June 2, 2019
By Jennifer Qayum, OD
Pediatric Optometrist, Children’s Mercy Hospital
Review of Optometric Business, May 2019
Myopia is a growing epidemic, with about 30 percent of the world currently myopic, according to numbers cited by the Brien Holden Vision Institute. By 2050, based on current trends, almost 50 percent of the world’s population will be myopic.
With so many people myopic, it’s only natural that parents would be open to finding a way to stem the growth of myopia in their child’s eyes. Here’s how my pediatrics-only practice, which is part of Children’s Mercy Hospital of Kansas City, Mo., has grown our myopia management services.
In addition to enhancing quality of life, controlling myopia can improve eye health, as those with high myopia are at increased risk for conditions such as retinal detachments, glaucoma and cataracts.
Myopia management is a growing segment of our practice. I have four slots a month designated for new myopia management patients, and we are currently booked out for approximately six months.
Step One: Educate Yourself
Most major optometric conferences have at least one lecture on myopia progression, and myopia treatment as a topic has become a popular one over the past few years. I recommend doing your own research and reading recently published studies as well.
As with any medical treatment, a peer-reviewed, prospective, large study is ideal. Especially with a treatment like myopia progression, which is so variable and dependent on the individual patient, the larger the study, the better idea we have of when the treatment is most likely to be effective.
One of my favorite overview articles is: Huang J, et al. “Efficacy Comparison of 16 Interventions for Myopia Control in Children: A Network Meta-analysis.” Ophthalmology. 2016 Apr;123(4):697-708.
Myopia Management is Something Parents Want to Learn About
You may advertise on your practice web site and on social media that you offer myopia management treatments, but many parents still will not ask you about it. They may forget or may assume their child’s level of myopia is not significant enough for treatment. It is up to you as the doctor to educate all parents with children whose myopia could benefit from treatment, including the eye health risks that myopia poses.
Myopia management falls into the wheelhouse of optometry, and is something that optometrists can easily implement in their practices. As observed at many conferences, the research on myopia progression is continuing to expand, providing us with more information on how to properly handle these patients. In addition, parents are reading about myopia progression on social media and in the news, so they sometimes have questions about whether it would be right for their child.
Having a quick 1-2 minute “script” about myopia management for patients and their parents can easily help grow this part of your practice. This short discussion can help parents understand why myopia treatment is an option for their child and if they would like to pursue further discussion.
Let Patients Know What to Expect Financially
Patient insurance does not typically cover myopia clinic visits or treatment, and this is information that should be shared with families before beginning treatment. Many practices use a global fee to cover myopia clinic visits.
Multifocal and orthokeratology lenses are not deemed medically necessary by insurance companies. In addition, compounded atropine 0.01 percent is not approved by the FDA for myopia control and is not covered by insurance.
Manage Patient & Parent Expectations
Treatment efficacy is not guaranteed, so I am thorough in discussing treatment options with parents. My conversation in the exam room always begins with myopia etiology and normal progression patterns (approximately 0.50DS of progression/year).
I then explain to parents that an effective treatment may slow down progression by approximately 50 percent, or 0.25DS per year. This often surprises parents because they do not realize that we still expect some progression even with myopia treatment.
I also always remind parents that we cannot reverse the myopia their child already has. After discussing these facts with parents, I then discuss treatment options including atropine, multifocal contact lenses and orthokeratology contact lenses. I keep the conversation and education as unbiased and evidence-based as possible, presenting facts and statistics from studies. By doing so, the parents can make an informed decision about treatment options.
Create a Myopia Management Exam Protocol
My practice has a myopia clinic in which all patients receive an axial length measurement (we use a Lenstar) and cycloplegic retinoscopy. I prefer retinoscopy over auto-refractor because I find my measurements to be more accurate as I control the patient’s fixation. Most credible myopia progression studies measure success of treatment by cycloplegic retinoscopy, axial length, or both, so I model my clinic off these same standards.
Set Aside Necessary Doctor Chair Time
Our myopia clinic is one half-day per month. Each patient is allotted 45 minutes. The appointment begins with an approximately 15-minute work-up by a technician which includes VAs, pupils, stereoacuity, worth 4 dot, IOP check, gathering HPI/chief complaint and dilating the patient with cyclopentalate 1 percent and tropicamide 1 percent.
While the patient is dilating, I typically spend approximately 30 minutes discussing myopia etiology and treatment options with the patient and family. By then, the patient should be fully cyclopleged, so I perform retinoscopy and an ocular health exam. After I have gathered that data, the patient typically has their axial length measurement done. I then work with parents on creating treatment plans.
Network with Other Health-Care Practices to Generate Referrals
The majority of my myopia management patients come to me as consults from other practitioners, so letting other doctors in your practice and within your community know that you are interested in seeing patients for myopia control is the easiest marketing strategy.