May 31, 2023
Dr. Andrew Neukirch
ROSEMONT, Ill. – At THE Myopia Meeting held here May 21, 2023, Andrew Neukirch, OD, of Carillon Vision Care in Glenview, Ill., presented how he has achieved success by becoming a leader in myopia management. He shared how he has become the top prescriber of MiSight 1 day contact lenses using a fitting technique and education method that have proven effective at getting parents and patients to commit to myopia management:
“I started my myopia management journey about 10 years ago with orthokeratology. That’s what anyone was doing back then. This has spiraled to more than 350 kids who are currently in myopia management treatment right now. This represents over half a million dollars of revenue on an annual basis coming into our relatively small practice. Our practice is about 1.6 full-time equivalent doctors. I’m the 0.6.
“I am proud to be the top MiSight-prescribing optometrist in the United States. I’ve been using this lens for well over three years now, which took our practice to the next level. I got involved with myopia management to get our practice away from its dependence on vision plans. When I bought this practice over 12 years ago, I saw the stranglehold that the vision plans had on the day-to-day operations — and on the happiness of the staff and the former owner as well.
“I saw an opportunity with all of these myopes coming into our practice, who were getting worse and worse year after year. In fact, there are 278 kids with myopia per eye care practitioner in the United States.
“So, I started with OrthoK. I went to Vision By Design, bought myself a corneal topographer that I couldn’t afford at the time because I wasn’t really making any money yet, came back home on a Monday, wrote my informed consent agreements, and was gung ho about signing people up. In that first year, I got two people in treatment. One of them was a staff member that wasn’t even paying.
“The following year we got six patients into treatment. Then, it spiraled from there as we got used to the language of how to present this, but our messaging back then was all wrong. We pitched orthokeratology as an option that wouldn’t require daytime glasses or contact lenses. We knew it would slow down myopia, or may even stop it in some cases, but that wasn’t the right message at the time.
“Thankfully, we as a profession have figured this out. Everyone understands we’re trying to ultimately slow down that final level of myopia and reduce the risk of ocular disease later in life. In fact, over two years ago now, the World Council of Optometry passed a resolution announcing myopia management as their standard of care.
“It’s very important to recognize the kids who are at the highest risk for these higher levels of myopia. We know that the age of onset impacts that final level of myopia. We know these kids who are 5, 6, 7, 8 years old are going to be our highest risk patients, so it’s very important to get them into treatment at a younger age.
“When we do myopia management consultations, I ask parents, ‘Did you know we have these technologies? We can slow down how fast your kids’ eyes are changing by approximately half, but it’s only half of wherever it is that we start, so the earlier the better.’
“We also know that increasing levels of myopia cause increasing levels of these ocular diseases later in life at almost an exponential rate once we get past minus four, minus five. If we can just slow down the progression of myopia by one diopter, that will reduce the risk of that patient developing myopic maculopathy by 40%, and the risk of developing glaucoma or other uncorrectable visual impairments by 20%.
“So how effective is MiSight? We have about 150 or so kids in MiSight at this point. We have had a couple dozen in the lens for over three years. They’ve now been through their fourth year of treatment. What I’ve seen clinically, and what we see in the actual seven-year MiSight clinical data, is that 41% of those kids progressed by a quarter diopter or less over three years. So, over three years’ time, almost half of these kids progressed a quarter diopter or less. That’s a pretty great testament to how well this lens works.
“MiSight has made my life so much easier. I want to do what’s best for these kids. So, I’m going to prescribe the FDA-approved option. We have a much higher acceptance rate when I talk about things like the MiSight lens. The MiSight lens is child friendly, and it’s easy to use. It’s also doctor friendly and easy to use.
“Here’s a pro tip if you haven’t been doing a lot of MiSight yet. Let’s say you have 10-year-old little Johnny in your office, who’s a -3.00D myope, and his parents are interested in getting him into contact lenses for the first time. He’s on your schedule for a brand new contact lens fit. Go ahead, be the doctor. Prescribe what’s best for little Johnny. Put him into the MiSight lens right there without committing the parents to your myopia management program. Treat it like a regular contact lens fit.
“Then, just take that one minute to educate the parent about why it is you’re using this lens: ‘I’m putting Johnny into a single-use, one-a-day, throwaway contact lens. It’s safe, but it also slows down how fast little Johnny’s eyes are going to change by over 50%. I’m going to send you home with these materials. I want you to take them home. I want you to read about them. And then I want you to come back armed for that one-week contact lens follow-up with all the questions that you might have, and bring your spouse with you as well.’
“Then, you turn that one-week follow-up into the actual myopia management consultation where we talk about why it is that we really want to do this, and why it’s important to slow down how fast little Johnny’s eyes are changing. Every single time that we’ve done this, that has always resulted in a child successfully put in the treatment.”
