The industry’s understanding of myopia, including its causes and factors that contribute to its progression, is still very limited. As with any new research or technology, learning to adapt these updates into a practice can be a slow process.
However, while research continues to evolve and new information becomes available, the industry has to overcome that resistance, and we have to focus on prevention. “It’s not necessarily about stopping the increase in the number of their prescription. We’re concerned more with the health risks,” Dr. Hosein says.
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Getting started with treatment options for myopia control
There are currently three key treatment options in the world of myopia control:
While they do all have the ability to serve your patients and potentially help halt the progression of myopia, it’s important to find the option that works best for them. Dr. Hosein works largely with incredibly young patients and has found a great deal of success in using .05% diluted atropine drops with them as there are higher rates of compliance when their parents are able to apply the drops directly. Slightly older patients, however, have found success with the proper lenses.
Handling children and contact lenses can be tough. Follow along with this interview with Dr. Linda Chous, OD for some insider tips.
These treatment options can be immensely helpful, but the treatment process is preceded, more importantly, by proper diagnosis. If you plan to integrate myopia control into your practice, myopia experts recommend taking an all or nothing approach. This is primarily because you want to do your due diligence and properly treat patients suffering from myopia in full.
Dr. Hosein points out that “when [we’re] talking about myopia progression, we’re really talking about the axial length of the eye, not necessarily the numbers.” To properly monitor the progression of myopia you’ll need devices like a pentacam and perform A-scans to get the full picture.
If you’re unable to bring on proper equipment, work to build referral relationships with other ODs in the area. You can still do your part to identify myopia and educate your patients, but they should be treated wholly with the right equipment.
How do I talk to my patients about myopia?
Myopia is a complex subject and starting your conversation with a patient’s parents can be a valuable step in halting progression. Identification is only the first step, but once you can confirm the issue (based on either your own equipment or from refractive changes) you can work on educating them on the disease.
Starting the conversation
While many people will gravitate toward the cost of care, you can draw the conversation toward the importance of going through a full evaluation and instead discuss the ramifications of not treating or managing myopia properly. Costs can be prohibitive for some patients, but at the practice level, it is your duty as an OD to provide information and educate your patients and their caregivers on their health.
Myopia specialty practices may even consider advertising that specialty, though the terminology can be lost on patients unfamiliar with the disease itself. Some patients, Dr. Hosein highlights, may even be unfamiliar with “nearsightedness.”
Keep in mind that the largest brands in the eyecare space may be embracing myopia education and prevention as a brand, it isn’t always necessary to tout it as a small business. If you see the signs in a patient, simply open the floor for discussion and offer insight and treatment options as you would with anyone else.
Building a treatment plan
Once you’ve had a conversation with a patient and possibly their parents, you’ll want to work with them to follow through on a full treatment plan. It’s important to schedule time to follow up with your patient several months after an initial appointment or after prescribing a full treatment plan.
But what happens is a patient returns and their myopia has progressed further? Unfortunately, there is no guarantee that ODs can completely stop myopia from advancing, but they can work to slow that rate of change. Educating patients on that fact from the start can also help to smooth that conversation down the line. These treatment plans, ideally, will extend until the patient is about 18 years old as at that point the eye will be fully developed, and it is unlikely that the axial length will change much further.
It’s essential to consider the lifelong ramifications of uncontrolled myopia, and even though the direct treatment of myopia is uncommon in the industry today, there are many patients that can benefit from an OD’s assistance in reigning in myopic progression.