has led me to adopt a deeply preventative approach to eyecare. When a myopia management patient gets in my chair, I’m never offering them a treatment from the standpoint of just another treatment. My goal always is to choose a treatment that best suits the patient and that can give them the best quality of life–today and into the future.
Early Adoption of Myopia Management Treatments
Since I’ve been in the eyecare field, I’ve had a passion for preventative care. Because of this, I always try to start myopia management as early as possible. As soon as we start seeing any kind of change in a patient’s prescription, we initiate conversations about the different treatments available and try to get the child started as soon as we can.
Similarly, I do everything in my power to get the most current treatments in our office. When MiSight lenses first became available, I was the first practice in Cincinnati to offer them to patients. More recently, I was one of the first practices in Ohio to offer the Essilor Stellest spectacle lens for myopia management. I’m also in the process of working with HOYA to become a clinical site for the MiYOSMART spectacle lenses, which aren’t yet FDA approved in the U.S.
It’s important to me to always be at the forefront of what’s happening in eyecare–not to say that we were first, but to make sure our patients know we’re doing everything possible to give them the highest quality of care. When patients are in your chair with retinal detachments and other concerns that are treatable, and in some cases preventable, that motivates you to do everything you possibly can to improve their lives.
Implementing the Essilor Stellest Lens
Before the FDA approval of the Essilor Stellest lens, we offered patients every other available myopia management treatment–low-dose atropine, multifocal soft contact lenses and orthokeratology. However, having the Stellest lens has been a true game changer for our patients and their parents.
With a spectacle lens for myopia management, we have another tool we can offer, and we can expand our reach of patients who could be eligible candidates for myopia treatment. For the parents who struggle to put eye drops in their kids’ eyes every night, or who think their child is too young to handle contact lenses, this opens up a whole new option to still offer them treatment. We’ve had parents of younger children who were a bit more hesitant to enroll in a myopia management treatment, and now that we have a spectacle lens option, it’s a no-brainer for them.
While myopia management isn’t new to our practice or our patients—we’ve had some patients doing low-dose atropine for the last eight years!—having a spectacle lens option for myopia management has been helpful. Parents’ reactions and the overall acceptance rate has been a bit better since the introduction of the Essilor Stellest lens. As a practitioner, I love that I have the whole spectrum of options available to them, and for parents, some of that education isn’t necessary, because everyone is familiar with glasses.
Overcoming Challeneges of a New Treatment
In the last several months, we’ve sold dozens and dozens of pairs of Stellest lenses. Prior to the official approval, we had patients that we knew would be good candidates for them. We did our homework and started planting the seeds to let them know this was a possibility, so when the FDA gave it the green light, we were able to place multiple orders within the first week or two.
As with any myopia management treatment, one of the primary challenges is the cost and the lack of insurance coverage. When the Stellest lenses initially launched, there wasn’t any insurance coverage. However, over the last several months, the landscape has been steadily improving. EyeMed, which is based in Cincinnati and covers many of our patients, was the first to provide coverage, so that has been incredible for our patients. Now, VSP also provides coverage. As more companies offer coverage for myopia management treatments, these therapies will become more accessible to more patients.
Start Myopia Management Conversations Early
Since myopia management has become such a pivotal part of our practice, I’ve found that parents love it. We make sure that conversations around myopia management start early. Oftentimes, the nitty gritty of those discussions isn’t happening the first time that parents come in, because there are a lot of factors they need to consider. But the discussions need to start early! The idea is that the next time they come back in, or if we’re seeing the child progress quickly, we’ve already had that initial conversation, and then we can start discussing the best treatment options. Keeping that open conversation at every appointment and through every stage is critical to making parents feel like they’re a partner in their child’s care.
Another key component of this is scheduling longer appointments for myopia management patients. I know that many of the offices around us have much shorter appointment times, and we still have 30-minute time slots, but we also have appointments specifically to talk about myopia management. Sometimes we don’t have enough time in a traditional exam, but it’s always worth it to have them book the extra time and have those longer discussions with parents.
It’s also important to me that if a child’s prescription has progressed, I don’t want the parent to never have had a conversation about myopia management before. I want to be able to say, “You’re informed, and you’re educated. If you decide that you don’t want to go that route today, that’s okay. But you have the information.” Having a parent say “no” one day doesn’t mean it’s a no forever, and having those conversations early makes the biggest difference.
A Focus on Quality of Care
To other practitioners, I would say: follow your passion.
If you truly believe a treatment or a new piece of equipment or the latest technology will improve care for your patients, your patients will sense that belief and be more receptive. The more you talk to your patients, the more they’ll understand, and the more they’ll trust you. Our goal is always to give our patients the best experience possible and to improve their lives as best we can, and that guides all of our decisions.
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Dr. Malinda Pence, a graduate of The Ohio State University College of Optometry, is a dedicated optometrist passionate about providing family eye care in a community-based practice. She is an active member of the AOA, OOA and Cincinnati Optometric Association. After briefly practicing in a local commercial setting, Dr. Pence realized her vision of delivering advanced medical eyecare within a community-based environment. In 2002, she decided to acquire a long-standing Madeira practice that had served the community since 1956. With determination and a strong commitment to patient-centered care, Dr. Pence transformed the practice into a full-spectrum medical care clinic.
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Read more from Dr. Pence in Women in Optometry here
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