Effectively managing myopia requires practitioners to understand the underlying theory—however, this isn’t where the journey of learning ends. As demonstrated by the careers of Chandler R. Mann II, OD, Sabrina Gaan, OD, and Eric S. Heaps, OD, the successes and failures of every case that you navigate will offer experience that informs your future practice.
In this episode of Myopia Mindset, they look back at some of their most formative cases to share what worked—and what didn’t—alongside the lessons that you can take from the exam lane.
When personal experience shapes myopia care
What has had the biggest influence on the way you think about and manage myopia? Although each case comes with its own lessons, looking back at their careers, the doctors can each think of specific instances that were particularly formative in shaping their approach to myopia control.
For Dr. Heaps, one such example is that of his own son, who is already myopic at the age of five. Because many members of their immediate family have high levels of myopia, Dr. Heaps was able to start myopia intervention in his son early, providing him with Stellest glasses.
“My son isn’t wearing contacts yet. However, even when it comes to Stellest glasses, being able to look at a patient and explain that I use them on my own child can really make an impact.”
And, being both the parent and practitioner in this instance has also meant that Dr. Heaps could gather real-world data that enabled him to refine his approach to modalities, like atropine, that patients are increasingly researching and asking questions about.
One of the additional benefits of starting his son on low-dose atropine drops was being able to assess potential side effects, such as struggling with light sensitivity as an individual with both light skin and eyes—which his son didn’t experience. Although low-dose atropine still isn’t Dr. Heaps’ first choice for the majority of patients, he has confidence when using it to treat younger, very high-risk patients.
It’s also important to note that the point to take from a case isn’t always that something needs to change; sometimes it’s instead that you’re on the right track. To illustrate this, Dr. Heaps looks to an early orthokeratology (ortho-K) patient who happened to be best friends with the very first patient he’d provided this modality to.
Seeing that the results he’d already delivered were not only benefitting his original patient, but had opened another’s eyes to myopia control via ortho-K, increased his confidence in continuing to offer it in his practice.
Building confidence in both patients and practitioners
Confidence can also come as a by-product of successfully navigating unusual or high-pressure situations. This is something Dr. Gaan learned when, within her first few years of practicing. She recounted being asked to fit orthokeratology lenses for a -2.00D five-year-old patient. “I told his parents that I’d never fit a five-year-old in ortho-K before, that five is really young, and that I wasn’t sure if I could do it—but his dad told me that I could,” she recalls.
After confirming that the parents were aware of the risks of using contact lenses and that they were going to help their son to take care of and use the lenses properly to avoid them, Dr. Gaan proceeded. Despite never having been in a situation quite like it before, not only was she able to fit the lenses, but the patient remained stable for the 2 years Dr. Gaan remained at this practice.
However, practitioners are not the only ones that can grow in confidence as a result of effective myopia control. Dr. Gaan observed this firsthand through her management of an 11-year-old myope. Although it was clear that this patient needed correction, having -2.50D of myopia, she’d refused glasses due to a desire not to stand out among her peers.
Because of this, the patient was not only unable to see things clearly—a particular problem as a soccer goalie—but had limited confidence, leading her to constantly hunch herself over. Although the patient’s father originally didn’t want her to wear contact lenses, after impressing upon him their need—not only for preventing further myopia progression but also to make his daughter more physically comfortable in her skin—he agreed to let Dr. Gaan fit her with ortho-K.
“The minute we put the lenses in, she was glowing. She literally looked like a completely different—super confident—person. It was almost as if her whole personality changed.”
For Dr. Gaan, this case provided a reminder that, even though parents may not always be instantly onboard, getting them there can make a world of difference.
Face the fear of failure
All three practitioners acknowledged that the fear of making a myopia management mistake is very common, especially in the beginning. Although this is natural, especially for eyecare providers, who are consistently aiming to deliver the best possible results, Dr. Mann encourages providers to avoid being inhibited by the fear of failure—highlighting that it can actually be your greatest ally on the journey to success. He points back to a patient that he first started managing when he was still newer to fitting ortho-K as an example.
“Don't be afraid to do something because you're worried that it might take more time, or that you might mess up and fail. We all fail. Failure makes us better at everything.”
Seeing that, at nine years of age, this patient already had high myopia, Dr. Mann first considered a combination approach of ortho-K and a soft lens in the hopes of reducing at least half of the -10.50D the patient was experiencing—however, it proved ineffective.
“I ended up spinning my wheels for a while because I didn’t realize such an approach doesn’t work 99% of the time; there’s not enough cornea to compress,” he explains. As his first attempt wasn’t working, Dr. Mann decided to switch things up, putting the patient on a combination of MiSight and atropine drops with spectacle lenses on top for residual correction.
This new therapeutic regimen—borne from the understandings gained from its predecessor—took this child from increasing by 2.00 to 2.50D per year to being one of Dr. Mann’s most stable patients. "It’s made a difference to his family too. His mom cries tears of happiness every time she comes in; it’s the best feeling," he added.
Conclusion
While the ideal scenario involves identifying at-risk or pre-myopic children early and securing parental support for intervention—particularly among parents who are already high myopes—this is not always achievable.
Nevertheless, as demonstrated by our experts’ experiences, continued learning, adaptation, and refinement of both communication strategies and clinical implementation can lead to greater success over time. With persistence, clinicians can steadily build a stronger track record of effective myopia management outcomes.
This article was written by Oscelle Boye, MBiomed, based on the recorded conversation between Drs. Mann, Gaan, and Heaps.
