How to Get Mom to Say “Yes”

By Gary Gerber, OD
Co-Founder, Treehouse Eyes

“Mom, you’re right. Your son does need braces to straighten his teeth,” said the orthodontist.

“I guess I always knew this day would come. His older sister needed them, and it seems like all the kids in his class have them. I just didn’t think he’d need them so soon,” mom replied.

“We’re finding the sooner we intervene, the better the results we get. Someone from my staff will discuss the next steps with you. Things like scheduling, payments, etc. Sit tight. They’ll be right in,” said the doctor as he walked out the door.

Ten minutes later, the mom commits to a $5,500 two-year treatment plan and is concerned how the family budget, already seemingly at the breaking point from other commitments, will handle an expense she expected wouldn’t happen for another three years.

I’m not here to write about orthodontic practice management. Instead, the above is a striking example filled with the EXACT reasons why optometry struggles to answer the omnipresent question, “Why haven’t I heard about this before?” In our case, “this” refers to myopia management.

You would think with more than 25 percent of kids in the U.S. already being myopic, with that number increasing daily, and close to 100 percent of parents believing (right or wrong) that their kids’ excess digital device use absolutely causes myopia, and with more than 40,000 ODs schooled in the eye-health consequences of myopia, that parents would come in begging for us to treat their kids! Rather, anyone who has ever attempted to treat a myopic child knows it’s just a matter of time until you hear the question, “Why haven’t I heard about this before?”

The core difference between orthodontics and myopia management is that braces for teens are a fait accompli. The reason that is true is because braces have been around longer and become the expectation or norm for young teens. But why have braces become the norm and myopia management hasn’t? Dentistry long ago accepted orthodontics as the essential requisite method to straighten kids’ teeth. When the orthodontist says, “You’re right. Your son needs braces” there is no educating parents as to why. With 30 percent of kids in the U.S. in braces and less than 1 percent in myopia management treatment, it’s easy to see why moms have heard of the former and not the latter. Our industry has queued up only one expectation for the parents of our myopic kids. Their kids will eventually wear eyeglasses.

Next, the fees for braces are expected by parents. With so many kids already in braces, there’s a reasonable expectation of what the fees will be. And the doctor and his staff are non-apologetic and matter of fact when presenting the fees. “Your kids need braces” is very different than, “You should take your time thinking about getting him braces because they are quite expensive.” In our case, the fees charged for myopia management services are customarily markedly higher than a pair of eyeglasses. Parents have an expectation of what glasses cost and use that as the reference point for myopia treatment fees.

What the above reasons have in common is an education gap. Parents don’t’ know what “myopia” is (and calling it nearsightedness makes things worse), let alone that it should be treated and is indeed treatable.

Close the education gap the same way you sell glasses to presbyopes – immerse the practice in all things myopia
Why is telling a presbyope you have an available eyeglass solution so easy to discuss and so easy for the presbyope to understand? When presbyopes enter your practice, it is immediately apparent you offer optical solutions. OD offices bombard patients with a loud and clear message, “We sell eyeglasses here to fix vision problems.” Therefore, when an eyeglass solution is required, doctors are comfortable discussing it, and it makes sense to patients that glasses are a viable solution to their reading problems.

In building Treehouse Eyes, we saw many doctors struggling to incorporate myopia management into their practices with the same level depth and confidence as presbyopia eyeglasses. There was no “immersion into myopia” for parents of myopic kids. This led to parents hearing about myopia treatment for the very first time – ever – in the examination room. After building several centers exclusively dedicated to myopia treatment for kids, I can assure you that a counter card sitting behind three others in your waiting room or a poster that has become hallway white noise is not enough to raise the level of awareness that your practice is THE place for expert myopia care! To get to that point you need to elevate awareness to the same degree your presbyopes see! Here are six steps to do that:

  1. Reposition your thinking on myopia as the critical disease state that it is. Myopia isn’t normal. Yes, a -1.00 57-year-old patient has some functional advantages but remember – we’re not supposed to be myopic!
  2. Low amounts of myopia matter. A -0.75 eight-year-old is already on the wrong side of the refractive number line and should be treated. The odds are very high that left untreated low myopia will get worse.
  3. Make sure your myopia clinical skills are highly tuned and up-to-date. Dabbling and offering less than a complete toolbox of solutions is a sure way to fail. Do you only have one brand of PALs available for presbyopes?
  4. Get the right equipment and technology to do this for real. That means at a minimum, an optical biometer to measure axial length and a stand-alone topographer. These are non-negotiable “must haves.”
  5. Make sure your staff is highly educated and supportive of your efforts and can confidently, accurately and succinctly answer parent questions like, “Why won’t my insurance pay for this? Why so expensive? Why not just get glasses?”
  6. Prominently feature myopia management on your website and social media channels. Be VERY careful to not run afoul of FTC and FDA guidelines when you do this. Get professional help if you’re unsure.

If you’re not willing to commit to the all of the above, just like you understand the need for expertly done vision therapy, refer myopic kids to a colleague who will work together with you for the betterment of your patients.

Understand the source of the education gap, don’t dabble in myopia care and address the gap as I’ve outlined above and you’ll start to hear, “Yes, I’ve heard about that, and it sounds like the right treatment for my son.”

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  1. How do you deal with pediatric ophthalmologists who are skeptical of this? The 3 I usually deal with are true believers in Atropine .01%, and I’m reasonably sure they are also on board w/ ortho K and MF CLs, but another one in the region, who met and talked to the mother (who is a -6.00D myope, as are her parents and siblings) of one of my patients -who I was ready to start on Atropine .01%- at a wedding rehearsal dinner, and told her that Atropine .01% Tx takes 2 years, that myopia isn’t really that big of a deal, that she can just wear glasses, etc. Prior to that encounter, mom did everything I recommended and totally trusted my judgement. After this encounter, that faith in me was totally shattered, and I was afraid they wouldn’t come back to me anymore. They have, but they’ve told me in no uncertain terms that they don’t want to hear any more nonsense about myopia prevention. The exasperating irony of this is , the ped OMD that basically threw me under the bus is young, and trained under one of the 3 ped OMDs I already work with who IS a huge believer in myopia prevention, and actually helped me get access to the Mayo Clinic (Rochester, MN) compounding lab so I could prescribe/provide Atropine .01% for my ped patients. My mentioning that fact to the family didn’t make any difference, and led to them telling me they didn’t want to discuss it any further (they “believe” her, not me!). I’m done pursuing this with them, their minds are made up-they are convinced this is just unjustified hype about something unimportant and not ready for prime time. How can this be fixed or prevented going forward? This didn’t come from some old, “old school” doc, this was someone recently trained.

  2. Jim,
    We feel your pain and it is indeed a constant battle. Here’s what’s worked for us.
    1. Presenting OMD peer reviewed literature. One of my personal favorites is this one: There’s a great quote in there that says, “It is essential for ophthalmologists to work with optometrists, who are frontline providers, to determine a collaborative framework and referral patterns to prevent myopic progression, educate patients on the risks of myopia, and proactively address associated pathology to serve the best interest of our patients.”

    2. Politely, professionally and courteously let the OMD in question know that you’re on your myopia game so much so that even if they’re “non-believers” you’d at least like to alert him/her that .01% is essentially “yesterday’s news” and most of the myopia experts no longer Rx it as front line therapy (point them to the LAMP study).

    3. Let the OMD in question know that his other OMD colleagues are supportive.

    4. Depending on how long you’ve been doing this, and assuming you have a big enough sample size with great clinical data, share it with the OMD. We’re showing about an 80% reduction in progression at Treehouse Eyes and the docs we’ve shared that with, including OMD’s, have been rightfully impressed.

    Finally, don’t let this doc dissuade you from continuing to do what YOU know is the right thing to do! There will always be those who might frustrate us in our efforts to do what we believe is best for our patients but keep fighting the good fight!

    Your ally in the battle on myopia,

    Gary Gerber OD
    Treehouse Eyes Chief Myopia Eradication Officer and Co-founder

  3. Perhaps the mom would listen to parents of children you have already treated. Do you have a network set up to allow this? I started a 7 year old who was already a -9.50 on both Atropine and multifocal contact lenses. When I asked why they hadn’t come to me sooner they said ophthalmologists they had been to said it didn’t work, but other parents told them it does work. She hasn’t changed in 4 years. Previously she was changing every couple of months. You really cannot change who someone chooses to put their faith in, so don’t take it personally, but you can educate them. What they choose for their child may not match what you would do for yours. There is hope for MD’s to come around; one of my myopia control children came in because their pediatrician’s child is doing it!


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