September 16, 2024
By Y. Shira Kresch, OD, MS, FAAO
We want our patients to be educated about the risks of untreated myopia, but we don’t want them to be scared into signing up for a treatment they have not thought long and hard about. I always emphasize what it is we’re trying to prevent.
Photo Credit: Getty Images
From the beginning of my time in the eye care field, I learned the importance of working with fellow eye care professionals — both ODs and MDs — to ensure patients receive a comprehensive approach to eye care. Myopia management is no different. While on faculty at Columbia University’s Ophthalmology Department, I worked closely with the pediatric ophthalmology division to launch its myopia management clinic. We held collaborative meetings both in person and virtually with optometrists, other academic pediatric ophthalmologists, and myopia researchers to develop protocols that would be respected by all parties involved. Fast forward to about six years later, this background was at the forefront in building a myopia clinic within my own cold start practice, Michigan Contact Lens.
Creating a Strong Referral Network
While market research is obviously important to ensure that a desired niche is necessary in the area planned for its implementation, I believe there is always room for a practice that provides excellent care — especially if its foundation is focused on collaboration. A successful myopia management program is referral dependent.
In building my practice, Michigan Contact Lens, my goal was to create a referral center for ophthalmology and optometry that would provide specialty contact lens, myopia, and dry eye care within my own neighborhood, all while practicing at a high level in specialty areas that I loved and maintaining the kind of work-life balance I was looking for as a very involved mom, community member, and homemaker. From my years of working within academic institutions, I knew that I wanted to focus on one area at a time, separated each by about six months — although all fit within the theme of contact lenses. First, we began with specialty contact lenses and focused on creating relationships with corneal specialists, comprehensive ophthalmologists, and optical chains in the area. Then we brought in myopia management about six months later, focusing on pediatricians and pediatric ophthalmologists.
As an example, I arranged a small talk during lunch at a big pediatrician group — the same office I take my children to. The office had me give a myopia presentation to all the pediatricians there. Pediatricians are a very underutilized resource for myopia because they’re the first line of defense. I was able to break everything down, answer their questions, and build the necessary relationship to make the referral process seamless. It is always shocking to me that parents simply don’t know about these treatments and hadn’t been told by their eye doctors or pediatricians when their children become myopic. I have gone to several pediatric groups in my area, spoken with their support staff and some of their doctors, and gave them some referral pads.
People always ask how to harbor good relationships with referral sources, and I think it’s really simple. Do a good job and always communicate — whether that’s with a consult note, email, or text. Let the referring doctor know you saw the patient they sent, the result of the consultation, the plan moving forward, and keep them informed about the process. If you are in it because you care, it will be obvious to your patients as well as to referring doctors. Good work pays off — they will see that their patients are well taken care of in your practice and continue to send more. Word-of-mouth is probably the best type of marketing (and the least expensive!) since patients love to share their positive experiences with friends and family. Just this week I had two patients come from two different pediatrician offices that I had not even spoken with. It turned out that each had other patients who shared their happy experiences, and their pediatricians referred me other patients.
Educating, Not Scaring
Whether I am speaking to a group of pediatricians, pediatric ophthalmologists, or patients and their parents, I am careful not to employ any of the scare tactics many of us are familiar with. We want our patients to be educated about the risks of untreated myopia, but we don’t want them to be scared into signing up for a treatment they have not thought long and hard about. I always emphasize what it is we’re trying to prevent. If a child ends up as a low myope in young adulthood, that is fine. (I know there are many reading this who would probably strongly disagree with me.) I explain to parents that although having no myopia is a coveted luxury, at the very least, we are aiming to realistically slow down the child’s progression as much as possible to avoid myopia in the “danger” categories. If you tell your patients no level of myopia is acceptable, you have to be willing to employ extremely aggressive myopia control in every single case — which comes with cost, risks, and side effects. Imagine telling a glaucoma patient that their target IOP is going to be aggressively low for every patient? You simply can’t do that safely in most cases and it’s not typically warranted — there needs to be an individualized plan to sufficiently lower IOP for each patient’s specific progression risk analysis.
The most important thing to me is for my patients to feel comfortable under my care and to know that I will treat them as if their kids are my kids. I don’t push any specific treatment, I lay out the research in bite-sized pieces, provide brochures and other reading materials, and allow time for questions as well as time to think things over before jumping into a specific treatment plan. Parents have to know atropine has a risk of rebound if started and stopped prematurely, and starting atropine is a strong commitment that sometimes people are not aware of. Contact lenses come with their own category of risks, and while they may be low, they need to be discussed at the onset. Communication and care build trust.
Let Your Patients Decide What They Can Afford
One pediatric ophthalmologist told me he does not let parents know about myopia management options because he knows they are expensive and does not want parents feeling bad they cannot afford it for their kids. I respectfully disagree. As a mom, I want to know all options available to me and their costs before deciding what I can and cannot afford. In fact, I see this as part of our obligation as eye doctors. How much would a person or parent pay to reverse their high myopia? Let people decide for themselves what the future health of their eyes is worth to them and their children.
That said, it is important to create a fair cost structure for your target demographic. Understand that the cost can be a challenge to families. Explain the worth of the product and have options such as CareCredit for patients to enroll in the office or a long-term pay plan. I remain hopeful that as more myopia therapies become available in the United States and gain FDA approval, we’ll be able to enroll even more patients in treatment plans for less cost to these families so that we can help many more children decrease their risk of high myopia.
As myopia is a hot topic frequently discussed with groundbreaking research, I look forward to continuing on in this journey together with my colleagues and patients!
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Dr. Shira Kresch has been practicing optometry for over seven years at some of the most prestigious medical centers in the country, including Columbia University’s Department of Ophthalmology and Kresge Eye Institute. Dr. Kresch has also worked on the faculty of Wayne State University School of Medicine as a Clinical Assistant Professor of Ophthalmology. She found a niche in specialty contact lenses, which led her to open her own practice with a focus on “hard-to-fit” contact lenses. Two weeks after opening the doors to her practice, she was named the national Theia Award of Excellence Young OD by Women in Optometry. |
