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September 3, 2024
For eye care professionals (ECPs) offering myopia management, having a strong referral relationship with local pediatricians can expand the reach of the life-changing treatments offered. However, it isn’t always easy to facilitate these relationships, leaving many children with myopia untreated.
In this interview, Review of Myopia Management sat down with Monica Jong, OD, PhD, FBCLA, Global Director of Professional Education Myopia at Johnson & Johnson Vision, and myopia management specialist Brianna Rhue, OD, FAAO, FSLS, to learn from their experiences in this area. They shared strategies for engaging pediatricians in myopia management, the role of the pediatrician in myopia management, the resources ECPs should have on hand to share with pediatricians, and more.
Review of Myopia Management (RMM): How important is the role of the pediatrician in a child’s myopia management journey?
Monica Jong, OD, PhD: Pediatricians play a pivotal role in myopia management. Pediatricians are often the central point of medical care for children and the first point of contact for screening and detecting ocular issues especially in North America. On top of that, pediatricians provide crucial education to parents and are a key source of referrals to eye care practitioners.
Today, the majority of referrals from pediatricians after failed vision screenings go to pediatric ophthalmologists.1 Unfortunately, we know that patients are waiting a long time for these appointments given the limited number of pediatric ophthalmologists.2 If children have to wait potentially months to see a pediatric ophthalmologist when an optometrist can help address the issue immediately, that can be detrimental to a child’s overall development. Optometrists are well placed to help address many pediatric vision issues, highlighting the need for stronger engagement with other health professionals involved in the care of a child.
RMM: Dr. Rhue, can you tell us about how you’ve built successful pediatrician-OD relationships and what that has meant in your practice?
Brianna Rhue, OD, FAAO: To piggyback on what Dr. Jong said, pediatricians can catch things much earlier, but often, pediatricians don’t catch myopia until it’s almost too late. Emphasizing the role pediatricians play in this from early onset, and emphasizing timely referrals is critical to filling a big gap in the system of care.
In our office, building relationships with pediatricians is a grassroots effort. I personally talk with local pediatricians, educating them on myopia management and the ways that we can work together to help children. I also make phone calls to offices in my area to talk about what I can do for the doctors’ patient base. I also have a practice liaison go and talk to different offices, further emphasizing the message that we’re trying to get across about myopia management.
Our main source of relationship-building has been sending referral letters to pediatricians after I see myopia patients. In the letter, I write that I saw their patient and advise them that we are treating the patient for myopia. This has been helpful because the pediatrician knows that their patients are being cared for, and they may be more likely to send and refer more patients back to you in the future.
RMM: What educational materials are most helpful for pediatricians to have on hand?
Dr. Jong: Pediatricians are incredibly busy. Education tends to be delivered quickly and by support staff. Here at Johnson & Johnson we have created evidence-based education materials about myopia, why it matters and what the latest evidence-based management is in an easy to understand format that is delivered succinctly — designed for the busy pediatric practice. These include short videos, brochures, FAQs and are part of our Pediatrician Referral Toolkit. Johnson & Johnson research shows that pediatricians want evidence-based information about myopia management.1 In addition to that, there is a report on myopia by the World Health Organization (WHO),3 and there are key review papers that we can provide to the pediatrician if they want to see more evidence.4,5
RMM: Dr. Rhue, what do you think is important to call out in your discussions with pediatricians?
Dr. Rhue: When talking with pediatricians, we emphasize the fact that the science behind myopia management is developing quickly. Getting Johnson & Johnson behind this with an FDA-approved treatment speaks volumes. The limited federal approvals have contributed to why myopia management has been so slow to catch on in the United States. If we look at many other parts of the world, they’re so far ahead of us in terms of myopia management options available to practitioners. Pediatricians also have a lot of familiarity with the Johnson & Johnson brand so this really helps open a conversation about myopia management.
RMM: What does the eye care community wish pediatricians knew about myopia management?
Dr. Rhue: Early treatment intervention is key. Myopia has traditionally been a wait and see game. However, we’re seeing young patients developing myopia earlier, and it’s often progressing faster. Kids spend less time outdoors these days. There are guidelines regarding outdoor time and screen time that health care professionals may be missing the opportunity to talk about with patients.5 Myopia isn’t something we need to wait to treat as evidence shows myopia in a child will likely progress.6-9 Therefore, we have to aim to get ahead of it, and collaboration between health professionals will help create real change.
RMM: Dr. Rhue, do you have any practice tips that you’d like to share?
Dr. Rhue: For optometrists or pediatricians, it’s all about having these conversations with parents, and it shouldn’t be a hard conversation. I know pediatricians are working harder than ever, but this is just a natural fit into what they’re already saying. All health care professionals are talking to patients about screen time, near work, and their time outdoors. This is a natural way to talk about the importance of regular eye exams.
Dr. Jong: That’s an incredibly important point. We have to think holistically when it comes to myopia management because myopia is a multifactorial condition, and it’s about recommending the most appropriate management combined with lifestyle recommendations and regular follow up. Each and every child with myopia deserves to access the latest evidence-based management because every diopter matters.10
References
- Johnson & Johnson Vison. (2022). Pediatrician Survey, July 13, 2022.
- Walsh HL, Parrish A, Hucko L, Sridhar J, Cavuoto KM. Access to Pediatric Ophthalmological Care by Geographic Distribution and US Population Demographic Characteristics in 2022. JAMA Ophthalmol. 2023 Mar 1;141(3):242-249. doi:10.1001/jamaophthalmol.2022.6010.
- WHO. (2016). WHO Report: The Impact of Myopia and High Myopia. https://www.iapb.org/learn/resources/the-impact-of-myopia-and-high-myopia/
- Brennan NA, Toubouti YM, Cheng X, Bullimore MA. Efficacy in myopia control. Prog Retin Eye Res. 2021 Jul;83:100923. doi:10.1016/j.preteyeres.2020.100923.
- Gifford KL, Richdale K, Kang P, Aller TA, Lam CS, Liu YM, Michaud L, Mulder J, Orr JB, Rose KA, Saunders KJ, Seidel D, Tideman JWL, Sankaridurg P. IMI – Clinical Management Guidelines Report. Invest Ophthalmol Vis Sci. 2019 Feb 28;60(3):M184-M203. doi:10.1167/iovs.18-25977.
- Hou W, Norton TT, Hyman L, Gwiazda J; COMET Group. Axial Elongation in Myopic Children and its Association With Myopia Progression in the Correction of Myopia Evaluation Trial. Eye Contact Lens. 2018 Jul;44(4):248-259.
- Tricard D, Marillet S, Ingrand P, Bullimore MA, Bourne RRA, Leveziel N. Progression of myopia in children and teenagers: a nationwide longitudinal study. Br J Ophthalmol. 2022 Aug;106(8):1104-1109.
- Chua SY, Sabanayagam C, Cheung YB, et al. Age of onset of myopia predicts risk of high myopia in later childhood in myopic Singapore children. Ophthalmic Physiol Opt. 2016;36(4):388-394. doi:10.1111/opo.12305
- Mutti DO, Sinnott LT, Brennan NA, Cheng X, Zadnik K; Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study Group. The Limited Value of Prior Change in Predicting Future Progression of Juvenile-onset Myopia. Optom Vis Sci. 2022 May 1;99(5):424-433. doi:10.1097/OPX.0000000000001883.
- Bullimore MA, Brennan NA. Myopia Control: Why Each Diopter Matters. Optom Vis Sci. 2019 Jun;96(6):463-465. doi:10.1097/OPX.0000000000001367.
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