June 15, 2023
By Laura Vasilakos, OD, FCOVD
Much like primary care providers measure blood pressure as a risk factor for disease, I hope that eye care providers will be measuring AL on all patients as we currently do with IOP. Myopia is a byproduct of an elongated eye, and we need as much data as possible to treat our patients better.
After graduating from the New England College of Optometry in 2005, I started my career by working in a primary care setting for the next decade. From there, I transitioned to a practice focusing more on specialties — vision therapy, neuro-optometric rehabilitation, and, of course, myopia management — before opening my own practice, Family Eyecare Solutions, in 2018.
My experience with myopia management goes back about ten years, and it came as a result of the work I was doing with my patients. Many families came into my office with a history of retinal complications from high myopia, and I was also seeing their children. Rather than just increasing their contact lenses or glasses prescriptions every year, I wanted to be able to do something that would actually slow their progressing myopia. This is ultimately what sparked my interest in orthokeratology and myopia management treatments.
Getting Started with OrthoK
I started my myopia management journey by immersing myself in the education available then. The Vision By Design meeting was the first event I attended related to myopia management, and it allowed me to dive deep into getting started with OrthoK. From there, I took classes from BHVI, Myopia Profile, and MyopiaCare.
When I first started prescribing myopia management for my patients, OrthoK lenses — specifically Paragon CRT — were the first treatment I offered. I started with patients with minimal to no astigmatism, average corneal Ks, and low to moderate myopia. The initial OrthoK fittings went well, and patients and parents were happy with the ability to be spectacle free during the day and have their myopia progression slowed at the same time.
In time, I expanded my offerings with additional OrthoK designs, multifocal soft contact lenses, and low-dose atropine. Low-dose atropine was and still is a helpful entry point for young progressive myopic children who need myopia management treatment but may be hesitant or not yet ready for soft contact lenses or OrthoK lenses.
Fine Tuning the Myopia Management Approach
Over time, and with more training and education, I was able to grow my myopia management practice and begin streamlining my myopia management patients to deliver the highest quality of care. In addition to refraction and topography readings, I always measure myopia patients’ binocular and accommodative functions. I use a Medmont topographer to map their corneas, even if they may be starting with soft lenses, because I want to have a baseline if the patient changes to OrthoK in the future. In addition, I have recently added a Zeiss IOL Master for axial length (AL) measurements. I plot the AL on a centile graph while the parents are in the office to demonstrate the risk of high myopia and the treatment effect over time.
Currently, my treatments include low-dose atropine, MiSight 1 day contact lenses, Biofinity multifocal contact lenses, and orthokeratology. I have been reading promising new research on the benefits of red light therapy for myopic patients. Since I already utilize syntonic photobiomodulation therapy with some of my post-concussion, strabismus, and amblyopia cases, I plan to incorporate red light therapy as a combination therapy with a few current patients who are in myopia management but are at high risk of progressing. Each patient is treated based on their unique case and situation. I believe that combination treatments can be helpful for patients who have started on one modality but are still progressing or are at a high risk of progression.
When it comes time to choose a treatment option for a child, whether one or multiple, it’s always decided on a case-by-case basis. I begin with the age and maturity of the patient, then their spherical equivalent (SE) and AL measurements. I review all options and then rank them in order of my recommendation to the parents and patients.
Education is Key to Getting Parents on Board with Myopia Management
Getting patients — and perhaps more importantly, their parents — to understand myopia and the associated treatments, including why it’s so critical to get started with treatment, is my number one priority. I have a lot of education in my office. My office manager, who answers incoming calls, has been educated about the myopia management options and the “why” of managing myopia.
Most parents who are already myopic understand the need for myopia management in their children. The more difficult parent education comes with those parents who are not myopic. I demonstrate their child’s approximate refractive error by having them view a distance chart through a plus (+) lens with the same myopic power in (-). I also created custom brochures that highlight the three pillars of my practice: vision therapy, myopia management, and neuro-optometric rehabilitation.
Education and awareness have been the most significant challenges I have faced. Since I have a niche practice without primary care — and services are out of network for all medical and vision insurances — attracting patients and parents has also been a challenge. To overcome these challenges, my office utilizes social media and word of mouth from current patients to grow our patient base. Social media plays a prominent role in education for current and prospective parents, and it also helps attract new patients to our practice. Education is critical to everything — even for me as a practitioner. I read a lot online, such as Review of Myopia Management, attend virtual and in-person courses on myopia management, and I do everything possible to stay up to date on the latest research and news in the field. The more I know, the better I can answer questions from patients and parents, and the better quality of care I can provide.
Making Myopia Mainstream
In thinking about the future of myopia management, I hope that measuring axial length will become mainstream in the next five years. Much like primary care providers measure blood pressure as a risk factor for disease, I hope that eye care providers will be measuring AL on all patients as we currently do with IOP. Myopia is a byproduct of an elongated eye, and we need as much data as possible to treat our patients better. I hope that by viewing myopia as not just a refractive error, more patients — and the general public — will embrace myopia management options.
|Dr. Laura Vasilakos, or “Dr. Laura” as many call her, is a friendly, compassionate listener, attentive to your vision care needs. After receiving her doctorate in optometry from New England College of Optometry in 2005, Dr. Laura pursued an additional 250 hours of post graduate education in binocular vision, vision development, and vision therapy. As a Fellow in the College of Optometrists in Vision Development (COVD), Dr. Laura is board certified in vision development, behavioral and developmental vision care, optometric vision therapy, and vision rehabilitation. She also provides functional and preventative vision care services to her patients, including myopia control. She is the Chairperson for the Northeast Congress of Optometry, a local chapter of the Optometric Extension Program, as well as an Infant SEE state liaison.|