Eyecare practitioners are constantly trying to figure out which treatment option would be most effective for their patients who have myopia. Treehouse Eyes partner practices now have a new resource that can help them answer that question.

The recently released Treehouse Vision System 2.0 (TVS2) is an updated algorithm that allows practitioners to input their patient’s specific myopia progression risk factors and current level of refractive error and find the most efficient treatment options. According to Treehouse Eyes, the protocol is backed by data from its patient population, as well as previous myopia management studies. The TVS2 not only recommends an initial treatment option, but also gives annual axial length targets and what treatment changes may be the most effective if those targets are not met, according to the company.

Here we share the clinical experiences of three practitioners who are using the Treehouse Eyes’ TVS2 in their practices.

Please tell us about your general experience with Treehouse Eyes’ TVS2.

For Christopher Browning, OD, who practices in Greenwood, IN, the algorithm has been incredibly helpful in taking the guesswork out of the decision-making process for the best clinical outcomes for his patients. “We run a busy clinic with lots of kids and parents that are all very concerned about their kids ‘getting worse’ at anything,” he explains. “So, the algorithm helps to keep us following the scientific studies and explain to the parents why one treatment is better than another—because it has worked for many other kids in the same situation as their child.”

Ryan Stybel, OD, who practices in Manhattan Beach, CA, agrees that the algorithm has made the decision process simpler. “The algorithm has made it easier for us to understand the best treatment plan and have the confidence we are going to minimize the degradation of our patients’ eyes,” he says. “It is simple to follow and lays out treatment based on risk factors and current patient statistics, such as axial length and level of myopia.”

Who are the best candidates for TVS2 and why?

Dr. Browning believes that all kids can be candidates for the algorithm because “myopia is not acceptable or a normal state of the human eye.” He adds that his practice has even started treating very young patients that should be farsighted but are emmetropic because “we’ve seen their axial length increase dramatically and we know they are going to be nearsighted, just like their highly nearsighted parents or siblings.

“The algorithm has been great for helping to decide the best treatment of the kids who initially present as a good candidate for several different types of treatment,” says Dr. Browning. “The algorithm helps us get to the most effective treatment efficiently.”

Dr. Stybel adds that all children are candidates, not just the ones who have myopia. “The patient may have greater than age expected axial length and risk factors but not be myopic yet and we would consider treating that patient,” he explains.

How has the TVS2 algorithm helped with troubleshooting for patients?

Dr. Browning notes that the TVS2 algorithm allows him to explain to the parents why something their child has already been doing, such as just using the atropine prescribed by their primary eyecare provider, may not be a comprehensive way to deal with their child’s myopia. “There are a few patients who we started with a few years ago that we’ve modified their treatment plan based on the new [2.0] treatment algorithm to improve their results,” he says.

Dana Reinhardt, OD, who practices in Bethesda, MD, concurs that, as a health care provider, she always wants to do her best to help patients. To her, this means practicing evidence-based medicine. “TVS2 effectively takes Treehouse Eyes’ data and recommends the most effective treatment option,” she says. “Once you’ve started your patient with the recommended treatment, there are targeted annual axial length goals. If you have a tricky patient who is not meeting his or her targeted goal, TVS2 provides guidance on next steps so you can make treatment changes specific to your patient.”

Please tell us about a particular success story with this product for a given patient.

Dr. Stybel recounts the story of a 13-year-old female, who has had stable myopia and axial length using soft multifocal contact lenses. He notes that her myopia is relatively mild, but she has some genetic and environmental risk factors. “The algorithm treatment path designated soft multifocal contact lenses as the best initial therapy,” he says. “We started with that treatment and haven’t looked back as we have been successful in her treatment by limiting her axial elongation.”

Dr. Reinhardt tells of a consultation that she had with a patient who was referred over by a local optometrist. “The patient was young, only 8 years old, but already highly myopic,” she says. “After going through the consultation and explaining the various options, the patient’s mother was completely on board with the recommended treatment. However, the patient’s father was initially very apprehensive.

“After explaining the data behind my recommended treatment, he felt more confident in the decision,” she continues, “and we were able to get his daughter the help that she desperately needed.”

Dr. Browning also had a patient who was very young. “Max is a 7-year-old boy who was referred to us by a nearby office because his nearsightedness had doubled each of the last three years. And, he had been bummed about watching his glasses get thicker and thicker,” he says. “His mom was concerned about him being as nearsighted as she is.”

He explains that TVS2 helped them decide on the best course of action. “We started with orthokeratology and had some pretty good success in slowing things down, but needed to add atropine to get his axial length to slow down sufficiently.” CLS