March 15, 2022
By Bhavin Shah, BSc (Hons) Optom, MCOptom, MBABO, MBCLA
We have a lot to learn from people within the eye care industry and people outside the industry. Having a fresh perspective can help solve problems.
My time in the eye care field began 25 years ago. While I started out working for a small independent group of practices, after a large corporation acquired it, I shifted my focus to another area of eye care — developmental and behavioral optometry. This gave me a much deeper understanding of our visual system and how to help make a more significant impact in my patients’ lives.
My journey with myopia management started not long after that. I heard about the theories of hyperopic retinal defocus and the use of low-dose atropine and multifocal contact lenses in 2010 from studies conducted in the Far East. Then, things became more personal when a pair of 12-year-old twins with convergence insufficiency came into my practice a few years later. I began treating the more symptomatic patient with vision therapy for six months. Though they both started with similar myopic refraction, the child being treated hardly progressed, while his twin progressed at -1.00D each year.
I’m always curious about learning why things happen — especially when there is a potential mystery. Although the few studies that have looked at training for binocular vision/accommodation have not found a conclusive link between myopic progression, I feel that further investigation is required.
This curiosity into the field of myopia management was piqued even further in 2015 when I was examining a 7-year-old child of a friend of mine. This child had progressed by over -1.00D in a year, and both child’s parents were high myopes and were extremely worried about the high progression. I had been reading about the use of dual-focus contact lenses, and we had access to center distance multifocal lenses that would be replaced on a monthly basis. Although regulatory authorities have not approved the lenses for myopia management, I believed they could potentially satisfy some of the design characteristics that were shown in the early studies. At the very least, I could provide this patient with clear vision when participating in sports and other activities. After this successful fitting, this child had little myopic progression over the next year and a half.
I kept up with this process over the next year, fitting myopic children with center-distance multifocal lenses. By 2016, the initial pilot for CooperVision’s MiSight 1 day contact lenses had launched in the U.K. Within two years, my practice became one of the largest providers of MiSight contact lenses in the U.K. Since then, I’ve also incorporated orthokeratology and other soft multifocal contact lenses for myopia control into my practice.
Creating a Relationship with Patients and Parents
When creating a treatment plan for myopic patients, I have a system that I have developed and optimized over the last five years. I start by taking baseline topography/axial length and perform a refraction and binocular vision/accommodation assessment. This allows me to build a rapport and connection and understand the child’s “visual world,” including their visual needs and demands. This system helps guide my choice in treatment selection and the likelihood of success with each option. I will always try to fit contact lenses in the first instance where possible because I have observed that the benefit of being spectacle-free gives huge intangible advantages for a child in their development.
When educating parents about myopia and the available treatment options, I try to adopt the same approach as when I’m in the exam room with a patient. Understanding how parents cope with the news that their child is myopic and how they manage and decide to start a treatment plan is crucial to the conversation. Parents have a range of emotional and logical thought processes. We must communicate and manage with empathy and authenticity in the best interest of their child.
I’ve developed a parent/patient behavior model in response to managing their child’s myopia and the answers they need to drive their decision. I have most of this information on my website, but I may also provide predicted progression in a graph that is tailored to the child. Time to have these conversations with parents (and involving the child) is essential. I also have many years of practice data detailing my patients’ experiences with each myopia management treatment modality, which I can share with patients and their parents. I’ve found that testimonials and recommendations help build trust and build up my reputation as a leader in the field.
Utilizing the Advantages of Social Media
Social media and the internet have played much more prominent roles in my practice than before, as patients and parents can now share their stories. I try to use this to my advantage by making my website as comprehensive as possible. I started by going through all of the questions that parents had asked me in the exam room and wrote content based on them. If one parent asked the question, I believed others would have the same question.
This strategy has ultimately been successful in terms of growing my patient base. I get most of my new patients from recommendations and parents who have visited my website. Often, parents who are recommended to me will visit the website for confirmation, which helps educate parents and build trust.
In addition to my website and social media, I’ve also started a podcast — More Than Optics. Over the years, I have met so many interesting and motivational people within the optical industry. I love hearing the stories of people within the industry who have pursued interests and passions outside of optometry. Along with my co-host, we want to have conversations with people doing fascinating things to inspire others to follow their dreams. We’ve learned so much just by listening to their stories and how they applied knowledge and experience gained through optics in their outside interests.
I have a lifelong thirst for knowledge, and thus my practice has innovation as a core value. We have a lot to learn from people within the eye care industry and people outside the industry. Having a fresh perspective can help solve problems. My experience of understanding and managing people and their core needs and desires has enabled us to provide a service that impacts our patients at a deeper level.
Bhavin Shah, BSc Optom (Hons), MCOptom, MBCLA, is a multi-award-winning behavioral optometrist with over 25 years of experience in the industry. Since 2016 he has used behavioral science and insights to build a six-figure myopia management clinic in London, offering a full spectrum of contact lenses and spectacles. Bhavin Shah graduated from UMIST (University of Manchester) in 1996. He was recognized as the Contact Lens Practitioner of the Year (2019 and 2020), and his practice, Central Vision Opticians, was recognized as Children’s Contact Lens Practice of the Year (2018) and the Technology Practice of the Year (2020). He has written about myopia for several professional and general publications, as well as appearing on podcasts and as a speaker on the topic.