February 1, 2023
By Glenda Aleman Moheeputh, OD
One of the biggest takeaways from myopia management is that both optometry and ophthalmology play a critical role, making co-managing our patients important. Collaborative care is the way of the future for eye care and myopia management.
What is the best treatment option for myopia management? This is a question I often hear from ophthalmologists, optometrists, and parents. However, it is not a one-answer question. It requires a more complex and in-depth discussion that should not be taken lightly. Although soft multifocal contact lenses, orthokeratology, and low-dose atropine effectively slow myopia progression and axial length elongation, other factors should be considered when prescribing myopia management therapies. Co-management with an ophthalmologist is often the recommended course of action.
Creating Relationships with Fellow Eye Care Professionals
Dr. Marc Bosem, a cornea specialist in South Florida, does not see pediatric patients. However, he is a very optometry-friendly ophthalmologist. He makes it a point to talk to his highly myopic adult LASIK patients about the genetic component of myopia, and he recommends that parents seek help for their myopic children. I’ve worked closely with Dr. Bosem since I completed my residency in his office. He has always made it a point to educate his patients about myopia management and refers them to my office for a consultation.
“As a refraction surgeon, it is important to work with primary vision care optometrists who specialize in myopia management,” said Dr. Bosem. “We refer the children of our LASIK and ICL patients for myopia management on a routine basis. I encourage environmental, device, and medication therapy for myopia management. I also attend myopia management meetings in our community at least four times a year to stay connected with our primary vision care colleagues.”
That same commitment to myopia management extends throughout Dr. Bosem’s entire staff. Michelle Gonzalez, OD, is an optometrist in Dr. Bosem’s office, and she has been a great resource to our office over the years.
“Working in a refractive practice for many years, I have seen the steady increase of highly myopic LASIK consults,” said Dr. Gonzalez. “More than ever, I feel the urgency to educate our patients to have their children evaluated, so when needed, myopia management can be implemented as soon as possible. It has been exciting and rewarding to collaborate with Dr. Glenda and other optometrists to catch myopia early and help patients become safer and healthier candidates for refractive surgery later in life.”
Teen Patient Demonstrates Excellent Example of a Successful Collaboration
Recently, Dr. Bosem referred a 14-year-old Hispanic male patient to our clinic for a myopia management consultation, which showed an excellent example of a successful collaboration between ophthalmology and optometry. Dr. Bosem performed surgery on both of the child’s parents and then recommended the child come to our office for myopia management treatment. Both of his parents had a history of myopia greater than -5.00D — pre-surgery, the mother was -5.75D (OU), and the father was -6.00D OU.
The child’s entrance visual acuity (VA) was 20/CF@4FT, OD, and OS, subjective manifest refraction (MRX) was OD: -5.75-1.00X30 OS: -6.00-0.25X 150 axial length OD: 25.99 mm, and OS: 26.12mm. He was wearing single-vision soft daily disposable contact lenses (SCLs). The patient was on the school’s water polo team and enjoyed playing basketball in his spare time. Based on the patient’s prescription and extracurricular activities, he was prescribed OrthoK. The patient was given one box of MiSight 1 day contact lenses, -3.50 OU, to wear during the day, as needed.
Figures 1 and 2: The patient’s baseline topography
After one night of OrthoK treatment, the patient’s unaided VA was: OD: 20/100-1, OS: 20/150, OU: 20/70, Subjective RX: OD: -3.25-0.75X30, OS: -3.25-0.50X160. The patient reported eight hours of overnight wear and no issues with insertion and removal. After three weeks of treatment, the patient’s VA was the following: OD: 20/20-2, OS: 20/25, OU: 20/20, subjective RX: OD: -0.25, OS: -0.50-0.25X150. The patient reported having great distance and near vision and only used the SCLs during the day for the first week. The OrthoK treatment was successful.
Figures 3 and 4: One Week F/U
After six months of OrthoK treatment, the patient’s unaided VA was the following: OD: 20/20, OS: 20/20-1, MRX: D: Plano, OS: -0.25. Additionally, axial length OD: 26.08mm, and OS: 26.21, a change of 0.09mm in OD and OS. The patient reported maintaining great stable vision during waking hours and had no issues with the lenses. The patient and his parents were delighted with the treatment and were grateful to Dr. Bosem for referring them for myopia management.
Creating a Local Community of ODs and OMDs
Our community of eye care professionals in South Florida work together closely to ensure all our patients receive the proper care, especially concerning myopia management. We’re actively working to combine professional organizations of optometrists and ophthalmologists to promote inclusion and collaborative patient care.
When working with another eye care professional, trust is critical. I’ve worked with Dr. Bosem for several years, and we trust each other and have faith in each other’s knowledge and professional judgment. Co-managing patients with him has been easy. I work to stabilize the patient’s prescription, and as the patients grow into their early adult years, they become candidates for LASIK. Dr. Bosem and I can review the patients’ progress together, and as I start the OrthoK washout process, they start seeing Dr. Bosem to better understand what LASIK surgery will be like for them. We must work together because patients can’t just come in and say they want LASIK tomorrow — it’s a process. Co-managing this way lets us both know that the patient is stable and a good candidate for LASIK.
As an OD, I think having that personal connection is essential when working with ophthalmologists in your area. I would encourage ODs to introduce themselves to their local ophthalmologists — go to their offices, provide your CV, bring your business cards, and invite them to your office for educational meetings to talk about co-management for future patients. I always want to feel comfortable and confident when I refer my patients because I want to ensure that they will be taken care of when they leave my chair. Before establishing a solid referral program with an ophthalmologist, I make it a point to visit their office so that I can familiarize myself with the clinic, staff, and provider.
One of the biggest takeaways from myopia management is that both optometry and ophthalmology play a critical role, making co-managing our patients important. We know that myopia, especially high myopia, makes the risk of pathology much more likely. We must proactively work with retinal or glaucoma specialists to protect our myopic patient’s long-term eye health. Collaborative care is the way of the future for eye care and myopia management.
|Glenda Aleman-Moheeputh, OD, graduated from Nova Southeastern University with a Bachelor of Science degree in Vision Science, and she received her Doctor of Optometry degree from NSU’s College of Optometry. She served as the President of the American Academy of Myopia Control and Orthokeratology (AAOMC) South Florida Chapter from 2019-2020. She is also the lead ambassador for the Optometry Divas Miami Chapter and acts on the Chair Advisory committee of the Broward College Opticianry program.|