The Economics of Myopia Management

Since starting my career in optometry, I always had an interest in myopia management and specialty contact lenses. After working in private practice for the beginning of my career, we officially opened the doors to the Charlotte Contact Lens Institute in February 2023. We’re a primarily referral-based office, and we typically do not perform primary eye care exams — our specialty is specialty contact lenses and myopia management. Over the course of my career, I’ve learned how to approach having tough conversations with patients, how to price my services in a way that benefits the practice and allows for more time with each patient and the ability to invest in the best technology for monitoring the conditions we specialize in, while providing patients with the highest quality of care. 

The Financials of Myopia Management
As an office that does not accept any insurance, our practice may be viewed skeptically by many ODs who feel it may be difficult getting patients on board with a specialty such as myopia management. However, we’ve found a system that works for our office and our patients. We offer a subscription plan where the patient has a contractual agreement to make monthly payments for a minimum of 12 months. With that monthly payment, they receive their lenses either for the year if it’s for orthokeratology, or we give them three months at a time for soft contact lenses. 

I’ve found this payment structure to be advantageous over offering a global fee because it helps make it more accessible to patients. Rather than paying a large sum, we’re breaking it down into smaller dollar amounts each month, and that’s been effective for our patients. We also help cover a large portion of our costs in the first year by charging a consultation fee and then a dispense fee.

How to Charge for Different Treatments
When it comes to charging for different treatments, I’ve set it up so that both OrthoK and soft contact lenses are the same price, and low-dose atropine is a bit cheaper because there are no material costs associated with that modality. I’ve noticed that for the first year of myopia management treatment, you typically have more chair time with OrthoK patients, but lower material costs. The opposite is true for soft contact lenses. I see those patients for fewer follow-ups, but the material costs are higher, so it evens out to be around the same price for both of those treatments. 

Many doctors struggle with how to price their myopia management packages, but I developed a system that is effective for our whole team. We started by calculating my chair cost to determine how much it takes to break even when a patient comes to visit our office. I took that number and thought about how many follow-ups that particular patient would have, and then that’s the minimal price to break even. Then, I thought about what I felt the service was worth above and beyond that breakeven price. I then added my material costs on top just as I would price a premium soft contact lens.

Instead of thinking about how other practitioners were pricing, I used this model, which benefited our office in a few ways. One, it made us confident that we weren’t losing money on how frequently we see these patients for follow-ups. Two, it helped my confidence in telling patients the price. It also helped our team’s confidence in sharing prices with patients because we were very transparent about it. So, when our team quotes myopia management treatments after knowing why our prices are what they are, they are a lot more confident. There is no hesitancy talking about the dreaded number. 

Getting Parents on Board
Even though most of the parents coming into my office are specifically seeking myopia management, the cost of treatment is still a barrier in some cases. Many parents also have questions about why their insurance won’t cover myopia treatments if I’m describing them as medically necessary. It’s our job as doctors to help parents see the value in what we’re doing. 

We know as doctors and eye care practitioners that myopia increases the risk of diseases later in life. In my experience, when you educate parents on that, it does not really resonate with them as much as the emotional impact that myopia has for children. In the exam room I like to discuss  the confidence and self-esteem that comes with wearing contact lenses. I often reference a paper by Dr. Jeffrey Walline that highlights these concepts and the emotional benefits of putting kids into contact lenses. Kids are typically willing to try new things, and their self-perception improves. 

Above and beyond that, I emphasize what their child’s vision could look like as myopia progresses over time. I’ll put plus lenses in front of the parents’ eyes to help demonstrate this. If the child was at -0.25D a year prior, I’ll put +0.25D over both parents’ eyes. If the child progresses to -1.00D, then I’ll put +1.00D over the parents’ eyes. From there, I project what their child’s vision could look like two to three years from now based on their previous progression. This allows me to show the parents how their child’s vision has worsened, and I think it’s very important to use verbiage, such as “worsened” versus “changed” as it speaks to the concerning nature of myopia progression in children . 

Usually when parents see how their child’s world is becoming blurrier and blurrier, that makes a big emotional impact for them. Unlike a lot of other medical conditions, you can look at a child and have no idea that they can’t see. So, it’s hard for parents to really understand what they’re going through, and once they have that understanding, that’s helpful. I, of course, also talk about the disease process that is at an increased risk with untreated myopia, but that’s not my main emphasis during these discussions. I try to drive home the emotional impact with parents and emphasize that we have the tools to help. 

Getting Started with Myopia Management
For any practitioners considering getting started with myopia management, my biggest piece of advice would be that it’s okay to be told no. That’s the thing that I struggled with the most. I was discouraged the first time that I got into practice and patients just weren’t getting it. That should never stop you! It’s okay to be told no. My second piece of advice would be to have a technician or a team member that is your partner in education on myopia. If you have a team member who helps with the quoting process and the education process, once that patient leaves your exam chair, they’re critical for patient conversions. 

The ability to provide our youngest patients with these services is such a rewarding part of what I get to do everyday. While adding any specialty comes with skepticism, doubt, and challenges, there are tangible ways to make the process smoother and more successful for your business.