Due to the current increase in myopia prevalence seen in everyday practice and the staggering projections for future prevalence, many clinicians currently agree myopia management is a necessary addition to primary care and not a specialty service. However, successful implementation can be tricky.
This article highlights the top five hurdles typically encountered in practice and offers realistic solutions to overcome them.
1. Where do I find the myopic patients?
Myopia is by far the most common refractive error, so there is no shortage of myopic patients to manage.1 To break it down further, there are approximately 278 myopic patients for every eyecare provider—including both optometrists and ophthalmologists.2
If you are just starting out with myopia management and in an established practice, the best place to start is your own patient base. Using your electronic medical record (EMR), perform a search for pediatric patients within the desired age range and then further filter the search for myopic patients who are currently spectacle wearers or single-vision contact lens wearers.
This simple search provides an instant patient base for myopia management. You can send a targeted email or newsletter featuring myopia management specifically to those patients or have them on your radar at the time of their annual appointment.
If you do not typically see children, another approach is to target myopic adults who likely have or will have children. Genetically speaking, children are more likely to become myopic if one or both parents are myopic.3
The goal is to have the conversation early. I typically say something along these lines: “Wouldn’t it be awesome if your prescription was at least half of what it is now? We currently have options for your child that will likely keep them from becoming as nearsighted as you are!” In my experience, every parent is intrigued, and you have now planted the seed for myopia management when the time comes.
If you are establishing a practice, here are several ideas to drive pediatric patients into your practice:
- Your office website is the lifeline to your practice. Make sure your website is up to date with all of the services you offer. Specifically, information about myopia management should be on the homepage and easily visible and accessible.
- School nurses and pediatricians need a nearby optometrist to whom they can send children when they have failed a vision screening, or when parents or teachers are expressing concerns about a child’s vision. There’s no better referral than to you!
- Personally reach out to or visit school nurses and pediatricians within a reasonable distance from your office.
- Be sure to provide them with business cards and information detailing your office’s services, especially highlighting myopia management.
- Parents of children heavily involved in sports are typically hyper-concerned about vision and the potential for worsening vision. Take any opportunity to speak to these parents, especially the parents of your own children's teammates, about the benefits of myopia management.
2. The "Myopia Talk"
Discussing myopia management can be daunting and intimidating, especially since most parents are going to hear it for the very first time in your chair. The key to the first conversation is to not overcomplicate the topic. Resist the urge to discuss myopic defocus and endless statistics.
I typically lead with the following: “Your child has myopia, which means the eye is growing too long, which is why they have blurry vision. Lengthening of the eye can cause the back of the eye to weaken over time. Thankfully, we have several options to help slow down this process.”
Most parents are intrigued, which provides an opening to discuss all of the myopia management options for which the child is a candidate. Discuss myopia management as THE option, not AN option.
3. Discussing myopia management fees
Once the discussion about the need for myopia management is completed, the natural follow-up question from parents is, “How much does this cost?” or “Does my insurance cover this?”
Regardless of your pricing structure, be sure that you or your team members discuss fees with confidence and unapologetically. Myopia management is more than just an eye exam. It is a program created by a trained myopia management specialist that is designed to PROTECT a child’s vision.
Be sure to clearly delineate what comes with the program. For example: “The program includes insertion and removal training and support, a year's supply of contact lenses, a back-up pair of glasses, and a 6-month follow-up with axial length monitoring.”
Unfortunately, insurance does not directly cover myopia management at this time, but be sure to leverage all available rebates and mention the use of Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs).
4. The child is not ready to wear contact lenses or use drops
Many parents believe their child is incapable of being responsible enough to successfully use contact lenses and/or apply drops each night. The simple solution would be for the parents to take on this task for the child until he is ready to do it on their own.
However, studies have shown that children are not only capable of wearing contact lenses as early as age 8, but thrive athletically, socially, and emotionally after wearing contact lenses.4,5 Sometimes, a tiered approach needs to be implemented to prepare a child.
First, have them start putting in artificial tears for a few weeks to get accustomed to putting something refreshing in the eye. Oftentimes, children are ready after this step to try contact lenses. If not, consider switching over to atropine for 3 to 6 months in order to get a myopia control strategy in place.
Of course, be sure to warn parents of the potential of a slight sting. At each scheduled follow-up, attempt contact lenses in the office. Patience and positivity are paramount at these visits. If the child is not quite ready to transition to contact lenses, encourage them, recognize their accomplishment, and simply try again next visit!
5. The parents decline myopia treatment
Many parents will be excited about your expertise and also be willing to do whatever you recommend for their child, but there will undoubtedly be skeptics. The key is to be mentally prepared for it—understand that they are likely not declining because of mistrust but because of apprehension.
This apprehension often stems from myopia management being a novel concept to them—or because the cost has caught them off guard. Either reason is completely understandable.
Be gracious and understanding and reiterate that your goal is to recommend what is in the best interest of their child. Send the parents home with information about myopia management and also consider a follow-up call to ask if any questions have arisen since the last visit.
Most importantly, express your sincere concern by scheduling a 6-month follow-up. This visit serves two purposes; first, the parent realizes that you are concerned enough not to wait a full year, and second, that it is possible that their child’s prescription will have changed in that time frame, further emphasizing the need to act.
Conclusion
The road to a successful myopia management program for each child may look completely different. Sometimes, it will be perfectly linear, and other times it will be windy and bumpy.
The goal is for each child to at least have the opportunity for myopia management through proper education and diligence from their eyecare provider.
