There’s no need to preface this article with widely known stats about the myopia epidemic. Instead, what needs to be addressed is the proverbial elephant in the room related to that epidemic. Namely, if there are so many myopic kids who need help, and we have the science and technology to help them, why don’t more eyecare providers practice full-scope myopia management?
Through my professional endeavors, I have spoken to literally hundreds of practitioners. Based on those discussions, I can list the top four reasons—in my opinion, invalid reasons—why more practitioners don’t practice myopia management.
- “It’s not really a problem that needs treating, especially in young kids who are low myopes.” By far, this frustrating comment is the biggest obstacle addressing the myopia epidemic. After all, if practitioners don’t recognize myopia as anything more than an optical inconvenience, who can blame them for not treating it? Related to this thought is, “I saw a –0.75D 9-year-old girl today. I told her mom ‘We’ll watch things for now’ and instructed the mom to bring her daughter back in a year.” I’m sure that what this physician will watch is his patient getting worse.
On one hand, no one knows which kids will or won’t get worse. Therefore, opting to withhold treatment to wait and see whether there is progression seems reasonable. However, in a young patient such as this, the odds are overwhelmingly high that progression will happen. On the slim chance that you treated this kid and the myopia did not progress (and there’s no way to predict that with certainty yet), you are essentially weighing the risks of treating (very low) versus the risk of progressing (very high). If this patient comes back next year and is at –1.50D, what then? Wait again?
- “I don’t have the right technology.” In the case above, I purposely did not list the patient’s axial length. If it was 25mm versus 22mm, you’d have an even stronger reason to treat. Bluntly, not treating myopia because you don’t have the technology is a poor excuse. Go buy it or refer to someone who has it. This is no different than referring out a patient for optical coherence tomography or dry eye therapy if you don’t have that technology. If you want to master myopia management in your primary care practice, don’t dabble. Get the technology that you need.
- “How do I know that a treatment will work on a particular patient?” You don’t, but you do know that they work well on most kids most of the time. Your glaucoma therapy doesn’t work for every patient every time, but that doesn’t preclude you from treating those patients.
- “I’m not comfortable charging high fees.” Fees don’t have to be high or low. Like any fee for any service, they should be commensurate with the time and expertise that you will provide. There is no doubt that it will take more time to treat myopic kids than simply handing them a pair of glasses. Charge appropriately for the time and investment that it takes to treat these kids, like you (hopefully) do with everything else in your eyecare practice.
The Final Argument
Let’s give you the important stats now. About 30%, or 15 million, kids in the United States already have myopia. Yet, by our estimates, less than 5% of practitioners have mastered myopia management and are stepping up to take care of these kids. Look inside yourself to overcome the above reasons, and join your colleagues in this important battle on myopia. CLS