May 15, 2023
Shefali Miglani, OD, has been practicing optometry for the last 20 years, but when she started specializing in myopia management eight years ago, she discovered a whole new way to encourage parents and patients to get on board.
“Don’t focus on myopia and how it can possibly blind their child,” said Dr. Miglani. “We doctors tend to focus on too much information in the exam room and scare them to death. It’s really the lack of connection between the parent and the doctor. The onus is on us to change our behavior as optometrists if we want the parents to change theirs.”
So, she did just that with an approach that applies three strategies — priming, stacking, and the expertise halo — and she delivers them via a series of videos from Hoot Myopia Care.
“Here’s how it works: Parents leave our exam room, they scan a QR code, and they’re sent short videos automatically from Hoot to their cell phones, spaced out a few days apart. They’re automated and they’re generated through just a click of a button. It’s a few messages that tell them everything about myopia. It’s not overwhelming, and it works.
To learn more about Dr. Miglani’s unique approach that applies her background in behavioral psychology to encourage parents to begin managing their children’s myopia, John Sailer, Editor-in-Chief of Review of Myopia Management, interviewed her about her practice and about Hoot Myopia Care. Read the interview below, or listen to it here:
John Sailer, Editor-in-Chief, Review of Myopia Management: Hello and welcome to Review of Myopia Management‘s interview series. I am John Sailer, Editor-in-Chief of Review of Myopia Management, and we have the pleasure today to be interviewing optometrist Dr. Shefali Miglani of Monroe Eyecare in Monroe, New Jersey, where she specializes in myopia management for children. For the last 20 years, Dr. Miglani has run her private practice, then shifted to focus on myopia management for the last eight years, where she has grown from a few patients a month to now hundreds of myopia management patients across the state and outside the state of New Jersey. Dr. Miglani is also Chief Medical Officer of Hoot Myopia Care, where she helps to design and develop scientific protocols and parent-friendly content on myopia management for doctors on the Hoot platform. Dr. Miglani is a graduate of SUNY College of Optometry and received her undergraduate degree from Rutgers University, where she majored in Chemistry and Psychology. Welcome, Dr. Miglani. We are so pleased to be with you.
Shefali Miglani, OD: So happy to be here, John. Thank you for having me.
RMM: Okay, great. So, let’s get right into it, Dr. Miglani. Let’s learn a little about yourself and your practice, and then, given your background in behavioral psychology, let’s specifically cover The Psychology of Parents that Drives Myopia Management Growth.
From a Handful of Myopia Management Patients to Thousands
Dr. Miglani: I started my private practice cold 15 years ago as your mom-and-pop optometry private practice. It was very general. Then a few years into me practicing, I realized that the epidemic of myopia was growing. Something was wrong when the same child was coming every six months to get new glasses. I started digging into myopia management and what I can do to be the solution to this problem. That’s when I started eight years ago getting into myopia management and learned over the years, tried a number of things, had a lot of setbacks, some things worked, some didn’t. But we were able to grow our practice, as you said, from a handful of myopia management patients in the program to now hundreds or even thousands, by identifying the real customer, which is the parent.
This comes from the works of Joseph Campbell that I studied, which is The Hero’s Journey, and the marketing guru Don Miller’s Building A Story Brand. I had the pleasure of being in his class. I learned that creating your story and identifying the hero of my story, the story that usually plays out in my exam room, is very important to identify that real hero. I must identify who the guide for that hero is so that I can make the biggest impact.
Too often we optometrists get wrapped up in trying to be the hero of this child by having this beautiful topography map and designing this beautiful lens. But the optometrist is not the hero. The hero is also not the child. He is the patient. The real hero of my story in my exam room is the parent. When I realized that and made that fundamental shift from the patient, the OrthoK lenses, the technology, to the parent, I started getting myopia signups in large numbers. We started asking parents what they really cared about, what were their obstacles.
The Parent Does Not Have a Myopia Problem; They Have a Parenting Problem
I focused on the parent’s journey in this story, what was going on at home, and what was the real problem today’s parent faces in our story. The parent does not have a myopia problem. They have a parenting problem. Their kids are surrounded by devices. They do their homework on their iPads. They socialize with their friends on Snapchat. They even relax on their phones by watching Netflix. I know that happens in my home with my two teenage girls.
We parents are struggling to get engagement with our child, and we kind of feel guilty because we know that these devices are not healthy for our children, and we don’t know how to solve this problem. By the way, our children are getting more nearsighted through this process, so there is a lot of weight on today’s parents’ shoulders.
Four Parts to Becoming the Myopia Management Guide
My job as an optometrist is to be the guide for these parents in four parts. Specifically, number one, you have to identify the real problem. You don’t focus on myopia and how it can possibly blind their child. Don’t talk about that in the exam room, but focus on what’s really on their mind, which is that devices are ruining my child’s life. This is what all the parents are thinking. You have to mind read. By the way, yes, their vision is also getting worse. The device part, the engagement part is the real pain point. The parents are struggling to maintain a work-life balance – their careers, taking them to soccer practice, and trying to get them into an Ivy League college. They’re overwhelmed. You must as an optometrist be the guide for that parent to make that real and meaningful connection with them. You have to bond with that parent.
Number two, you as a guide have to have a specific plan for them, which is one of the myopia management treatments chosen for that child. That is the easy part. We all know how to do that. That’s what we truly focus on, but we need to shift away from that, show them the outcome.
Number three is that the guide has to also show them a clear outcome of success. So, you paint a picture for them sitting in the exam room that when the child is ready to go to college, they’re 18 years of age, and we’re celebrating the success that the child ended up with the best vision possible.
Number four, your job as a guide is to make a clear call to action by saying something like, “I think you should enroll your child in the myopia management program right now, and I am the best practitioner to take that job off of your shoulders. So, I can get you to the finish line.” It’s like the parent is the Luke Skywalker, and the optometrist is the Obi-Wan Kenobi character in The Hero’s Journey.
This is how we are one of the busiest myopia management practices in the country.
RMM: Wow, very interesting to put it in the perspective of Joseph Campbell’s The Hero’s Journey and make the parent the hero in this story. Very interesting and effective. So, what would you say is the roadblock that you think parents have in getting their kids enrolled into a myopia management program?
‘Paralysis By Analysis’ – Doctors Focus on Too Much Information
Dr. Miglani: You know, I think they’re just really overwhelmed and they get paralysis by analysis. One of the biggest roadblocks for parents is that they kind of get slammed in the face with this diagnosis of myopia. They understand that for eons people, human beings have been getting glasses. They don’t understand the progressive myopia aspect of it and how the world has changed over the last 20 years with devices being introduced and the kids are being indoors because of them and intensive studying.
They don’t understand the subject matter, and it’s complex. We doctors tend to focus on too much information in the exam room and scare them to death. Or we don’t hit on the relevant points for us to make a compelling enough argument for them to act and change their behavior and get out of that sort of circular thinking for the parent because they just don’t understand. It’s really the lack of connection between the parent and the doctor. The onus is on us to change our behavior as optometrists if we want the parents to change theirs.
RMM: You touched on behavior, and that’s interesting because you have a background in behavioral psychology. So, how have you addressed that? What strategies have you deployed to help patients and the parents deal with the patient’s myopia?
Three Strategies from Psychology – Priming, Stacked Learning, the Expertise Halo
Dr. Miglani: The subject matter of myopia is complex. All of us recognize that, and that’s why not many optometrists are practicing myopia management. From my time as an undergrad and then at a behavioral psychology lab for three years afterwards working there full-time, I learned that the way people learn is systematic. There’s a science to it, so we deployed three key strategies from the world of psychology to the world of myopia management.
Number one is priming. You can’t blindside today’s parents with a diagnosis of myopia. Myopia is too complex and too scary for parents to fully understand in that 15-minute comprehensive visit. Parents are often like a deer in the headlights where they hear about little Johnny’s myopia diagnosis, and they usually say something like, “Well, let me think about this.”
Or very calmly they say, “Let me go home and talk to my husband or my wife,” and you never hear about them again. So we started with a pre-made Hoot handout on myopia in the pretest room, which primes the parent about myopia before they walk into the room. The handout has information about what myopia is (it’s the stretching of the eye), what the strategies to manage myopia are, why it’s necessary to act. Something simple but understanding it with graphics is important for them. It’s concise. They read that before they come into my comprehensive exam room. Then when I talk to them about myopia, they usually are nodding. They understand it. They’ve been introduced to some of the key terms. They understand something about that, and they are more apt to take action.
The further action that I’m asking them to take is to learn more about myopia. That leads me into my second strategy, which is stacked learning. Parents cannot eat a whole pie at a time. They need a slice of a pie at a time. They have a lot going on in their life. We don’t try to educate them in the comprehensive office. Too often doctors make that mistake, and they get overwhelmed. We try to educate them at home on their cell phones using videos. The learning is spaced out with these videos about myopia. Intelligently, it stacks new information on and builds on the previous information. I call it stacking, but I learned from my husband Bob that in the marketing world it’s called drip marketing.
Here’s how it works. Parents leave our exam room, they scan a QR code, and they’re sent short videos automatically from Hoot to their cell phones, spaced out a few days apart. They’re automated and they’re generated through just a click of a button. It’s a few messages that tells them everything about myopia. It’s not overwhelming, and it works. What doesn’t work anymore is when you pull up in the exam room the Brien Holden chart and show them the axial length chart. I tried that a lot because I’m a scientist, and I love the Brien Holden calculator, but it simply is not enough. Parents want the videos from their doctor.
Number three, the third strategy we use, is the expertise halo. When a parent asks a question, which is a very common question, “Is OrthoK safe?” they are testing us.
The parent wants to know that we are the expert or at least knowledgeable about the topic. So now when they ask us these questions, we zip out a Hoot clinical brief, which is cited with multiple studies from literature. By giving them this expertise halo of a beautifully cited clinical brief, you look like the expert you really are. They don’t just have to believe your word for it.
So, to summarize, the strategies of priming, stacking, and the expertise halo allow parents to learn about this complex subject matter in depth, on their own time, on their own devices, and in their own way. Hoot has allowed us to surround sound that experience for these parents in an intelligent and thoughtful way that creates results for both the patient and the doctor.
RMM: Okay, Dr. Miglani, very interesting approach to educating the parents and getting them on board. I hope a lot of the readers of Review of Myopia Management find it of interest and look into it further. Thank you very much, Dr. Miglani of Monroe Eyecare in Monroe, New Jersey, and Chief Medical Officer of Hoot Myopia Care.
Dr. Miglani: Thank you so much. It was a pleasure, John.
RMM: And thank you for listening to Review of Myopia Management‘s discussion with Dr. Miglani about The Psychology of Parents that Drive Myopia Management Growth.