September 16, 2024
By Rupa Wong, MD
Decreasing the chair time burden on pediatric ophthalmologists is key to ensuring as many patients as possible receive myopia management treatment.
Hawaii’s large Asian population made low-dose atropine a natural and easy fit for Dr. Wong’s practice. Photo Credit: Dr. Wong
As a pediatric ophthalmologist in Hawaii, I’ve been employing myopia management therapies for my patients for over a decade since the first studies were published out of Singapore. Hawaii’s large Asian population (>60% of the population is mixed race or Asian) made low-dose atropine a natural and easy fit for my practice. In 2020, our practice was the first in the state to utilize FDA-approved, daily disposable peripheral defocus contact lenses.
Embracing Myopia Management as a Pediatric Ophthalmologist
The WHO’s report on the impact of myopia and high myopia in 2016 was just one of few to highlight the alarming rise in the incidence of myopia amongst children. As I began sharing my experience with other pediatric ophthalmologists at local and national conferences, many were quick to point to the increased chair time as their primary obstacle to offering these therapeutic strategies to their patients. The growing shortage of pediatric ophthalmologists in this country has caused long wait lists, and many do not feel as if they can spare the time to fully address the myriad questions that arise from myopia management. As the Managing Partner of my private practice, I have instituted several workflows and processes to streamline efficiency in this area so that these discussions do not take away from caring for other patients.
Pre-Visit Preparation and Patient/Family Education
Just as a patient’s clinic visit starts with their first phone call, text, or email to the office, a myopia management visit can begin prior to the patient setting foot in your clinic. When my receptionist schedules appointments, they ask specific questions as to the purpose of the visit. Any visit for a failed vision screening, glasses update, or blurred vision is automatically directed to our practice website. There, we have a myopia management section, including an interactive quiz that parents can take to assess their child’s risk for myopia. The end of the quiz provides a summary of the literature and steps parents can take to minimize their child’s risk for myopia.
In addition, all the therapeutic strategies that we employ are thoroughly discussed on the website — low-dose atropine, daily disposable peripheral defocus contacts, and lifestyle modifications. Downloadable PDFs of the seminal publications (LAMP, Sunlight, and myopia, etc.) are also available for those parents who prefer to see the data.
All of this helps to decrease the amount of time I need to spend explaining the basics of myopia management to parents when they arrive at my office. They are already educated as to the fundamentals of the treatment strategies and come prepared with focused questions. For follow-up myopia management visits, my staff performs axial length scans using the Myopia Module of Haag-Streit’s Lenstar Myopia. This software compares and charts axial length progression and refractive error to age- and gender-matched controls. These graphs are given to patients before I even enter the room, facilitating parent education and discussion about the appropriateness of treatment. With this wealth of information, parents can be active participants in the myopia management process for their child, while I can still remain efficient in the exam room.
Maximizing In-Office Efficiency
Once in the office, my ophthalmic assistants and technicians are skilled to continue these discussions. I have trained all my staff who handle pediatric patients to perform cycloplegic retinoscopy. So, when a patient is found to be myopic (even at baseline exam), they know to automatically dispense a folder I have created for myopia management. The folder was inexpensive to print and contains biographical sketches of the doctors who perform myopia management, additional information on each therapeutic strategy, the above-referenced articles, and a paper version of the myopia risk quiz. The pricing structure is also detailed in the packet, similar to the manner in which cataract and refractive surgeons present their cash pay options.
The patient’s family has a chance to review the treatment options and evidence prior to me joining them in the exam room. This way, even if the family has not had time to visit our practice website prior to the appointment, they are familiar with the basics prior to my entrance, once again decreasing chair time. I firmly believe that every patient who is a pre-myope, myope, or progressive myope should be educated on myopia management. I never want a parent to tell me that they were unaware these options exist. By making the information readily available online and in the office, I can deliver on this goal.
Leveraging Virtual Assistants: Enhancing Patient Care and Coordination
Employing virtual assistants also allows me to streamline and maximize efficiency for my myopia management patients. I utilize a virtual scribe in the exam room, and I can immediately instruct her to help facilitate a patient’s prescription for low-dose atropine or to set up a contact lens appointment for soft daily disposable peripheral defocus contacts. She adds patients to a myopia management spreadsheet and then messages the on-site technicians their medical record numbers and treatment to the institute.
My technicians then take care of calling in the low-dose atropine to the compounding pharmacy or texting patients our contact lens homework video (a four-minute video we require for each new contact lens patient to learn and practice how to hold their eyelids and begin touching their eyes).
The virtual assistant then sends text messages informing families of the status of their drops or contact lenses, following up one week after the initiation of treatment to assess for side effects or issues. There are numerous touch points from my office during every step of the myopia management journey that do not involve my direct care unless a complication is stated.
Streamlining Myopia Management Care for Future Patients
I am passionate about myopia management and genuinely wish to see these treatments employed for all children who require them. Reaching that goal starts with decreasing the chair time burden on pediatric ophthalmologists so they can effectively discuss and utilize these strategies without sacrificing time spent seeing other patients. Training your staff and implementing workflows and processes to streamline the process is absolutely essential for us to reach the most patients.
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Dr. Rupa Wong is a pediatric ophthalmologist practicing in Honolulu, HI, for over 16 years. She graduated from Weill School of Medicine of Cornell University, completed her ophthalmology residency at NYU-Manhattan Eye, Ear & Throat residency, and her fellowship in Pediatric Ophthalmology and Strabismus at Boston Children’s Hospital. In addition to serving as Managing Partner of Honolulu Eye Clinic, Dr. Wong is a Clinical Associate Professor at the John A. Burns School of Medicine at University of Hawaii and is active in the American Association of Pediatric Ophthalmology & Strabismus. She has co-founded a Pediatric Ophthalmology Mentorship Program through the AAO and also serves as Vice-Chair of the Digital Media Education Committee and on the Recruitment Task Force of AAPOS. She also hosts a podcast with almost 100,000 downloads, It’s Good To See You, which delves into eye health topics and issues of work life balance. Dr. Wong also has co-founded a women’s multi-specialty medical conference entitled Pinnacle.
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