Proactive Myopia Management is Key to Visual Health

August 15, 2022

By Greg Luce, OD

In thinking about the future of myopia management, I think practitioners should instead think of the present. The future is now. Slowing the progression of juvenile-onset myopia happens now, which is very exciting. 

The staff at Murrayhill Eye Care: Rita Cook, OD, FAAO (left), Diane Robbins, OD (front center), Ann Slocum-Edmunds, OD (back center), and Greg Luce, OD (right)

I graduated from Pacific University College of Optometry in 1990, and two years later, my wife and I opened our office, Murrayhill Eye Care, in Beaverton, Oregon. Over the last 30 years in practice, we’ve brought on four optometrists and six office staff members. 

It’s hard to say anything in particular that prompted me to start offering myopia management. It really came down to understanding myopia as a disease rather than simply a refractive error. That was the mentality shift. When I was convinced that myopia is a disease based on our classic definition of disease in the human body, I was then ready to understand the treatment options and the available research on this disease that we’d been classically calling a refractive error. Since then, keeping up with current worldwide research on myopia management has been a weekly — if not daily — practice. 

Using Research to Implement Myopia Treatment Options
When it came time to start implementing myopia interventions into my practice, I utilized the research that had been done and the current studies to gain an understanding of the treatment options. I started with orthokeratology, as this was already a service handled by one of our associates in the office. Low-dose, off-label atropine was the next addition, followed by MiSight 1 day contact lenses. I also have been prescribing various multifocal contact lenses off-label, such as ProClear, Biofinity, and NaturalVue 1 Day. 

I started offering patients myopia management once I was up to date on the current research and had ample time to train my staff members on the messaging, handouts, and appointment and follow-up protocols. We had patients in mind and wanted to talk to every child and parent to teach them about these treatments. This transition felt natural, as I had been practicing pediatric eye care for three decades, and we have always been proactive in recommending routine vision and eye care for all children, regardless of their family history or refractive error. As part of this practice philosophy, I have always interacted with my patients about good visual hygiene education as a normal course of patient care. 

Finding a Treatment Plan for Each Individual Patient
Once I felt confident and ready to begin offering myopia management, I started to look at each patient individually and often asked myself if the patient was a viable candidate. There are patients with visually significant astigmatism, patients who are not motivated to wear contact lenses, and some who are outdoorsy. The decision-making process for treatments comes down to understanding the patient as much as possible. I ask them questions about their home lives, habits, activities, and what level of interest they have in those activities. If a patient plays recreational soccer once or twice a week for eight weeks, that’s a different habit than one who regularly plays club soccer year-round with workouts. So, we must dig deeper than just asking questions about their interests and hobbies. 

Beyond those questions, essential history and demographic questions come into play. We consider age, refractive error, family history, history of myopia progression, lifestyle, medical conditions, medications, allergies, and parent/guardian support. This often requires feeling out the parents, as well. Whenever one discusses disease and treatment, there is a back-and-forth that creates a certain vibe that seems to move in one direction or another. 

The diagnostic instruments at Murrayhill Eye Care cater to myopia management patients. 

During these discussions, I like to talk to both the kids and the parents because I need the kids to be motivated. Being part of the discussion and the decision-making process is a crucial part of that. While I haven’t found that patients prefer a particular treatment option over another, I think they tend to gravitate toward the best option for their situation. Of course, they all want the treatment with the best efficacy. I try to remember that I am the doctor and that I am being compensated for making recommendations based on my knowledge and experience. This is always part of the discussion; we have these discussions both in the exam room and sometimes over the phone or through email. It’s been rewarding to see their excitement to start treatment — and they get even more excited when they see that the treatment starts working. 

Murrayhill Eye Care has been serving the community for 30 years.

I also give a Myopia Treatment Synopsis handout to every family. It details the different treatment options and has reference materials for patients to do their further research at home. My message is always that myopia must be prevented for those at risk based on genetics and lifestyle and must be treated for those with the disease. Prevention and treatment are not new concepts in disease management; ECPs must adopt this concept in myopia management. 

Working Together on Myopia Management
Many of my myopia management cases come from referrals from other ECPs who don’t provide myopia management. While many of these patients end up in my office from word of mouth, I always try to be respectful and thankful to my colleagues who refer their patients to me. I also send them my treatment plan and compliment them on caring for their patients. When dealing with referral patients, one of the most significant benefits is that we know there’s less work involved in motivating and educating to treat and prevent myopia. 

I also work closely with other doctors in my practice on myopia management patients. One of my associate doctors specializes in OrthoK, so we co-manage patients prescribed OrthoK. I would encourage other practitioners to do the same, when possible, as sharing expertise in different treatment options can provide patients with the highest quality of care. While I’m the only doctor in our office who works on myopia management cases, all four doctors are very supportive of myopia treatment and prevention and will discuss these interventions with all our patients. 

In thinking about the future of myopia management, I think practitioners should instead think of the present. The future is now. Slowing the progression of juvenile-onset myopia happens now, which is very exciting. 


Greg Luce, OD, received his Doctorate in Optometry from Pacific University College of Optometry in 1990. He practices at and is co-owner of Murrayhill Eye Care in Beaverton, Oregon. He had served as clinical faculty and lead instructor for Pacific’s practice management curriculum. His writing and lecture topics include practice management, contact lenses, and pediatric optometry.
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