Myopia Management: A Pillar of Our Practice

Myopia management feels very foreign to a lot of eye care practitioners. It is a paradigm shift in our thinking to look at myopia as a disease and not just a refractive error. What compounds that is we may not see the full effect of management during our careers, since effects of myopia that we are lessening for a 7-year-old may not be evident for 50 or 60 years! 

However, independent practice owners shouldn’t be intimidated by this rewarding specialty. Over the last eight years, I’ve fine-tuned my practice’s approach to myopia management. Now with three locations, and four full-time ODs, we’ve accumulated a large database of myopia management patients, and we consider it a pillar that we’re building our independent practice around. 

Marketing Myopia Management Within Our Practice and Community
Within our practice, we have evolved our marketing efforts many times over the last few years. We created a separate branch of our practice — “The Myopia Matters Club” — which has its own logo, website, printed materials, etc. I like this approach because it creates instant credibility to a potential parent and lets them know that this is something we have invested a lot of time and effort in. It builds an instant comfort that they know their child’s eyes and myopia will get the best care. 

One of the latest things we’ve implemented is measuring the axial length of every child aged 16 and under during their routine exam. We then determine their risk for myopia progression. If they are high or medium risk, we send them a link to a password-protected video on the Myopia Matters Club website that discusses myopia management in detail. I have found that most parents do not elect to move forward with treatment after one visit, but by planting this seed, it allows us to have easier conversations at future appointments.  

Within the community, we have reached out to local optometrists, pediatric ophthalmologists, and pediatricians with information about myopia management and our services. This is extremely hard as it is difficult to get any of these providers to think differently about myopia. We have found the greatest number of referrals from optometrists in corporate settings. Some of these doctors realize the importance of myopia management but don’t have the tools or structure that allows them to treat it properly. The hardest group I have found is pediatricians, as many just don’t understand myopia or myopia management.   

Creating a Fee Structure
In the Myopia Matters Club, we have chosen to use the global fee approach. Like orthodontics, patients pay a set fee that includes all testing, treatments, etc. We had used an approach that charged a fee per each individual treatment when we first started myopia management, but we ultimately found that the global feel structure worked better for us. I personally like that patients are now not choosing treatments based on cost, and once they are committed, it becomes very simple. If we then add combination treatments or have to switch treatments, there are not any additional costs. We also offer a monthly fee option that allows parents to have a set amount charged on their credit cards each month. This has been appealing to a lot of families since it allows their child to be treated with less upfront cost.

Myopia management treatment is not covered by insurance at this time. When talking to parents about this, I’ve found that keeping it simple is the best approach. The less I say, the better the conversation usually goes. If I feel the parent is frustrated, I often tell them that insurance is not in the disease prevention business, and it currently is used to treat or manage current disease states. Myopia management can make a difference for these kids over the next 50 plus years, and most insurance companies don’t want to pay for something now that they will not see any benefits from that far in the future.  

When I first started offering myopia management, I struggled to find the confidence in having these difficult conversations with parents. With little experience and trying to discuss a brand-new category to the parent, it was very hard to appear confident when I didn’t have the experience to back it up. This was by far much easier when the parents have suffered from effects of high myopia themselves. When we discuss with a mom who is a -6.50D myope that has been watched for retinal holes or glaucoma, they understand the risks and will be more willing to help their child not suffer in the same way. Once I gained confidence with parents who were open to treatment, I was able to develop a “script” that allowed me to discuss with other parents and help them understand what we are actually preventing by managing their child’s myopia.

Getting Staff on Board and Investing in Myopia Management
Having staff support is an absolute must in order to be able to succeed with myopia management. We have our “Myopia Matters Club Coordinator,” Sabrina, who does so much to help us succeed. She makes sure all candidates for myopia management get a video that describes in detail what myopia management is, the options for treatment, and the details of our program. After they watch it, she reaches out to them to answer any questions and schedule a consult if they decide to move further. Once a patient starts treatment, she orders all supplies, handles any issues with the materials or any issues with payment, and makes sure patients get scheduled appropriately. Basically, she does everything behind the scenes, freeing me up to actually manage each child’s myopia, which has been essential. Since she has been trained, it has allowed me to focus on the patients, which has led to better care and making it enjoyable for me!

I believe there is some investment if myopia management is going to be done correctly. If we are performing myopia management, each case is very individual, and if you’re only offering patients soft multifocals and not discussing orthokeratology or low-dose atropine, then you may not be giving that patient the best treatment. Every treatment has a percentage of non-responders, which means a doctor should be prepared to give all options.

For independent practitioners who may be considering incorporating myopia management into their practices, my best advice would be to try not to get overwhelmed. There are countless resources out there to help you get started — many more than were available when I started in this field almost a decade ago. But starting with a simple case can be a good way to get acquainted. The less complicated, more straightforward cases can help you build success and feel confident, which will then lead to taking on more difficult cases.