August 29, 2019
By Brian K. Berliner, OD
The prevalence of myopia and high myopia is increasing in the U.S. and globally at an alarming rate, with significant increases in the risks for vision impairment from pathologic conditions associated with high myopia, including retinal detachment, myopic macular degeneration, cataract, and glaucoma.
Myopia is now the most common ocular abnormality in the world, yet many patients, parents, and other key stakeholders do not understand the significance of myopia and particularly high myopia to potential ocular health issues later in life. Myopia is often considered benign because it is easily corrected with glasses, contact lenses, or refractive surgery.
I recognized these alarming trends almost a decade ago and began taking steps to incorporate myopia management into my two sub-leased primary care practices located inside LensCrafters. Today, myopia management has become an essential part of my practices and generates substantial revenue. Here’s how I did it.
First, I educated myself about pediatric progressive myopia, the off-label treatment options available in the U.S., and how to create a treatment framework. I quickly learned from peer-reviewed research papers and optometric conferences about the world and U.S. myopia prevalence trends. I also learned that I needed to design a protocol and treatment plan based on the individual child’s needs and lifestyles. Since I already had a large adult population wearing orthokeratology (OrthoK) lenses, I initially heavily relied on orthokeratology to reduce the progression of myopia in children. Many children (and parents) like the thought of being spectacle-free during the day, especially if the child is involved with sports. From a practice management standpoint, I like the fact that OrthoK lenses are not available on the internet and a significant portion of our annual OrthoK myopia management fee is for professional services, not materials.
It hasn’t always been comfortable in my independent sub-leased corporate practice to have posters and brochures promoting OrthoK technology to eliminate the necessity for glasses, i.e., “no glasses, no daytime contacts, no kidding.” However, that did not ever stop us or inhibit our passion for myopia management. Our staff had to become proficient in introducing and educating the patient on the needs and benefits.
Although OrthoK is my go-to treatment modality for childhood myopia, today we prescribe all available evidence-based medical devices and pharma products to slow the progression of myopia: multifocal soft lenses, low-dose atropine, multifocal spectacles, and OrthoK.
Second, I had to ensure that my associate doctors were educated about myopia management. I discussed how to implement myopia management with them at every 1-1 and staff meeting. I sent them to many continuing education meetings to ensure they learned the treatment options and evidence-based facts.
Third, I have invested in key staff, bringing them to continuing education conferences and meetings so that they felt connected and educated about myopia care. As a result, they are comfortable proactively bring up the topic myopia management with parents of myopic children even when the parent says, “Why haven’t I ever heard of this?” Every successful myopia management practice will echo that it’s the staff that spends the most time with a patient and brings this modality to life.
I have always been a believer in investing in doctor and staff education. We jump-started our practice by attending a dynamic myopia management seminar with my team of optometrists and critical staff members. This seminar motivated us to passionately and consistently present myopia management to all appropriate parents/children, regardless of socioeconomic standing.
One of the most significant challenges with implementing myopia management into a busy corporate optometry office is scheduling. Each new pediatric comprehensive eye exam is booked for 30 minutes, but children often require much more time. Therefore, after we complete a comprehensive eye exam with myopic children, we reschedule for a 60-minute appointment when we will perform a cycloplegic exam and thoroughly discuss all treatment options with the parent and child.
When more complex cases come up involving either prescribing challenges or practice management issues with myopia care, it is vital to have a few mentors to discuss solutions and options. I have met many of my mentors at conferences and reach to them when I need a second opinion.
There will always be excuses for not practicing and providing this necessary care and treatment such as “In my practice, the staff is too busy, and due to the complex rotation of support staff and doctors there is inconsistent follow-up, and no one wants to take the lead responsibility.” These everyday obstacles are real but can be overcome. They are no longer an excuse not to embrace myopia management in any practice… corporate or private.
I have invested time, energy, and capital into keeping up with the latest in research and technology. I have read countless articles, attended webinars, and conferences around the nation. My dedication has led to my practices promoting and integrating myopia management in our corporate practice business environment. It doesn’t matter whether you practice in an independent sub-leased corporate setting like mine or in private practice; myopia management can be implemented successfully.
If you practice in a corporate location, I urge you to and jump in. With so many myopia treatment options available that have demonstrated efficacy, optometrists have a professional responsibility to discuss myopia management options with all parents of children at risk for progressive myopia.
Brian K. Berliner, OD, is an independent doctor of optometry inside LensCrafters with practices in Huntington Station, New York and Lake Grove, New York.