December 15, 2021
By Ashley Tucker, OD, FAAO, FSLS, ABO Diplomate
I always say that I am prescribing myopia management and not just recommending it. There is a lot of power in that statement.
After graduating from the University of Houston College of Optometry in 2010 and completing a Cornea and Contact Lens Residency in 2011, I started working at my current practice and immediately hit the ground running with myopia management. One of my partners, Dr. Ann Voss, had already been prescribing orthokeratology with her patients for several years, so some seeds had already been planted within our patient base. I gained a lot of experience with OrthoK during my residency, and I was excited to further expand that specialty in our practice.
We have created a culture within our practice of offering myopia management regardless of which practitioner is seeing a child. Though two of our partners are more focused on vision therapy, they will always discuss myopia management with children and their parents. We are dedicated to offering myopia management to all appropriate patients.
Evolving with Myopia Management is Key
The way I have approached myopia management from every angle — diagnostic equipment, treatment options, parent and patient education, products — has evolved over the years to ensure that everything I am doing is as up-to-date as possible.
When it came to educating patients and their parents, at first, I was only doing in-office education. I spoke to every single myopic child’s parents, and I even educated myopic adults whether they had children or not. We still do that in-office education, but we also have a pre-made packet of information with a document I have written with details about myopia and all available treatments. We also include brochures from contact lens and orthokeratology manufacturers and some current research articles.
When talking with parents, I let them know we now have options to keep their child’s axial length and prescription from getting worse. Most parents are thoroughly intrigued, which leads to great dialogue about myopia management and eventually a commitment to a treatment program. Unfortunately, others are not as receptive and do not see the value. I still send them home with the packet, and I note in their chart to revisit the topic the following year. If the child is at high risk for progression, I will recall them to recheck their prescription in six months. Frequently, when the prescription has worsened at that return visit, the parents will get on board with managing their child’s myopia instead of simply correcting it. I always say that I am prescribing myopia management and not just recommending it. There is a lot of power in that statement.
When I first started out, I was only offering OrthoK to my myopic patients, which went well. I started with 10 new OrthoK patients per year, then that grew to 50 new patients per year, and now we have over 500 patients in OrthoK lenses. We then started exploring the use of center distance soft contact lenses and hybrids for patients who were not eligible for OrthoK due to high prescriptions (both myopia and astigmatism) or who could not wear them for assorted reasons. This broadened our myopia management efforts and captured many more patients. Around this same time, we introduced topical low-dose atropine to allow an option for patients who could not or would not wear contact lenses of any kind. We have recently had remarkable success with CooperVision’s MiSight 1 day contact lenses.
Understanding Patients Helps Create a Treatment Plan
When I treat a myopic child, I offer every appropriate treatment option. Sometimes, it is pretty easy due to refractive considerations, but other times, they can choose between three or four different options. I recommend OrthoK as the contact lens option for most of my patients younger than 8 years of age, simply because it is typically easier on the patient and the parent. For contact lens-averse patients, atropine is the better option. Most kids who get accustomed to putting a drop in their eyes can easily transition to a contact lens option within a year. Older kids do great in soft contact lenses or even in a hybrid model, but many of them love the idea of daytime freedom, so OrthoK is attractive.
I always get to know the child and their parents, and we decide together. Parents often ask me to choose, which I do based on the child’s maturity, lifestyle, and refractive considerations. Frequently, I recommend a daily disposable over monthly replacement design to minimize contact lens complications. The main reason a parent would choose a non-daily disposable option is cost. In these cases, I will spend more time educating and emphasizing the importance of proper contact lens hygiene.
Dr. Tucker takes patients’ maturity, lifestyles, and refractive errors into consideration when deciding on a treatment plan.
When it comes to combination treatments, I offer them as needed. I always start with one treatment option then closely monitor high-risk patients (myopia less than age 8 and two myopic parents) for fast progression. If I am finding Rx progression of more than 0.50D per year on average, I add low-dose atropine to my contact lens wearers or strongly encourage a contact lens option for my atropine patients. Fortunately, for most patients, one treatment is enough.
Spreading the Word About Myopia Management Professionally
I am incredibly fortunate to consult for the specialty division of CooperVision and SynergEyes, so I have many opportunities to learn about and advocate for myopia management. However, I also attend the Global Specialty Lens Symposium, Vision By Design, and the American Academy of Optometry meetings annually. These meetings are incredible and full of lectures that have not only expanded my knowledge but continually motivate me about myopia management. I also subscribe to Review of Myopia Management, which I would highly recommend to anyone. Every edition of RMM has excellent, practical information that truly keeps me at the forefront.
When I am lecturing, my clinical experience comes into play. Most ODs want to hear the truth about what works and what does not in clinical practice, which can only come from real-life experiences. I always add in little nuggets from my practice that have helped me along the way, and I also use actual patient cases quite often — this adds value to what I am lecturing on. Also, because I am a lecturer and a major advocate for myopia management, I need to hold myself to a higher standard in patient care. I try to stay abreast of every new topic and innovation in myopia management so that I can offer my patients only the best.
Hope for the Future
We are heading in the right direction with more companies investing R&D resources in novel myopia management treatment options. I am very anxious about the arrival of the spectacle options in the U.S. This will truly be a game-changer that will allow us to treat even more myopic children. We will also have an FDA-approved atropine option from Vyluma coming soon. The arsenal of tools will be plentiful. I hope no child will be denied myopia management either because of cost or availability.
|Dr. Ashley Tucker graduated from the University of Houston College of Optometry in 2010 and completed a Cornea and Contact Lens Residency at UHCO in 2011. Dr. Tucker is a partner at Bellaire Family Eye Care, a private practice in the Houston, TX, area where she primarily manages patients in need of specialty contact lenses and myopia management. She is also a Visiting Assistant Professor at UHCO and is the course master for the Ophthalmic Optics laboratories. In addition, Dr. Tucker is a member of the Speaker’s Bureau for the Specialty Division of Bausch + Lomb, a consultant for CooperVision, and a lecturer for the STAPLE (Soft Toric and Presbyopic Lens Experience) program.