Big Macs, Braces and Myopia Management

October 1, 2020

By Gary Gerber, OD

Here’s a discussion that I don’t think anyone at McDonald’s has ever heard.

“If you want your Big Mac well done, that will take longer. Since it will take longer, there will be an extra charge of $1.17. Also, asking us not to put on pickles is another charge that requires even more time and expertise to circumvent our assembly line system. So, instead of $3.99, your well-done Big Mac with no pickles will be $5.81. Did you want fries with that?”

Similarly, I don’t think any orthodontist has ever said to a parent, “Your daughter needs braces. We are going to use 14 rubber bands. Each one costs $4.19. She will also need 27 inches of titanium dental wire at the cost of $42.11 per inch. Should she lose or break a rubber band, they are available at the cost of $4.19 each, and they come 20 to a bag. Since kids are always breaking rubber bands on their braces, you must get two extra bags to start. Also, it’s not uncommon for wires to break from time to time. When that happens, this dental wax should be put on the end of the wire until you bring her in for us to fix it. That way, the wire won’t jab into her cheeks. That costs $11.42 per container, and she’ll need two of those. Because her teeth are very crooked and, looking at your mouth, that’s likely due to genetics, she’ll need eight visits this year and six visits next year. If they weren’t in such bad shape, it’d only be four visits each year. But hey mom, you know how genetics is. Anyway, the damage for everything she’ll need is $5,426. Did you want to pay cash, check or charge?”

Yes. Both of the above discussions are silly. Why? First, as a Big Mac consumer vs. McDonald’s franchisee, you can’t appreciate the complexity (genuine or not) of the extra work to make your burger the way you want it. It’s something as a consumer you just can’t relate to.

Next, beyond the ridiculous “nickel and diming” for extra time for pickle removal and materials (rubber bands), something else is noticeably irritating in both presentations.

If you read the orthodontist’s presentation as though you were the parent, the comments likely got under your skin as something callous and cruel to say to the mother. Yet, many, if not most of us, charge parents higher fees for their kids’ myopia management services if their kids have a higher Rx or are progressing faster or have other confounding factors that may indeed take more time. Think about how that sounds to a parent. Does it take more time to treat a more complicated case? Yes, it does. Does it take more time to take the pickles off the Big Mac? Yes, it does. Not equivalent, you say? Yes, they are – to consumers.

“Mom, your daughter is highly myopic and has astigmatism. I’m confident I can slow down her myopia, but it’s going to be harder to do. That means it’s going to take more visits (well-done burger) and more lens changes to get to the desired result (no pickles). That makes her a Level IV case (teeth are very crooked). The fees are $2,800 for professional care. That includes the first three months of visits. After that, visits are $50 each. The first pair of lenses is $450 (titanium wire). If she loses a lens, those are $215 each (bag of rubber bands). That makes the total for today…”

STOP. PLEASE. STOP!! I’m begging you, and more importantly, so are parents.

Parents are having a hard enough time grasping the necessity of treatment, let alone deciphering complicated fees.

The solution? Keep it simple and easy to understand. Get your fees as streamlined and as globally encompassing as possible in their presentation. Give parents one less thing to stress over.

I recommend the model: “one fee for myopia management, regardless of the treatment modality.” It’s analogous to the orthodontia model: “It will cost $6,000 to give your daughter a beautiful smile.”

When I’ve previously had this discussion with doctors, their reflexive “but what ifs” are:

  1. But what if it’s a more complicated case?
  2. But what if we use atropine instead of a contact lens?
  3. But what if we must change from a contact lens to atropine?
  4. But what if we must add or take away something from the treatment?

My “but what if” response is easy. “But what if you don’t?”

To come up with a global fee that will allow this to work, look back at the last 50 kids you treated, regardless of modality or Rx. How many of those were highly astigmatic myopes requiring more than the typical number of visits? How many were lower Rx’s in super motivated and compliant kids? Take an average of all those kids and make that your global fee. That model will allow you the same average margin as all the cases you just reviewed. It’s simple math. On a purely monetary basis, averages being averages, you’ll make the same average profit per patient. On a more pragmatic view, with this approach, you’ll make more total profit because more kids will be treated due to the simplicity of the presentation.

Remember the Burger King jingle, “Hold the pickles, hold the lettuce. Special orders don’t upset us.” If that doesn’t resonate, buy yourself a Staples “Easy Button” and keep it in your exam room.




Gary Gerber, OD, is a co-founder of Treehouse Eyes, a company dedicated to providing expert myopia care for kids. You can learn how to bring this expert care model into your practice by contacting him at

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