As myopia prevalence continues to rise, it is essential for every practitioner to be well-equipped with the knowledge and tools to effectively manage these patients.
This includes understanding when to initiate myopia management, selecting the most appropriate treatment option for each patient, and identifying the key clinical data needed to guide decision-making.
Thankfully, introducing myopia management to families does not require any special equipment—it typically consists of an abundance of education and planting seeds.
However, practicing myopia management to the fullest scope does require some specialized equipment, such as a topographer and optical biometer.
Myopia equipment to keep an eye on
Currently, there are several combination pieces of equipment on the market that are specifically designed with the myopia management enthusiast in mind. Some of these devices include additional features that are not only helpful in myopia management but also in everyday clinical practice, adding extra value to the purchase. The price range for a brand new version of one of these devices is approximately $15,000 to $30,000.
Topcon MYAH
- Optical biometer
- Corneal topographer, including aberrometry
- Static and dynamic pupillometer
- Meibomian gland imaging
- Contact lens fitting tool
- Trend reports for axial length, prescription, and corneal power
Oculus Myopia Master
- Auto-refractor
- Optical biometer
- Keratometer
- Exclusive software providing eye growth analysis, risk factor identification, and treatment recommendations
Essilor Myopia Expert 700
- Optical biometer
- Corneal topographer
- Pupillometer
- Fluorescence imaging of contact lens fitting
Haag Streit Lenstar Myopia
- Optical biometer
- Keratometer
- Pupillometer
- EyeSuite Myopia: A report providing refraction progression trends and axial growth analysis
Table 1: Comparison of the four combination devices.
| Device | Features | |||||||
|---|---|---|---|---|---|---|---|---|
| Optical Biometer | Corneal Topographer | Pupillometer | Keratometer | Contact Lens FItting | Myopia Progression Analysis | Meibomian Gland Imaging | Autorefractor | |
| Topcon MYAH | X | X | X | X | X | X | ||
| Oculus Myopia Master | X | X | X | X | ||||
| Essilor Myopia Expert 700 | X | X | X | X | ||||
| Haat Streit Lenstar Myopia | X | X | X |
Why should I consider purchasing myopia-specific equipment?
In eyecare, most pieces of equipment—visual field, optical coherence tomography (OCT), and fundus camera—have a single function coupled with a significant price tag and footprint in the office. However, they are likely useful for a wide variety of patients, justifying their acquisition.
Although myopia management has yet to be fully adopted as standard of care within clinical practice, the number of patients with myopia will continue to grow, and the need for doctors specializing in myopia will subsequently continue to grow.
In fact, a recent study found there are approximately 278 myopic children per eyecare professional in the US.1 Therefore, it is crucial for eyecare professionals to position themselves to provide comprehensive care for these patients, ensuring they have the knowledge, tools, and strategies necessary to effectively manage myopia and slow its progression.
The devices mentioned above equip practitioners not only with the clinical information necessary to prescribe myopia management options but with additional tools to educate families and manage myopia—that’s a lot of bang for the buck! As an added bonus, most of these devices are no bigger than a standalone auto-refractor.
To learn how to best utilize optical biometry for myopic patients, check out Incorporating Optical Biometry Into Your Myopia Management Protocol!
Examining the benefits of buying a myopia-specific device
Axial length
Axial length, the distance from the front of the eye to the back of the eye, is a crucial data point in managing myopia. It provides an objective and reliable assessment of eye growth, which often correlates to myopia progression. On the other hand, refractive error is subjective as it depends on the patient’s cognition and cooperation and can fluctuate due to accommodation.
By combining both axial length and refractive measurements, clinicians are able to gain a comprehensive understanding of the patient’s refractive status, which enhances their ability to make more informed and effective clinical decisions in managing myopia. In addition, monitoring axial length on all patients regardless of their refractive error, can assist clinicians in detecting myopic changes even before onset. This provides a golden opportunity to intervene and potentially slow or stop myopia onset.
Lastly, for orthokeratology patients, differentiating between myopia progression and reduced acuity due to other factors can be quite challenging. Noncompliance, a poorly fitted lens, and/or undertreatment can all mimic myopia progression. For long-term patients, the only way to truly determine progression is to wash the patient out of their lenses and reassess. This is time-consuming and undesirable to most patients.
However, having access to axial length data offers valuable insight, allowing clinicians to more accurately assess whether changes in visual acuity are actually due to myopia progression, thereby improving the precision of treatment decisions.
Topography
A topographer provides a detailed map of the curvature of the cornea and can serve two purposes clinically: assurance of the patient’s corneal health and integrity, and assistance in fitting and troubleshooting specialty contact lens designs. Orthokeratology can oftentimes be successfully fit with basic clinical information such as refraction, keratometry readings, and horizontal visible iris diameter (HVID).
However, troubleshooting orthokeratology is highly dependent upon analyzing topographical maps and making lens adjustments accordingly. For example, when a patient reports reduced vision after several nights of overnight wear, it is nearly impossible to discern the root of the issue without a topographer (Figure 1).
In addition, many orthokeratology lens designs now rely heavily on topography to create customized lenses. As a result, the success rate of the first lens is often significantly higher, improving patient satisfaction and streamlining the fitting process.
Figures 1 and 2: Topographies from two different patients depicting poor fitting lenses, but both had 20/30 visual acuity. The top image is horizontally decentered, while the bottom image has a central island.
Figures 1 and 2: Courtesy of Ashley Wallace-Tucker, OD, FAAO, FSLS.
Pupillometry
Pupillometry is not a highly discussed dimension of myopia management, but it certainly has a solid place, particularly in pharmaceutical therapy. Since atropine impacts pupil size, measuring the patient’s pre-treatment pupil size can help determine the best concentration and predict if the patient may experience undesired side effects like glare and light sensitivity.
Furthermore, during treatment, the patient’s pupil size can be more accurately monitored to allow personalized dosing in order to balance side effects and efficacy. Although there is limited research on the impact of pupil size and the efficacy of orthokeratology, it is plausible that a larger pupil allows for more exposure of the retina to myopic defocus, thus increasing the myopia control effect.
However, a larger pupil may also make the patient more susceptible to halo and glare, especially at night. Thus, customizing lenses, particularly the treatment zone, while considering a patient’s pupil size, may improve their overall satisfaction and long-term success.
A review of return on investment
There are a few different methods to make the purchase of one of these devices profitable.
Currently, measuring axial length for myopia is not reimbursed by insurance. The current CPT code for biometry is 76519 and must be billed along with a medical diagnosis. The exception is when the patient has degenerative or pathological myopia (H44.2). Thus, this procedure would be out of pocket for most patients.
Similarly, topography has a CPT code of 92025 but must be coupled with a medical diagnosis to be covered by insurance. In most cases, this would not directly apply to myopia management either. It is within reason to bill the patient each time one of these tests needs to be performed.
Alternatively, they can be bundled within a myopia management package. The latter is the more streamlined approach—less burdensome on the family and allows the doctor autonomy when using their equipment. Topography needs to be done several times during an orthokeratology fitting, and axial length may need to be measured a few times per year to acquire reliable data.
Be sure to price the myopia management package to sufficiently cover clinical expertise, chair time, services, and products. If practicing in an area where there are few other doctors specializing in myopia management, surrounding doctors may consider referring patients because of this specialized equipment—either for full scope myopia care or for the desired tests like axial length and topography.
Although there may not be an immediate ROI after purchasing one of these devices, simply having it will boost your confidence and ability to properly manage myopia. This will inevitably lead to more patient referrals and an increase in individuals seeking this specialized service.
For a comprehensive refresher on optometry billing and coding, check out The Ultimate Guide to Optometry Billing and Coding!
Conclusion
As myopia continues to rise, the demand for doctors equipped with the knowledge and skills to fully care for these patients will also grow. Devices like the ones highlighted in this article are designed to elevate our practices and improve patient outcomes.
