Myopia is a global, growing crisis.
Its prevalence is likely to leap from 2 billion people worldwide a decade ago to nearly 5 billion midcentury, according to data from the Brien Holden Vision Institute.
Why is myopia suddenly on a meteoric rise? Experts agree that global changes in lifestyle—including fewer hours spent outdoors, more time spent on near work, and the prevalence of digital device use—are a contributor.
Fortunately, however, many eyecare professionals in the U.S. are beginning to ramp up services to educate parents and to help slow, stop, and even prevent myopia progression in young children. While some of this has long been an accepted part of patient care, the increased concentration on it as a specific practice specialty is exploding.
All this matters for a lot of reasons, not the least of which is education. Children with poor vision are, in fact, three times more likely to fall behind in class than their peers. And that’s just the beginning.
Recent research findings as well as milestones in treatment are definitely shaking things up.
TECHNOLOGY. CooperVision received U.S. Food and Drug Administration (FDA) approval, following a four-year study, of MiSight 1-day contact lenses. This represents the only FDA-approved daily wear, single-use contact lens designed to slow the progression of myopia when first prescribed to children between ages 8 and 12.
RESEARCH. According to the National Center for Biotechnology Information, a two-year study found the combination of orthokeratology and topical atropine 0.01% in children with higher myopia was 28% more effective than contact lenses alone. That number was 38% in children with lower myopia.
To do a deeper dive into myopia management in practice, EB interviewed two members of the Essilor of America Myopia Taskforce:
Alan Glazier, O.D., consultant and founder of the Myopia Institute and Shady Grove Eye and Vision Care in Rockville, MD.
Pamela Miller, O.D., FAAO, JD, whose solo practice is in Highland, CA.
We also spoke with Gary Gerber, O.D., co-founder of Treehouse Eyes, with 10 countrywide locations dedicated to myopia management in children, and founder of The Power Practice consulting group. Each offers a different take on managing myopia.
“Today,” explains Dr. Glazier, “we can offer therapy, not just crutches. Optometrists have a responsibility to understand myopia management because the paradigm is shifting. And, especially now with the approval of the MiSight lens, the standard of care is changing.”
That definitely doesn’t mean one size fits all, however. “There isn’t one ‘best’ treatment as it’s very patient specific,” explains Dr. Gerber. “That is one of the challenges that ‘dabblers’ in myopia management face.
“Having just one tool in the myopia toolbox does patients and the discipline a huge disservice. MiSight is one of many good tools available; and like the others, it’s all about choosing the right tool for the right patient.”
One big problem is getting the word out. “The majority of parents have never heard of myopia management, or they confuse it with the vision benefit from orthokeratology lenses,” says Dr. Gerber. “That leads to the next challenge...time. It takes considerable time and marketing resources to educate parents.”
Asked about the business benefits of expanding the myopia management portion of a practice, Dr. Glazier explains, “It’s referrals and, of course, higher profits because it’s mostly a non-covered service. Plus, it’s still nascent, so few doctors understand and emphasize it.”
How does a practice have to adjust to increase its emphasis on myopia management? “It’s sometimes more about changing your thought process than changing how you practice,” says Dr. Miller.
Some practices are totally refocusing and rebranding. Others, however, are what Dr. Gerber calls “dabblers.”
Regardless of where you fit, there are certain basic investments. In terms of equipment, it’s an A-scan. “It’s an expensive but definitely entry-level tool for this specialty,” explains Dr. Glazier. “And, everyone in the practice should be trained about it.”
Other basic changes involve scheduling and deciding how and when to best fit in longer appointments, plus how to accommodate families. Practical considerations include expanding space for training patients and families on contact lenses.
Also, you likely need additional seating for families, especially kids in the exam rooms (a big challenge given how small many lanes are) as well as in waiting and consultation areas.
As for challenges, Dr. Miller says lack of insurance is a big issue for patients in her practice. They simply can’t afford treatment that isn’t covered by insurance. Unfortunately, that does limit the reach of myopia management.
The other big challenge is, simply put, deciding how deep you want to dive. As Dr. Gerber puts it, “Done properly, and setting the proper fees for the time allocated (not always straightforward to figure out), it can be very financially rewarding.
“Not set up correctly, however, it can be a business drain because the primary care practice will suffer. Referrals come if you do a great job and IF you carefully explain to parents the real benefits of their kids being treated.”
COMING NEXT MONTH:
The debut of EB’s NEW Myopia Management column. In the first installment: Strategies to help “recreate” your practice PLUS ready resources to help you take a deeper dive into myopia management.