Finding My Niche with Myopia Management

March 15, 2023

By Brianna Rhue, OD, FAAO, FSLS

We need better involvement from all health care professionals to reach as many myopic children as possible. Even if you’re not practicing myopia management, you have to be talking about screen time, outdoor time, and bedtime with your patients.

Dr. Rhue examines her son Dalton for his myopia evaluation.

After graduating from Nova Southeastern University College of Optometry in 2009, I bought into a private practice — West Broward Eye Care — in Tamarac, Florida. It was a highly medical practice, and I could do everything I had been trained to do, but I had struggled to find my niche. I had started with scleral lenses and was gaining momentum, and although scleral lenses were fulfilling and still are, I knew I was still missing a key area in my practice. 

I started thinking about myopia when I was pregnant with my first son in 2016. I’m a -5.50D myope, my husband is a -6.50D myope, and that got me thinking. I started a random Google search for what I could do to slow down or prevent the onset of myopia in my child once he arrived, and I realized very quickly that we were decades behind other parts of the world in offering myopia management to our patients. My colleague, Scott Pearl, was really into myopia management at that time and convinced me to attend that year’s Vision by Design conference. After attending that conference, the rest is history. I drank the myopia Kool-Aid and started integrating what I had learned with my staff and into my practice. When I came back from the conference we built a program with the help of my staff, got it started, and away we went. 

‘What Kind of Myope Are You?’
My practice offers every available myopia management treatment — low-dose atropine, orthokeratology, and soft multifocal and dual focus contact lenses. (All that is available in the U.S. at this time). We also educate children about near work, outdoor time, and now the importance of a consistent bed time. How we choose a treatment regimen depends heavily on the patient and their family. Despite what measurements I’m getting, I can tell early on what kind of child I’ve got in my examination chair, which also helps curate the treatment plan. If they’re squeamish and not letting me touch them, we talk about atropine. We discuss OrthoK or soft dual-focus lenses if a child is enthusiastic. We also have products in our armamentarium such as SynergEyes lenses for patients with high astigmatism that may not fit into other lens designs. 

Additionally, monitoring axial length has become essential to my myopia management practice. Even when treating adult myopes — 20, 30, 40, or 50-year-olds, I always ask myself the same question: What kind of myope is in my chair? Are you a -4.00D 24 mm myope? Are you a -4.00D 27 mm myope who needs to be examined more frequently? Axial length has allowed me to look at myopia from the front to the back of the eye. It’s a whole refractive and anatomical process, and I think many of us are stuck at the front with refraction. By taking K readings/topography and axial length measurements, we are able to get the complete picture and tailor our evaluation schedules as deemed necessary, as well as our treatment protocols, based on these numbers together. You can still start a myopia practice without measuring axial length by looking at topography readings and their refraction and working backwards, but by measuring axial length, you are investing in your patients and your practice. 

Getting Both Parents Involved in Myopia Management
Before I walk into the exam room, I know if I’m seeing a potential myopia management patient. We’ve created a pamphlet to give to parents that outlines what myopia is, all the different treatment plans, and the benefits of starting this treatment. I have the parent start to review this pamphlet while I’m doing the exam and gathering the data. Most parents think they’re coming in to see me and will walk out with a $150 pair of glasses for their child. Most parents aren’t expecting to talk about thousands of dollars of treatment. So, before we even get into the conversation, I’m prefacing it with the pamphlet. I also don’t have the time in my schedule to devote whole appointments to myopia consultations, so I’ve had to master the myopia management elevator pitch. I’ve practiced getting my speech down to two or three minutes, which has been beneficial in keeping me on schedule and my staff from yelling at me that they missed lunch.

In this image of an MRI of the orbits, one can observe the difference in the axial length between both eyes, a scleral buckle in the right eye, and kinked optic nerves as seen in highly myopic eyes. Image courtesy of Joshua Pasol, MD.

My father was an amazing furniture salesman — he made and sold furniture. What I learned from him that has filtered over into my practice is that both parties (parents) must be present to decide and move forward. The same thing applies to myopia management. We need both parents present to seal the deal and have the family proceed with treatment for their child. Every year you wait to start treatment, we know it adds up on the back end. The first year of treatment is critical, and the sooner you start treatment, the better the child’s outcomes will likely be. So, my father would always say that if one person came in, they would likely go home and talk to their significant other before deciding, and he had a hard time closing the deal. When both people are there, it’s much more likely you’ll close the deal. I’ve used his guidance when talking with parents in the exam room. It’s helped me enroll more kids in myopia treatment, which is the right thing to do for the patient, we get both parents on board quicker, which also sets the patient up for long-term success. 

If only one parent is in the office with their child, I will have them FaceTime the other parent or get them on the phone to discuss options. We do this before I start my “pitch” or explain the treatment options. I ensure that both parents hear everything I say and can ask me questions together. Then, we figure out what the next step is going to be. We either decide on a treatment plan, or if they say no, I’m not discouraged by it — no usually means not right now, and we make a point to follow up with those patients in three months so they understand the importance of myopia management. As a mom, there’s no guilt from me when parents say no to my recommendations. Our goal is to set the child up for success, but sometimes, finances can make starting treatment difficult. While we offer our patients different payment plans, we try to be understanding of all our patients’ situations.

Making an Impact on the Future
Eye care professionals have missed generations of this axial length disease. As a practitioner and mother, I think of my kids and future generations — both children and optometrists. While my son is 6 years old now, in 30 years, I most likely will not be the one taking care of him. And in 60 years, I definitely will not be the one taking care of him. So, we need to work as a team with the generation of optometrists behind us (and retinal specialists and pediatric ophthalmologists) to impact childhood myopia. We don’t want to give myopic patients devastating news about retinal detachments or myopic maculopathy later in life. It can be challenging for practitioners to understand the long-term value we are giving our patients today who are 6, 7, 8, 9, or 10 years old. But we get to touch many families’ lives and become part of those families. 

Dr. Rhue’s whole staff is involved with myopia management.

I also hope that we’re able to find children sooner for treatment. We need better involvement from all health care professionals to reach as many myopic children as possible. Even if you’re not practicing myopia management, you have to be talking about screen time, outdoor time, and bedtime with your patients. Parents are coming in and asking about myopia management more than ever before, so if you’re providing this service, you have to be able to answer their questions and refer them to a practitioner who is doing myopia management. Let’s get proactive about myopia care, which is what our patients want! 


Brianna Rhue, OD, FAAO, FSLS, earned her undergraduate degree from the University of Arizona before earning her Doctorate of Optometry at Nova Southeastern University. She completed her residency at the Bascom Palmer Eye Institute in Miami and is a partner at West Broward Eyecare in South Florida. Dr. Rhue is passionate about health care technology, myopia management, specialty contact lens fits, and practice management. She enjoys sharing her love for technology and myopia management through speaking engagements to help optometrists understand business, technology, and new areas of care to help all parties involved. Dr. Rhue is the co-founder of Dr. Contact Lens and TechifEYE. Outside the office, she enjoys spending time with her husband and two sons, playing tennis, standing on her head in yoga, and traveling. 
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