April 1, 2025
By Aamena Kazmi, OD, ABO Diplomate
Photo Credit: Getty Images
As myopia prevalence increases globally, collaborative relationships with ophthalmologists and optometrists is essential for delivering comprehensive care. Building strong relationships with pediatric ophthalmologists and refractive surgeons is critical for optometrists who specialize in myopia control, especially with contact lenses.
Building Relationships with Pediatric Ophthalmologists
Many pediatric ophthalmologists concentrate on medical and surgical eye care and often do not fit contact lenses in their practice settings. While they frequently prescribe low-dose atropine for myopia management, they depend on a trusted optometrist to co-manage cases that require contact lens intervention. This is especially crucial for “fast-progressors” who need dual therapy or children prepared to transition to contact lenses for monotherapy.
Understanding the Ophthalmologist’s Preferred Approach
When establishing a referral relationship, it is important to discuss with the ophthalmologist their preferred myopia management methods. While some ophthalmologists support orthokeratology, many do not actively recommend it due to concerns about corneal health and the risk of infection with overnight wear. Instead, they may be more likely to primarily refer for FDA-approved soft daily disposable lenses or other daily wear options, including off-label EDOF, center-distance multifocal soft contact lenses, and center-distance hybrid lenses for more complex prescriptions.
Although a recent study confirmed that the incidence rate of microbial keratitis in adolescent patients using overnight orthokeratology lenses is similar to both that seen with daily wear contact lenses and the results reported in previous studies,1 it is crucial to respect what referral sources recognize as safe and effective methods of myopia management. By understanding the ophthalmologist’s perspective, an optometrist can align their recommendations accordingly. This ensures that referred patients receive care within the ophthalmologist’s comfort zone, promoting cohesive co-management and encouraging continued referrals.
Expanding Contact Lens Myopia Management Beyond Orthokeratology
Similarly, when creating relationships with potential ophthalmology referral sources, a key part of the conversation should be emphasizing that myopia management in contact lenses has advanced beyond just OrthoK. Many ophthalmologists may be unaware of the full range of available options, including:
- FDA-approved dual focus soft daily disposable lenses designed specifically for myopia control in children and adolescents.
- Off-label EDOF soft daily disposable lenses explicitly designed for myopia management in children and adolescents.
- Off-label center-distance monthly replacement multifocal soft contact lenses, which are also available in toric parameters and have historically been used to slow myopia progression prior to the addition of the spherical FDA-approved option.
- Off-label center-distance hybrid lenses, which offer a combination of GP optics and soft lens comfort for patients with higher astigmatism or who require more unique lens parameters.
Providing educational materials and research findings can help ophthalmologists feel more confident in referring patients for these options. This is also an excellent opportunity to initiate dialogue with nearby pediatricians for potential collaboration.
Maintaining Open Dialogue and Clear Roles
Clear and ongoing communication with referring ophthalmologists is essential for effective co-management. In some instances, ophthalmologists may wish to continue seeing the patient for general ocular health evaluations, managing binocular vision issues, or even for ongoing monitoring of myopia progression with atropine. This typically means that the patient’s preferred optometrist oversees the contact lens aspect of their care. In these situations, it is vital to clarify to the patient’s guardian which aspects the ophthalmologist is responsible for, while the optometrist concentrates on contact lens fitting and related myopia progression control.
To facilitate collaboration:
- Provide written updates on patient progress, particularly if axial length, refractive status/lens parameters, or treatment plans change.
- Respect the ophthalmologist’s treatment preferences while offering evidence-based insights into new options.
- Establish a protocol for follow-up visits, ensuring both providers are aligned on monitoring intervals and treatment modifications.
Exploring Other Ophthalmology Avenues: Establishing Relationships with Refractive Surgeons
Although refractive surgeons primarily treat adult patients, they can be valuable partners in myopia management. Many of their patients have children who are also at risk of progressive myopia. Educating refractive surgeons about myopia management options enables them to inform parents about the benefits of early intervention, leading to appropriate referrals.
Helping Surgeons Optimize Future Refractive Surgery Outcomes
Refractive surgeons aim for high surgical success rates, which are more easily achieved when patients have lower magnitudes of myopia. High myopia increases the complexity of refractive surgery and may reduce the likelihood of optimal visual outcomes. By keeping childhood myopia progression under control, optometrists help create a future patient base that is better suited for refractive surgery. The easiest way to generate referrals from refractive surgeons is to begin communication with surgeons you already refer to.
When discussing co-management with refractive surgeons, highlight that:
- Myopia control reduces the likelihood of severe myopia, leading to easier and more predictable refractive procedures.
- Parents receiving LASIK, ICL, or other refractive procedures are often highly motivated to ensure their children do not develop high myopia and maintain surgical candidacy.
- Refractive surgeons can serve as key players in combating the myopia epidemic by discussing myopia management during preoperative and postoperative consultations. Supporting packets that include articles from The New York Times, The Atlantic, and The Wall Street Journal, as well as information from the World Society of Pediatric Ophthalmology and Strabismus are invaluable resources.
Conclusion
Successfully managing pediatric myopia requires a collaborative approach. By fostering relationships with pediatric ophthalmologists, optometrists can ensure that patients requiring contact lenses for myopia management receive proper care while maintaining oversight from their ophthalmologist as necessary. Likewise, engaging with refractive surgeons can generate a steady stream of referrals by asking them to educate surgical patients about myopia control for their children. Open dialogue, mutual respect, and a shared commitment to patient care will lead to better outcomes for pediatric patients with myopia and a more integrated, effective approach to myopia management.
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Dr. Aamena Kazmi graduated from the University of Houston College of Optometry in 2015, and she is currently an associate at Bellaire Family Eye Care, a private practice in the Houston, TX, area. She primarily manages patients in need of dry eye management, specialty contact lenses, and myopia control. In addition, Dr. Kazmi is a consultant for CooperVision. |
MiSight 1 Day soft contact lenses are FDA-approved for the correction of myopic ametropia and for slowing the progression of myopia in children with non-diseased eyes who, at the initiation of treatment, are 8-12 years of age and have a refraction of -0.75 to -4.00 diopters (spherical equivalent) with less than or equal to 0.75 diopters of astigmatism.
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