November 15, 2024
By Joseph Munsell, OD
Dr. Munsell starts his myopia management education as early as possible. Photo Credit: Dr. Munsell
I was first introduced to myopia management in optometry school at Pacific University, though it was primarily related to orthokeratology. However, in 2020, I experienced a consequence of my own high myopic prescription.
I have a -12.00D prescription in one eye and a -15.00D prescription in my other eye. When I was a kid, myopia management therapies weren’t available, so my vision continued to get worse every year until I was in my early 20s. Then, four years ago, I had a complication called vitreomacular traction that could have permanently affected my vision. Thankfully, my vision was spared, but it was at that moment that I pledged that I would help as many kids with myopia as possible so they would have a chance to be spared from adverse outcomes like me.
Leaning on Industry Support
The great thing about the optometric community is that there are so many practitioners who are more than willing to help and offer advice. One individual who gave me excellent advice was Nick Lillie, OD, of Family Vision Optical in Allendale, Mich. We’ve discussed everything from pricing options, consent forms, follow-up schedules, and all the logistical components of myopia management. From there, I also listened to podcasts and attended webinars before experimenting and implementing things in my practice. If things worked well, I did more of it, and the things that didn’t work as well, I was quick to change.
Annual meetings such as the American Academy of Optometry and the American Optometric Association (AOA) also provide valuable information on the science behind myopia management. This year, the AOA and CooperVision launched a program called The Myopia Collective, which held its inaugural workshop for selected Change Agents. The workshop and Collective provided practitioners with a wealth of knowledge. Of course, I also always stay up to date on current articles through Review of Myopia Management.
Treating Patients on a Case-by-Case Basis
I make it a point to offer my patients all the myopia management treatments we can. I wanted to provide a full range of options so that we could optimize care for each child.
We offer patients low-dose atropine, which we order through a compounding pharmacy called OSRX. One of the benefits of this particular company is that they automatically send the patient a refill at the beginning of each month. We also have orthokeratology, of which my preferred manufacturer is Euclid due to the ease of fitting and their fantastic support team. For soft multifocal lenses, we offer both CooperVision’s MiSight 1 day and VTI’s NaturalVue Multifocal 1 day contact lenses. For diagnostics, we use the Nidek optical biometer to measure and track axial length to determine risk and treatment effectiveness.
We prefer to handle treatment plans on a case-by-case basis. We work with the patients and their parents to outline our treatment goals and discuss which method will best allow us to meet them. If, at some point during treatment, it is decided that another method would be more effective, we won’t hesitate to change. We have noticed, however, that our younger kids tend to choose low-dose atropine, while our older kids tend to prefer soft multifocal lenses.
Typically, I’ll give a patient between six months to one year to determine if the current therapy is ineffective or if compliance is an issue. Once compliance has been addressed and we’ve decided that the treatment truly is ineffective, we will consider combination therapy, such as adding a soft multifocal lens to low-dose atropine treatment or vice versa.
Educating Parents without Overwhelming Them
We have multiple points of patient contact where we discuss myopia management. After the patient’s initial autorefraction, if the tech sees a myopic prescription or the lensometer reads a myopic correction, they will ask the parent if they have heard of it. From there, they will provide a very brief surface-level description.
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Dr. Munsell’s practice offers full scope myopia care for patients. Photo Credit: Dr. Munsell
Then, once the patient reaches me in the exam lane, I start to plant the seed after refracting the patient. At the end of the exam, I go through everything more thoroughly. We have a complete packet that is branded to our clinics that we give to the patient’s parents. It includes a personal letter from myself, descriptions of what myopia is, why it is increasing, and the risk factors associated with it. It also includes brief explanations of each treatment method, as well as links to some pertinent studies. We also include informed consent papers and our payment policy contracts.
The parents initially find this information overwhelming, so I tell them to take it home and read through it with their spouse. If they have any questions, I encourage them to call me or schedule a full myopia consultation. During the official consultation, we measure axial lengths, discuss everything in more depth, and ultimately choose a treatment method that best aligns with everyone’s goals.
Despite our best efforts, public and patient awareness of myopia still need to be improved. Most parents think of it as a normal issue that is easily corrected by glasses. It can take multiple visits over multiple years, during which you reiterate the dangers of progressive myopia to try to change its perception to one of a disease state.
Spreading Myopia Awareness
Current and potential patients need to know that myopia is an issue before they will ever be open to correcting it. The more modes through which we spread this message, the better chance we have at treating more myopic patients. The lecture circuit has taught me the importance of good communication. It’s about more than just educating the patient; it is about communicating and connecting with them and solving the problem as a real team.
I believe the future of myopia management is strong. With new randomized controlled studies being published regularly and with our increase in knowledge about myopia as a disease, this is no longer a specialty to practice but a new standard of care.
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Joseph (Joe) Munsell, OD, is a partner at Cheyenne Vision Clinic and Laramie Vision Clinic. It is a 10-doctor, two-location clinic that practices full scope optometry. Dr. Munsell received his Doctorate of Optometry from Pacific University College of Optometry where he graduated Summa Cum Laude. He is certified as a Diplomate of the American Board of Optometry and is a Fellow of the American Academy of Optometric Medicine and Surgery. Dr. Munsell is a member of the Wyoming Optometric Association, American Optometric Association, the Optometric Society of Optometric Surgeons, and the Contact Lens and Cornea Section of the AOA. He is an adjunct clinical instructor for fourth year externs. His areas of interest are in ocular disease, myopia management, and optometric surgery. In optometry school, he was inducted into the Beta Sigma Kappa honor society and was named student of the year by the Greater Western Council of Optometry in 2016. Dr. Munsell was also awarded the Wyoming Optometric Association’s Young Optometrist of the Year in 2022. He graduated from the AOA’s Leadership Academy in 2023 and is a Change Agent for the Myopia Collective. Dr. Munsell lectures on advanced procedures and ocular disease at industry conferences. |
Some products covered in Review of Myopia Management are prescribed off-label in the United States because they are not FDA-approved for slowing the progression of myopia in children.
MiSight 1 Day soft contact lenses are FDA-approved for the correction of myopic ametropia and for slowing the progression of myopia in children with non-diseased eyes who, at the initiation of treatment, are 8-12 years of age and have a refraction of -0.75 to -4.00 diopters (spherical equivalent) with less than or equal to 0.75 diopters of astigmatism.
