From concept to execution, incorporating a new subspecialty requires a significant investment of time and resources for an eyecare clinic. While the benefits of establishing a myopia management center are many, practitioners who are new to the field are wise to establish a list of priorities that align their practice’s efforts and provide goals to work toward. Here are some of the myopia management priorities we have established at our practice.

Reach as Many Children as Possible

When we first began offering myopia management services, we prioritized reaching as many children as possible. This starts with discussing myopia progression and treatment options with every progressive myopic child and his or her family. A top tactic to become successful and efficient at engaging patients is repetition; keep in mind that if the eyecare practitioner doesn’t bring up myopia management in conversation, most patients won’t ask about it.

While it is necessary to establish appropriate fees to account for the purchase of specialized equipment, staff training, and increased chair time associated with myopia management, strive to minimize cost as a barrier to proactive myopia care. Set fees fairly but consider establishing a structure that enables most of the practice’s young myopes to receive proactive myopia treatment, rather than only a select few.

Select the Best Strategy

Methods that have been shown to slow the progression of myopia include orthokeratology, soft multifocal contact lenses, atropine therapy, and some spectacle lens designs (Huang et al, 2016; Lam et al, 2020). While all of these methods are effective, not every method is ideal for every child. The first step in selecting a treatment strategy is understanding that the best therapy is generally the one with which the patient will be most compliant.

For children who express significant apprehension about wearing contact lenses, atropine therapy is generally the best strategy. On the other hand, patients who express an interest in independence from glasses and contact lenses are excellent candidates for orthokeratology. For fast progressors and those at greatest risk for high myopia, don’t hesitate to consider combination therapy with orthokeratology or soft multifocals and atropine therapy, which may provide superior control of myopia progression compared to monotherapy (Wan et al, 2018).

Optimize Follow Up

It is critical that myopia management patients are monitored regularly to gauge both satisfaction with and response to the treatment modality prescribed. First, to prioritize follow-up, educate all myopia management patients and their families that the practice is happy to see them any time they experience a change in vision or issues with their treatment regimen. While patients rarely come in for these visits, emphasizing this point on the front end establishes the preferred dynamic: to see myopia patients regularly.

At the same time, strive to avoid making myopia management an inconvenience to patients. While it might be nice to have monthly cycloplegic refractive error data, it is certainly not feasible for the average child or necessary from a clinical standpoint. For most established myopia management patients, a six-month follow-up is sufficient to gauge response to treatment and adjust, if necessary.

Make Myopia Fun

Last, but certainly not least, prioritize making myopia fun for patients. While spending an hour at the eyecare practitioner’s (ECP) office several times per year may not be what most children consider fun, the increased frequency of follow-up allows the physician and staff to develop a close rapport with these patients and their families. Engaging myopia management patients on topics of interest to them, such as sports and hobbies, allows the practitioner to establish a bond, which can help maximize treatment compliance and cue the ECP in if another treatment modality may be more optimal. CLS

References

1. Huang J, Wen D, Wang Q, et al. Efficacy Comparison of 16 Interventions for Myopia Control in Children: A Network Meta-analysis. Ophthalmology. 2016 Apr;123:697-708.
2. Lam CSY, Tang WC, Tse DYY, et al. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol. 2020 Mar;104:363-368.
3. Wan L, Wei CC, Chen CS, et al. The Synergistic Effects of Orthokeratology and Atropine in Slowing the Progression of Myopia. J Clin Med. 2018 Sep 7;7:259.