October 15, 2025
By Michael Dittman, OD
Photo Credit: Dreamstime Photos
Two of the hottest topics in eye care right now are myopia management and dry eye treatments. However, despite being extremely prevalent in optometry, many providers are not optimally treating these conditions.
The Ham Story
Unfortunately, many practitioners are still offering myopic patients single vision glasses or contacts, and dry eye patients get over-the-counter artificial tears. The general recommendation for these patients is to maintain their annual eye appointments. Or, they are dreadfully advised to return to the office “as needed.” These treatment plans remind me of the infamous “Ham Story.”
The “Ham Story” is the tale of a young girl watching her mother bake a ham for a family gathering. She noticed her mother cutting off the ends of the ham before placing it in the oven. The young girl asked her mother why she cut off the ends of the ham, and her mother replied that she learned the technique from the girl’s grandmother, but she wasn’t clear about the reason. Curious, the mother called the girl’s grandmother to inquire about the ham.
To everyone’s dismay, the grandmother had no idea why she, too, cut off the ends. The trio decided they had to contact the girl’s great-grandmother to understand this most peculiar family tradition. When the great-grandmother answered her phone, they posed the bewitching question: “Why do you cut the ends off the ham before placing it in the oven?” The great-grandmother chuckled and said, “I just never had a pan big enough to hold a whole ham, so I always had to cut off the ends to make it fit!”
Adopting Current Treatment Options
The moral of this story is that people, including eye care providers, often stick to outdated practices without questioning them. Optometrists must advance their management of these diseases to obtain better outcomes for their patients.
If you’re new to one or both conditions, it is understandable to have questions about where or how to start. Fear not: This article will address these important questions and explore the connections between recognizing and treating myopia and dry eye.
Start at Patient Check-in
Patient check-in is the first opportunity to probe into these conditions. It’s key for your staff members to know which patients are potential candidates for myopia management or dry eye. Associate providers and practice staff should know that every patient under 18 is a possible myopia patient. Similarly, if the patient is 18 or older, the potential for ocular surface disease, or dry eye, is assumed until proven otherwise.
But, providers must also be cognizant that children under 18 may be suffering from dry eye disease as well. Researchers conducted a literature search from 2000 to 2002 using PubMed, identifying 54 eligible studies from 2,633 articles.1 The results were eye opening in that the prevalence of DED in children ranged from 5.5% to a whopping 23.1%!
Once that’s been established, think about your office. Use your waiting area to your advantage! Place brochures and signage that discuss myopia and dry eye treatments where every patient will see it. Create questionnaires that highlight the patient’s potential risk for having or developing these conditions.
For myopia candidates, it’s important to ask about the refractive history of family members (such as parents or siblings). For children, be sure to ask questions about their lifestyles, including the amount of time spent on devices and outdoors. Luckily, fantastic dry eye assessment tools already exist, including the speed test or OSDI. Practice staff can provide the questionnaires at check-in, and patients can complete them while awaiting their appointment.
Pre-testing
Your technician can continue patient questioning during pre-testing. This is a good time to ask patients about sports or swimming during the summer, as these factors can help you decide whether orthokeratology could be a successful myopia treatment versus soft multifocal contact lenses. New patients wearing glasses should be asked questions about prescription changes over the last few years.
On the other hand, potential dry eye patients should be asked questions about their experience with intermittent blurriness, crusting of the eyes in the morning, watery eyes, or feeling tired at the end of the day. Ensure the technician is hyper-aware of any positive answers, and encourage them to discuss potential causes with the patient. They can also provide respective disease brochures for more disease and treatment details.
Information is Power
In addition to your traditional pre-testing exams, incorporating axial length readings for patients under 18 is beneficial to both myopic and non-myopic patients. The results can be used to form a chart to determine eye growth rate, and it can also be used to assess the efficacy of any myopia treatment you choose. Our office currently uses (and loves) Ocumetra, which helps us educate parents of our younger patients with ease.
Also, consider doing meibography for all patients—especially those over 18. Meibography is a fantastic educational tool that underscores the importance of dry eye treatment. A popular tool is the Oculus Keratograph 5M, which measures meibography and performs tear analysis and tear break-up time analysis. For those offices that are looking to maximize space or need to purchase both pieces of equipment, the Topcon MYAH is an extremely robust tool that can perform both axial length measurements and also meibography.
Patient Education and Treatment Initiation
Once check-in and pre-testing has been completed, it’s time for patient education. It is imperative to educate your patient about progressive myopia and dry eye, as well as the dangers associated with these conditions when they’re left untreated.
It’s also a good idea to share information that patients can review at home. Be sure to include additional education on all aspects of the specific disease program, including treatments available, cost and details about the treatment process. One option is an educational video personally made by the optometrist. These can be made accessible via QR code that links to the practice website with the embedded video.
It is enticing to squeeze all these exciting habits into your primary care exam, but it is challenging to include everything seamlessly within the existing exam flow. Personally, I have found a higher success rate when the patient returns for a scheduled consult, having already been well-informed about the process.
Finding Success
Suppose an optometry office and/or practitioner follows these steps and implements these protocols within their primary care practice. In that case, they will be amazed at how many patients are candidates for these services, allowing the practice to treat myopia management and dry eye at the highest level.
It is also interesting on how elevating the standard of care within our offices for one specialty can increase the amount of referrals for both. There have been numerous times in our office where we initiate detailed dry eye treatment plans for a parent who has been suffering for years, who has been told by other eye care providers to just try artificial tears. Once we are able to show them that dry eyes are actually a disease, and we have options to elevate care, they often bring their children in for myopia management. In these instances, parents quickly realize the parallels between dry eye and myopia. In the same way artificial tears aren’t a solution for their dryness, stronger glasses aren’t a solution for their child’s myopia.
Ultimately, as providers enhance the care they offer to their patient population, this will also allow their practice to become more profitable. It is truly a win-win situation!
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Michael Dittman, OD, is the founder of Dittman Eyecare and The Myopia Matters Club. He started Dittman Eyecare in 2003 with one doctor and two staff members, and grew the practice to having four doctors, 25 team members, and three locations north of Pittsburgh. Dr. Dittman also founded The Myopia Matters Club, which is a separate branch of the office solely focused on myopia management services for children who are myopic or high risk to become myopic
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References
1 Stapleton, F. et al. Dry eye disease in the young: A narrative review. The Ocular Surface, vol. 31, January 2024, pgs 11-20.
