October 15, 2024
By Alyssa Pack, OD
Dr. Pack’s experience with myopia management began with her own history as a myope. Photo Credit: Dr. Pack
In a family of several optometrists and a myope myself, my experience with myopia management is incredibly personal. I graduated from Southern California College of Optometry (SCCO) in 2020 and began practicing during that unconventional year of COVID. My first job was in my parents’ office, Pack and Bianes Vision Care Eastlake, where I still work four days a week.
Then, in 2022, my husband Dr. Justin Nguyen and I opened our own office, EyeCare at the Cove in La Jolla, California, where I work one day a week. I also work at Total Vision Lemon Grove one day a week. Working at all three practices in very different demographic areas has been instrumental in helping me find the best approaches for promoting myopia management.
A Personal Connection
I’m such an advocate for myopia management because I’m a success story myself. I was fortunate that my father Dr. John Pack was an early adopter of Paragon CRT orthokeratology lenses and fit me at age 10. Twenty years later, I still wear Paragon CRT lenses and love them. When I started treatment, my prescription was -1.00D, and today, it’s remained steady at about -1.00D.
Even though I was exposed to myopia management on a personal level from a young age, I didn’t really dive deep until I was in optometry school. We had fantastic professors who were early adopters of the treatments, and many of them were even involved in early research. Dr. Dashaini Retnasothie and Dr. Mark Bullimore provided excellent resources such as flowcharts and FAQ sheets, making it easy to incorporate myopia management into my practice.
Once I began practicing, continuing to fit OrthoK was a no-brainer. Since our office already had a myopia management program in place, it was easy to incorporate low-dose atropine and soft multifocal contact lenses once we figured out pricing and found a compounding pharmacy.
Education Starts in the Exam Room
Ensuring patients and their parents are properly educated on myopia management is critical to successful treatment outcomes and getting parents on board with implementing a treatment plan. Years ago, my parents created an OrthoK treatment program that included a package price covering the fit, the lenses themselves, and all follow-up visits. As other myopia management options gained popularity, we consulted Facebook groups and local doctors to develop our pricing strategies.
When it comes to talking with patients and parents in the exam room, making things personal can be helpful. I explain that when they were growing up, there were no treatments to slow the progression of nearsightedness. Now, we have ways to help. I emphasize that starting the program can reduce their child’s risk for future eye disease, make them a candidate for LASIK, and reduce the need for thicker glasses.
Dr. Pack’s family of optometrists has been practicing myopia management for years. Photo Credit: Dr. Pack
Nearsighted parents can usually empathize, but for those who aren’t, I use a trial frame to show them what different prescriptions look like. I provide parents with research articles, brochures outlining treatment options, and a FAQ sheet that addresses key concerns. The Brien Holden Vision Institute (BHVI) also has excellent resources that ECPs can share with parents. Typically, only one parent is present at the exam, so having enough information to bring home to share with their spouse is very important. Examples are also beneficial. My mom Dr. Beverly Bianes enjoys telling her patients about other myopia management success stories, including my own.
Navigating Different Treatments
Getting patients started on a myopia management treatment plan is typically determined by the patient’s individual needs. I usually prefer to start with contact lens treatment since it addresses both vision correction and myopia management. Although low-dose atropine has been shown to be safe, I prefer not to have a child on long-term medication unless necessary. Several factors influence the choice of treatment, such as financial constraints, a child’s comfort with contacts, corneal shape, or other specific needs such as rapid growth or swimming. It’s essential to listen to the patient and their family and, if needed, schedule a follow-up consultation.
Dr. Pack and her husband Dr. Justin Nguyen opened their practice in 2022. Photo Credit: Dr. Pack
Our office was an early adopter of OrthoK lenses, and we’ve had great success with them over the years. Word of mouth also helped spread popularity. However, price was always a barrier for many families, so offering low-dose atropine provided a more affordable option for parents. It also worked well for younger children or those who didn’t want to wear contacts.
I typically reserve combination treatments as a last resort. If a child is on atropine, I prefer to increase the dosage first before adding another treatment. If there’s still progression, I recommend switching to a different therapy, such as soft contact lenses. For children already in OrthoK or soft contact lenses who are still experiencing rapid axial length growth, I then consider adding atropine as an adjunct treatment.
The Future is Bright
With the increasing prevalence of myopia around the world, I expect this field to continue growing. Additionally, with myopia control spectacles on the horizon in the U.S., we’re likely to be able to treat even more patients seeking treatment. Many eye care professionals are emphasizing the importance of myopia management treatment as the standard of care—not just an option.
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Dr. Alyssa Pack completed her undergraduate degree in Biological Sciences at the University of California, Irvine, and graduated Summa Cum Laude from the Southern California College of Optometry in 2020. In 2022, she and her husband, Justin Nguyen, opened their private practice, EyeCare at the Cove Optometry, in La Jolla, California. Dr. Pack is an active leader in her professional community, serving on the board of the San Diego County Optometric Association and as an Ambassador of the San Diego Optometry Divas. She also serves as an advisor on the board for Oculogx’s OphthalGPT. Recently, Dr. Pack was honored with the Distinguished Alumni Recent Graduate Achievement Award from Marshall B. Ketchum University. Dr. Pack is dedicated to protecting the gift of sight, whether helping patients see clearly with new glasses or contacts, introducing innovative treatments to relieve dry eye, or supporting children’s vision through myopia management. In her free time, she enjoys aerial yoga, hiking, and listening to podcasts, and she loves spending time with her husband and their dog, Mako. |
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.
