Optometrists today have many unique and different career paths available to them. In this article series, we’ll be engaging with optometrists from various common (and not-so-common) practice modalities to get a firsthand perspective on what optometry is like in their setting.
Today, we’re interviewing three optometrists who share their professional experiences of practicing myopia management: Laura Goldberg, OD, MS, FAAO, Dipl ABO, Gary Gerber, OD and Thanh Mai, OD, FSLS.
Dr. Goldberg is an associate optometrist at Woolf Eye Lab in Pasadena, MD and is passionate about bringing a multitude of myopia management treatment options to her patients. Dr. Gerber is the co-founder and chief myopia eradication officer of Treehouse Eyes. His team helps to spread awareness on the importance of myopia management and prevention of its potentially sight-threatening complications. Dr. Mai is the co-founder of Insight Vision Center in Orange County, CA, and has extensive experience using today’s technologies to provide various cutting-edge myopia management treatments for his patients.
What advice would you offer to optometrists considering a career path in myopia management?
Dr. Goldberg: Make sure you are up to date on current literature. Understand that patients usually pay out of pocket and you have to be able to convey the value of myopia management and that you are treating myopia instead of just using a band-aid with glasses. Also, myopia management reduces risk of serious ocular pathologies such as retinal detachment, glaucoma, etc. You don’t need a lot of fancy equipment to offer myopia control (autorefractor, topographer if available). Don’t be afraid to try it, atropine at low doses is very safe, paragon CRT has a great team that can walk you through the fitting and customization process for orthokeratology, and all you need is a Biofinity multifocal or Naturalvue set to fit multifocal CL. Treatments can be combined such as atropine and multifocal contact lenses or atropine and orthokeratology.
Dr. Gerber: Like anything you set out to do in your practice, commit to doing it for real and don’t dabble. That means setting aside the requisite time to learn the clinical skills, create a business plan (to include budgeting for technology, marketing plan based on consumer research, staff training, opportunity cost, brand building, market research, fees, etc), staff training plan, space allocation, scheduling templates, legal documentation and patient forms, etc.
Dr. Mai: Have the mindset that myopia is a disease and that you have the professional obligation to help these kids from getting worse!
Is further training required for optometrists to successfully practice in a myopia management setting?
Dr. Goldberg: Further training is not required, a lot can be self-taught with the help of mentors, the labs, and just practice. Plenty of helpful websites such as myopiaprofile.com and myopia Facebook group.
Dr. Gerber: Extra training is needed—but it’s well within the scope (and we believe obligation) of every OD to do this. If they’re just not interested, that’s fine! Just like they may not be interested in vision therapy, they can refer kids out to docs who are doing full scope (non-dabblers) myopia management.
Dr. Mai: Further training is necessary if you want to be successful. There is much more to being a doctor than just clinical knowledge. How do you communicate with the patient your treatment plan so that they follow through? How do you communicate with your staff so that the patient is supported? How do you create awareness in your community that myopia is a disease that needs to be managed in children?
What is the most rewarding aspect of providing myopia management services to patients? What is the biggest challenge?
Dr. Goldberg: A rewarding aspect of myopia management is getting to make an impact on children’s vision and actually TREAT myopia instead of just putting a band-aid on it.
One of the biggest challenges is having the patient’s parents understand the value of myopia management and that it is a monitored treatment process. Also, multiple follow-ups are usually required, especially for orthokeratology. Orthokeratology is usually the most effective but required about 6 follow-ups within a few months period for first-time fits.
Dr. Gerber: It’s very cool to use an optical device like a contact lens and have it make a significant organic impact on a kid's life. I can’t think of anything else we do that bridges optics to physiology and eye health like myopia management. Of course, it’s pretty cool when a kid can see without an optical device, but that’s not myopia management. That’s ortho-K–there’s a difference!
The biggest challenge is lack of parent awareness and our biggest challenge at Treehouse Eyes is docs who dabble. That will invariably give this important discipline a bad reputation since kids will get less than optimal results. You gotta do this for real! Not doing so is like sending a kid with a CI home to do pencil pushups and saying you do vision therapy.
Dr. Mai: It is very rewarding to know that you can make a difference in a child's vision for life. The biggest challenge we face though is the lack of general awareness amongst the general population and still amongst many optometrists who do not consider myopia as a disease.
What essential pieces of ophthalmic equipment are required to successfully provide myopia management services?
Dr. Goldberg: Required: autorefractor/phoropter, slit lamp. Beneficial: Corneal topographer, and A-scan (to measure axial length).
Dr. Gerber: An optical biometer. Those who say you can do myopia management without one are wrong! Myopia is an axial length disease. If you don’t accurately measure it, how will you know if your treatment is working? Using Rx as a proxy isn’t good enough.
Dr. Mai: The ability to measure axial length should be required.
Given the current trends in myopia management, is there one specific treatment modality that is more optimal than others, or is it important to have a wide range of treatment options available to patients?
Dr. Goldberg: Three options: Multifocal contact lenses, Orthokeratology, and Atropine. All have shown to be very effective; it is good to have a variety to meet the needs of various patients (some want CL, some are too young to handle CL so use atropine). Orthokeratology not only slows myopia but also allows for 20/20 vision during the daytime without correction (great for athletes or swimmers).
Dr. Gerber: Like everything else we do, you have to know how to use all the tools in the toolbox. Just like there’s not one way to treat dry eye or glaucoma, the same is true with myopia management. Even if there were one magical treatment, for example, if atropine worked 100% of the time, what would happen when a mom says, “I’m not fighting with my son every night to put in drops.” You need a plan B, C . . . Z.
Dr. Mai: It is important to have a wide range of treatment options. You should do what works for each patient and not just do the same approach every time.
Conclusion
Myopia management is a unique niche within the optometric profession. Optometrists practicing in this setting provide much-needed care to patients at risk for the myriad long-term ocular sequelae associated with myopia.
Optometrists interested in pursuing a career path in myopia management have the option of starting while still a student. Many 4th-year externship rotations are available throughout the country, allowing students to gain better insight into whether or not this practice modality is right for them. New grads can also opt to pursue one of the many unique pediatric residency programs available as well, as myopia management is becoming a growing part of pediatric eye care.
Be sure to also speak with other colleagues, faculty, and professional mentors to see if a career path in myopia management is right for you.
