We’re all aware that myopia is a growing problem. A recent study highlighted the gradual increase in myopia prevalence from just over 24% in 1990, to an estimated ~40% come 2050—things look especially dire for adolescents, nearly half of whom will be myopic come the century’s midpoint.1
Despite this, some practitioners still struggle to effectively manage these patients. In this episode of Myopia Mindset, Chandler Mann, OD, Sabrina Gaan, OD, and Eric Heaps, OD, explain why—and how—you should dive into myopia management.
Pathways into myopia management
There are almost as many entry points into myopia management as there are practitioners.
For example, although both Drs. Mann and Heaps initially delved into myopia control due to their personal connection with the condition—the former having a godfather who experienced bilateral retinal detachments, a direct result of high myopia; and the latter being myopic himself—they established their programs under different circumstances.
Working in a corporate-aligned practice, Dr. Heaps has had to work with limited resources. This has meant waiting until options such as MiSight myopia-control soft contact lenses gained enough traction to be greenlit at his location—or multi-purpose equipment, such as a topographer, was brought in, that could further expand his myopia control offerings.
Conversely, Dr. Mann first dipped his toes into myopia control while working at the Berkeley Eye Center in Houston, Texas; and further expanded his myopia management reach by starting a specialist program when he opened his own private practice.
However, not all routes are conventional—or gradual. As an associate optometrist, Dr. Gaan took over for a retiring doctor who’d provided lots of orthokeratology (ortho-K), giving her no choice but to jump into the deep end and follow suit.
Although she readily admits there were difficulties—especially in the beginning—having now spent over 15 years managing myopia patients, Dr. Gaan has found myopia management to be incredibly rewarding to deliver.
Practical strategies for getting started
Dr. Mann notes that there’s often a level of trepidation when it comes to myopia control, because many practitioners still erroneously believe they need to be a specialist to provide this care.
So, as a part of your primary optometry practice, what options are available for your patients? Although Dr. Mann has used other modalities to treat patients in his program, including Stellest lenses and atropine, his go-to option is MiSight.
As a soft, spherical contact lens, fitting MiSight is easy, with practitioners only needing to adjust for the amount of correction required. And, because MiSight actually prevents a patient’s myopia from getting worse, it makes little sense for practitioners to offer any other non-correcting lenses when faced with a myopic patient.
It’s important to remember that this isn’t a one-size-fits-all option. There are various things—including ocular factors, such as having large degrees of cylinder, and lifestyle factors, like regularly partaking in water sports—that may render a patient unsuitable for MiSight.
Enter: orthokeratology
This is why the experts also encourage practitioners to provide ortho-K. Although the prospect of starting ortho-K can seem daunting, Dr. Gaan provides reassurance, explaining that technological advancements have made this therapeutic modality more accessible than ever to practitioners who are just starting off.
“CooperVision’s support is also fantastic,” she adds. “If you have any questions—for example, if you put a lens on and the patient isn’t seeing exactly right—you can just get in touch with their consult team, and they’ll walk you through the process or, if needed, send you a new one.”
But when it comes to getting started with either modality, all three doctors channel the advice Dr. Mann’s mentor, Ashley Wallace-Tucker, OD, FAAO, offered when he was venturing into providing ortho-K: just dive in—although, like anything, there may be a learning curve at the beginning, you can do it.
“I remember being so happy when I had my first MiSight patient,” Dr. Heaps recalls. “That really helped get the ball rolling, and you gain additional confidence each time you do it.”
Engaging and educating parents on myopia management
However, even once you’re offering myopia control, because so many myopia patients are children, you still need to get their parents on board with these corrective steps.
Here’s the experts’ advice for having effective parent conversations:
- Use resources: The main thing parents say when Dr. Heaps brings up myopia control is, “I didn’t know this was a thing,” demonstrating the importance of awareness. Add resources to your reception, pre-testing, and initial consultations, alongside training your techs and staff about the topic to begin the conversation.
- Dr. Mann also explains that handing parents pamphlets prior to their child’s clinical examination gives them a chance to inform themselves about the condition and the options available, so they can get on board with the conversation faster.
- Come together: Not all parents bring their child to the optometrist together—and some parents are no longer together. This might mean they need time to go and discuss things before coming to a decision.
- Dr. Heaps likes to arrange a follow-up appointment, ideally a few weeks later, but encourages parents to at least adhere to the recommended biannual appointment schedule, so no more than 6 months goes by before a decision is made. Alternatively, you could also offer an in-person or phone parental consult, in which both parents can come together to discuss their child and their options with you.
- Get the messaging right: Let parents know that their child has myopia, that the majority of the time it’s a progressive problem requiring urgent intervention—and that, if you don’t do anything, things will get worse. Parents may be particularly receptive to analogies or visual aids (such as patient projections), or to you being open about the fact that your recommendations are what you would do if placed in their shoes, as Dr. Gaan highlights.
- All three doctors note that parents commonly ask about LASIK. Here, it’s important to remember that if a child is too far gone, they no longer qualify to be a LASIK candidate.
- Have a long-term perspective: Sometimes, despite your best efforts, parents won’t initially be receptive. Although this can be disappointing, Dr. Mann reminds us that the optometrist’s job is to provide parents with the information needed for them to protect their child.
- “Don’t get discouraged if they don’t listen initially,” says Dr. Gaan. “You’ve done the job of educating them, and when they come back next time, and their child’s prescription has gotten worse, they’ll remember that what you were saying was true, and they’ll be ready to sign up.”
In conclusion
With myopia prevalence continuing to rise—particularly among children and adolescents—optometrists can no longer afford to sit on the sidelines.
As Drs. Mann, Gaan, and Heaps illustrate, there is no single path into myopia management, and practitioners do not need to be specialists to begin. Whether starting with MiSight, incorporating ortho-K, or expanding services over time, the key is to take that first step and build confidence through experience.
By utilizing available resources, communicating clearly with parents, and maintaining a long-term perspective, practitioners can successfully integrate myopia control into primary care—and make a meaningful difference in their patients’ futures.
