By 2050, myopia is expected to become a leading cause of permanent blindness worldwide, with the number of myopes reaching almost 5 billion.1 Since the 1970s, the prevalence of myopia has nearly doubled.2 While genetics is a factor, science points to increased screen time and less time outdoors as key factors driving this myopia boom.3
Myopia significantly increases the risk of:
- Glaucoma—14.4x for myopia >8.00D4
- Cataract—3.3x for myopia >6.00D5
- Retinal Pathology—7.8x for myopia >8.00D6
Statistics like these demonstrate the growing need for myopia management experts to help tackle these disturbing trends.
The benefits of using ortho-k for myopia management
In his practice, Dr. Thahn Mai focuses primarily on specialty contact lenses and has a passion for myopia management with orthokeratology and other methods. Although they “do all the types of myopia management” and will adopt the best approach for the child, he said ortho-k often ends up being the treatment of choice.
After evaluating the patient’s profile, history, prescription, axial length, and other factors—and then discussing available options—the lifestyle benefits of ortho-k along with the dual purpose of myopia management and vision correction usually helps parents and patients decide.
“When you talk about the dual purpose of it…that combination of doing both at the same time…when a patient hears that they say, ‘Give me that,’” Dr. Mai said.
As far as benefits to the practice, Dr. Mai said ortho-k “really sets you apart,” since it’s not widely available. Additionally, he’s found that offering ortho-k helps to boost patient loyalty and referrals.
“When you do [ortho-k], your patients are extremely loyal to your practice,” he explained. “The patient is amazed when they see 20/20 the day afterwards. And guess what happens? They tell their friends, so it helps to generate [referrals] and builds the practice as well. It's a practice builder, but most importantly, it's good for the patient.”
Diagnostic and treatment workflow
When asked to describe the cadence from initial evaluation to a recommendation for treatment, Dr. Mai said if the patient has already had a primary care exam, at consultation they usually measure axial length, a cycloplegic refraction, and corneal topographies.
“At a minimum, that's usually enough for you to make a recommendation in terms of what to do next,” he said.
He also said it’s important not to overwhelm a patient (and parents) with too much information about myopia management all at once, noting that in the context of the higher cost of ortho-k, the “number one reason” patients don’t sign up is that the information is too new to them.
“The goal of the primary care examination at that point would not be to discuss myopia management. It would be to book the myopia management consultation,” Dr. Mai said. “At the consultation, you'll discuss all the options, the axial length, history of progression, whatever you need to do, and then make the recommendation at that time.”
To avoid information overload and the potentially negative impact on receptivity to ortho-k treatment, he said it’s critical to get “the setup” right.
“It's the work you do beforehand to educate the patients. Did you send them an email ahead of time? Did you send them a YouTube video explaining what you're talking about? Maybe you have a whitepaper or an e-book you've written that you can send them ahead of time to educate them about what you do,” he said, also emphasizing the importance of clear communication to help parents understand “why you're doing this and why it's helpful for their child.”
When asked about his preferred ortho-k techniques, Dr. Mai said that instead of ortho-k fitting with diagnostic trial lenses, they do a lot of “empirical fitting” by getting measurements, topography, prescription, etc.
“We usually order empirically based on that data. What we find is that it streamlines the consultation and makes it easier. It also shows the parents and patients that they are getting a custom lens,” he explained. “When you're ordering empirically, at least in our experience, 90% of the time to 95% of the time we're done in the first or second lens, as well.”
Tips for getting started
In terms of advice for those who are considering adding myopia management to their practices, Dr. Mai said it’s important to start with a mindset that recognizes myopia as a disease.
“The number one reason people don't get this going is they don't believe myopia is a disease. It's a disease of the eye in which the children's eyes are getting too long. And there are visual and ocular consequences, especially later, because of it,” he said. “If you believe that first, like I do, patients will come on board with you. Because patients don't buy what you do, they buy what you believe in.”
Dr. Mai said when practitioners approach myopia with such a mindset, “then you're going to treat it like you treat any other disease. …If you have that mindset, then you're on the right track to creating a world-class myopia management practice.”
To get started, he recommended that optometrists start “from the inside out” by first training themselves and members of their staff on myopia management technologies, as well as getting a coach or mentor. Once expertise is developed, then marketing to the community can begin.
“But don't go into the community and start doing your marketing until you can do the internal processes first,” he said.
Partnering with Euclid for myopia management
Dr. Mai is so passionate about myopia management that he views it as “the biggest thing in optometry that will change in the next few years.”
“It is coming on like a tidal wave and myopia is only growing in proportion epidemically,” he said.
Dr. Mai partners with Euclid to offer ortho-k for myopia management and cited several benefits of doing so.
“Euclid is great. A lot of orthokeratology companies do a great job, but I'd say one of the key differentiators is the customer service, the support, the consultation,” he said, adding that with the support Euclid provides, practitioners don’t need to be familiar with ortho-k to get started.
“When I first started, I knew nothing about doing orthokeratology,” Dr. Mai explained. “So the good thing about Euclid is that you don't need to know what you're doing yet, because they’ll help you. The consultants can troubleshoot what's going on. They'll help you out because they're really nice.”
References:
1. Holden BA, Fricke TR, Wilson DA, Jong M, Naidoo KS, Sankaridurg P, Wong TY, Naduvilath TJ, Resnikoff S. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology. May 2016;123(5):1036–1042.
2. Vitale S, Sperduto RD, Ferris FL, 3rd. Increased Prevalence of Myopia in the U.S. between 1971-1972 and 1999-2004. Arch Ophthalmol. 2009 Dec;127(12):1632-9.
3. Morgan, I.G., Ohno-Matsui, K., and Saw, S.M. Myopia. Lancet. 2012; 379: 1739–1748
4. Mitchell P, Hourihan F, Sandbach J, Wang JJ. The relationship between glaucoma and myopia: the Blue Mountains Eye Study. Ophthalmology. 1999;106:2010-5.
5. Younan C, Mitchell P, Cumming RG, Rochtchina E, Wang JJ. Myopia and incident cataract and cataract surgery: The BlueMountains eye study. Investigative ophthalmology & visual science 2002;43:3625-32.
6. Group TEDC-CS. Risk factors for idiopathic rhegmatogenous retinal detachment. The Eye Disease Case-Control Study Group. American Journal of Epidemiology 1993;137:749-57.
