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Professor Padmaja Sankaridurg, B.Opt, MIP, PhD
BHVI

The evidence for the rising prevalence of myopia and, therefore, its burden is irrefutable and substantial. In affected individuals, regular oversight is needed during the progression phase to restore visual acuity, and at higher levels of myopia, more frequent monitoring is required to detect and manage any associated complications.

Although the condition stabilizes in early adulthood, in late adulthood, there is potential to develop complications especially in those with high myopia.

A number of strategies, both optical and pharmaceutical, slow the progression of myopia in comparison to single-vision spectacles and contact lenses. Employed appropriately, they reduce the risk of the eye attaining higher levels of myopia. However, in spite of the advances in myopia management, to date, single-vision spectacles or contact lenses continue to remain the most frequently used approach to manage myopia1. Clearly the process of managing any clinical condition is a complex decision that requires a careful assessment of risks versus benefits. Several factors may be responsible for the low uptake of myopia control strategies such as lack of sufficient and long term data on efficacy or safety of a particular strategy, practitioner skill base for a strategy, access to product, patient motivation, cost, convenience and acceptance, stable myopia, age of the individual and so on. While deliberating on the risks versus benefits for the newer myopia control options, it is also timely to weigh the risks versus benefits of continuing with single vision products. In this respect, there is an ongoing debate in the community on whether the use of single vision soft contact lenses and/or spectacles accelerate the progression of myopia.

The key point to managing myopia is

Dr. Sally Dillehay, Myopia Meeting Correspondent
BHVI

The Global Specialty Lens Symposium (GSLS) 2020 held January 22-25, 2020 in Las Vegas, USA featured 4 preconference tracks focused on Myopia Control as well as the main conference kicking off with Clinical Controversies in Myopia Management. Over 3 days, GSLS offered 10 hours of CE around myopia control. Organizers of the meeting announced that starting in 2021, GSLS will offer an entire day focused on myopia management with the inaugural Global Myopia Symposium.

Organizers of the meeting announced that starting in 2021, GSLS will offer an entire day focused on myopia management with the inaugural Global Myopia Symposium.

Among the many informative presentations, James Wolffsohn, FCOptom, MBA, PhD, presented on the 2018 responses to the Global Trends in Myopia Management Attitudes and Strategies in Clinical Practice, a self-administered, internet-based survey with 971 respondents in countries around the world. Concern about myopia was very high among all practitioners, especially those in Asia, and practitioners reported they were proactive in implementing myopia control strategies. However, more than two-thirds of practitioners (67.5%) reported still using single vision spectacles or single vision contact lenses as the primary mode of correction for myopia patients, citing concerns around cost (35.6%), inadequate information (33.3%), and unpredictability of outcomes (28.2%) as the main justifications.

Among multiple presentations looking at combination therapies of orthokeratology (OK) and 0.01% atropine (A), Qi Tan, MSc from Hong Kong Polytechnic University, presented data through 12 months of a 24 months study. At 12 months, axial length growth in  OK+A was 0.07+0.16 mm  compared to the 0.16+0.15 OK group alone and  was statistically significantly different (SSD). However, the difference was SSD for the first 6 month period, but not the second 6 month period, indicating an additive effect of Atropine with OK which was short lived. The Atropine group had slightly larger pupil sizes, and they postulated that the enlarged pupil size from the Atropine may be exposing the retina to increased amount of higher order aberrations, which may be part of the additive effect observed.

Concern about myopia was very high among all practitioners, especially those in Asia, and practitioners reported they were proactive in implementing myopia control strategies.

One of the featured debate topics was “Does the peripheral refraction matter for myopia progression control”? Prof. Earl Smith presented data from animal models that peripheral hyperopia does impact the development of myopia, but mainly within the 20-25 degrees around the fovea. Studies that have not found a connection to peripheral refraction have often used data from 30-45 degrees outside of the fovea, which may indicate that those data are not sensitive enough to detect what is occurring closer to the fovea. Dr. Don Mutti took the counterview that peripheral hyperopia is not correlated with myopic progression, and pondered whether we have correctly identified it as the actual mechanism for myopic progression.

Although there were many such interesting debates related to myopia  control mechanisms and management, an area that presenters appeared to agree was that there is ample evidence for multiple effective treatments to slow progression of myopia. For young children at risk of onset of myopia, counseling on improving outdoor time may be what is needed. For children already myopic and progressing, different treatments are available in different parts of the world. But whether you select specialized spectacles, orthokeratology, soft multifocal contact lenses or low dose atropine, the take home message for me from GSLS was that practitioners need to start NOW to proactively manage myopia.

Although there were many such interesting debates related to myopia  control mechanisms and management, an area that presenters appeared to agree was that there is ample evidence for multiple effective treatments to slow progression of myopia.

If you are uncertain where to start, the series of courses from BHVI provide a solid foundation on which to build and grow your myopia management practice.

The Global Specialty Lens Symposium (GSLS) 2020

Krupa PhilipBOptom, PhD
Brien Holden Vision Institute

Myopia, a growing public health concern, has been rising in prevalence with almost 50% of the world’s population estimated to be myopic by the year 20501. Sight threatening complications such as cataract, glaucoma, vitreous liquefaction, and a range of retinal and macular anomalies known as myopic maculopathy could occur as a result of high myopia (worse than -6.00 D). Younger ages are associated with greater annual progression and thus, early-onset myopia is likely to result in higher levels of final net myopia2. It is, therefore critical to curb the burden of myopia through strategies aimed to control and slow the progression of myopia.

There now exist several optical and pharmacological interventions to slow myopia.

Presently, optical interventions for myopia control include peripheral defocus correcting spectacle lenses, bifocal spectacles, progressive addition spectacles, multifocal soft contact lenses and orthokeratology3. Of these, single vision spectacles designed to alter peripheral defocus demonstrated only a small treatment effect, less than 14% reduction in myopia progression4. Bifocal and progressive addition spectacles demonstrated variable treatment effect (6% to 51%) in reducing the progression of myopia. Among the optical interventions, orthokeratology (30% to 50%) and multifocal soft contact lenses (centre-distance multifocal contact lenses – 38%) showed promising results in slowing myopia progression.

The knowledge base is encouraging for combination

Wednesday, 30 January 2020: BHVI shared today that its research collaborator Hai Yen Eye Care has achieved a nationwide first, opening a research centre in Ho Chi Minh City, Vietnam.

The Hai Yen Vision Research Institute is the first of its kind in Vietnam, a research arm in the private ophthalmology sector. BHVI’s Professor Padmaja Sankaridurg, Head of Myopia Management and Intellectual Property at BHVI and Yvette Waddell, BHVI’s CEO, were in attendance for the opening ceremony of the research wing. In addition, Prof Sankaridurg participated as an honorary speaker in a half day workshop on myopia management.

“As a group, we have a very close connection with Vietnam and specifically Hai Yen Eye Care and the opening of this research arm represents an extension of our reach, “says Yvette Waddell, CEO of BHVI. “Myopia is the fastest growing vision impairment facing the world today and we know the growth is particularly rapid in South East Asia including in Vietnam. Further research, collaboration and training of professionals is essential, and we are proud of our world-renowned reputation in this space.”

The collaboration between BHVI and Hai Yen Eye Care reaffirms BHVI’s commitment to increase its global reach in the area of myopia management.

“BHVI has been a significant collaborator and contributor to our research and the role they have played in helping us develop our research teams cannot be overstated,” says Professor Tran Hai Yen, President Hai Yen Vision Research and Training, Cofounder & CEO Hai Yen Eye Care. “To have Professor Sankaridurg and Ms Waddell here for our opening and providing us with a half day workshop on myopia management reinforced that we are at the forefront of myopia research in Vietnam and are accessing the world’s best insights.”

Currently myopia affects over a quarter of the world’s population, with numbers affected continuing to grow.

Hai Yen Eye Care provides high quality international-standard eye care in Vietnam. Co-founder and CEO, Professor Tran Hai Yen is a member of the American Society of Cataract and Refractive Surgery, American Academy of Ophthalmology and Board Member of Vietnam Ophthalmology.

BHVI shared today that its research collaborator

Weizhong Lan
MD, PhD

It is well understood that myopia commonly onsets in early childhood and continues to progress until late teenage years or early adulthood. The primary structural change in myopia is axial elongation beyond the intended eye length. As a result of the longer than normal eye length, the eye is at risk of developing complications such as retinal break and detachment, myopia maculopathy, choroidal neovascularization and glaucoma, especially in later life and the risk increases exponentially with the degree of myopia.[1, 2]

Therefore, a key goal for myopia control is to control or slow progression to reduce the risk of high myopia.

In a myopic eye, there is good correlation between axial length and the degree of myopia. Therefore, both are good indicators in assessing the rate of progression of myopia. It is now well understood that myopia progression is faster in younger children and slows with age.[3] The younger the age of onset of myopia, the greater the risk. In addition, ethnicity, parental myopia, and schooling are factors that were found to influence progression.

The key point to managing myopia is

Dr. Sally Dillehay, Myopia Meeting Correspondent
BHVI

THE Myopia Meeting (TMM) was held in early December 2019 in San Francisco, with just over 100 people in attendance. TMM is headed by the Chief Medical Editor for Review of Myopia Management, Dr. Dwight Akerman, and managed by its publisher, Jobson Medical Information, LLC.

TMM was a full day of excellent information presented by Drs. Mark Bullimore, Noel Brennan, Maria Liu, Tom Aller, and S. Barry Eiden. Throughout the day, workshops and exhibits by various sponsoring companies helped to round out a full day of learning with 6 COPE approved CE hours.

Even at age 25 or older, at least 1 in 6 myopes will still progress at least 0.50D over 5 years.

Drs. Bullimore and Brennan presented a thought provoking summary of 12 evidence-based things that we all need to know about myopia. Myopia is the leading cause of irreversible vision loss, and yet its major cause of vision loss, myopic macular degeneration (MMD), is the only leading cause of blindness without an established treatment.

It may surprise you that 30% of those who develop MMD are moderate myopes in the range of -2.00 to -5.00D. Although age is the most important determinant of myopia progression, race (Asian), family history (2 parents), gender (Female), all represent additional factors in the rate of progression. The exact age when myopia progression stabilizes varies widely, but at age 15, 50% of myopes are still progressing. Even at age 25 or older, at least 1 in 6 myopes will still progress at least 0.50D over 5 years.

Likewise, many children with photophobia do not always have dilated pupils, so pupil size has limited value in predicting issues with glare, photophobia, as well as accommodation. It is common to see an anisocoria with 0.01, 0.025, and 0.050% atropine.

Dr. Liu presented her observations on atropine use, based on patients seen in the University California Berkeley School of Optometry Myopia Clinic. She has observed that low-dose atropine can create cycloplegia, mydriasis, photophobia, and allergic responses. Many children with dilated pupils have no photophobia.

Likewise, many children with photophobia do not always have dilated pupils, so pupil size has limited value in predicting issues with glare, photophobia, as well as accommodation. It is common to see an anisocoria with 0.01, 0.025, and 0.050% atropine. She has also noted a hyperopic shift in even 0.05% atropine at the 1 month visit, due to relaxation of tonic accommodation. She recommended starting with 0.025% atropine, measuring amplitude and facility of accommodation, pupil size, slit lamp exam and IOP at each follow up visit, which she completes at 1 week, then every 3-6 months.

Based on a repeatability study for myopes for one visit to the next that Dr. Eiden performed with several other practitioners on the IOLMaster (publication in progress), he recommends taking 20 measures of axial length on each eye to be able to track progression at the 0.04mm or 0.125D level.

Dr. Aller presented on his extensive clinical experience with a wide variety of soft multifocal contact lenses for treating myopia. His clinical data has shown a better effect on decreasing myopia progression by using higher add powers, based on both refractive error and axial length changes.

Dr. Eiden presented on the use of orthokeratology in his practice. He targets patients progressing 0.50D/year or greater, with increased concerns about risks for Asian eyes, onset of myopia younger than age 7, less time spent outdoors, and increased amount of time spent on reading/near work.

Dr. Eiden measures axial length on every myope, with a measure of 23 mm being the start of concern, and 26 mm having a greatly increased risk of retinal complications. Based on a repeatability study for myopes for one visit to the next that he performed with several other practitioners on the IOLMaster (publication in progress), he recommends taking 20 measures of axial length on each eye to be able to track progression at the 0.04mm or 0.125D level.

Regardless if your treatment preference is low-dose atropine, orthokeratology, soft multifocal contact lenses, or even a combination of those, all of the experts agreed on one thing: we all need to be doing everything that we can NOW to treat myopia as a disease with the potential for serious long term visual consequences.

Regardless if your treatment preference is low-dose atropine, orthokeratology, soft multifocal contact lenses, or even a combination of those, all of the experts agreed on one thing: we all need to be doing everything that we can NOW to treat myopia as a disease with the potential for serious long term visual consequences.

If you weren’t able to make it to TMM San Francisco, there will be 4 additional sessions throughout 2020: March 15 in Spokane WA, May 3 in Morristown NJ, August 30 in Cambridge MA, and October 18 in Chicago IL. Visit http://reviewofmm.com/ to sign up for the excellent content available and for more details about the future THE Myopia Meeting.

THE Myopia Meeting (TMM) was held in

Dr. Sally Dillehay, Special Content Contributor
Brien Holden Vision Institute

Managing myopia as a disease represents a major shift in thinking for many eye care practices.

It is no longer enough to prescribe thicker glasses or stronger contact lenses to progressive young myopes. Practitioners must use available information and intervention strategies to proactively manage myopia with the aim of decreasing potential factors associated with increased risk of cataracts, glaucoma, retinal detachment, and myopic macular degeneration.1

Clinical excellence in managing myopia must include strong communications with patients and parents, and involvement of the practice staff is an essential part of the practice’s fundamental shift from prescribing glasses or contact lenses to treating the underlying risk factors for myopic progression.

Managing myopia as a disease represents a major shift in thinking for many eye care practices.

Importance of staff

Staff members are one of the most important components of success to any optometric practice. But practitioners often lament that one of the most difficult tasks for running a practice is training and keeping staff members.

As in any health care practice, staff members report that professional development is important to them in order to remain engaged and avoid burnout.2 Van Vuuren et al3 investigated the factors that contributed to patient loyalty within an optometric practice and determined that interactions with the practice’s staff were critical to maintain patient loyalty.

With the number of formal optometric staff educational programs dwindling over recent years, practitioners must be prepared to provide initial and on-going training to continually develop their staff and ensure high quality communications that address patients’ needs and exceed their expectations.

SOPs allow a practice to be consistent and accurate, which can lead to increased efficiency and patient communication. SOPs also assist with coverage due to staff time off or turn over.

Creating standard operating procedures

As discussed in the BHVI Myopia Education Program: The Business of Myopia, creating Standard Operating Procedures (SOPs) for practice procedures is an effective method of engaging staff and training each person on how to complete a task in a way that maximizes operational efficiency and quality of care.

SOPs allow a practice to be consistent and accurate, which can lead to increased efficiency and patient communication. SOPs also assist with coverage due to staff time off or turn over.

Importantly, engaging staff as an active part of creating the SOPs allows them to have ownership and pride in contributing their knowledge, experience and ideas on how to improve operations and quality for the practice. Involving staff in this process will help to get their buy in with the focus on managing myopia as a disease, similar to how the practice would manage other potentially progressive and vision-threatening diseases such as glaucoma or diabetic retinopathy.

As a practice moves into proactively managing myopia, it will need to create new procedures, and perhaps to acquire new equipment; and with that practitioners may need to delegate new tasks to staff, so as to spend more time in consultation with the patient and parents/caregivers.

SOPs will help to ensure that the entire practice, including all staff and practitioners, are presenting a uniform approach on the benefits of proactively managing myopia, the available treatment options, the procedures, billing and follow up schedules.

Having pre-printed brochures or information packets can assist with answering some of the more common questions. But using staff to handle as many of the questions as possible, is also a great way to help the practice handle patient flow and stay on schedule.

So many questions!

One thing to be prepared for when actively managing myopia, is that there will be many questions from patients, parents, and caregivers. These questions can easily require an additional 15-30 minutes when discussing the currently available treatment options for myopia.

Having pre-printed brochures or information packets can assist with answering some of the more common questions. But using staff to handle as many of the questions as possible, is also a great way to help the practice handle patient flow and stay on schedule.

While clinical questions about which treatment is recommended or how a specific treatment is believed to decrease myopic progression could all be handled by the practitioner, staff training to handle other questions will be essential to success.

Surveys of patients have shown that a positive experience with staff helps to increase patient satisfaction when they are able to engage with patients in an authentic manner.3

Develop scripts

Some of the more common areas in myopia management that a practice should develop scripts on how to discuss each item with patients and parents/caregivers, include:

  • Reasons why “regular” glasses and contact lenses do not help with progression of myopia
  • Benefits of myopia management
  • Myopia as a risk factor for potential long term changes in vision
  • Examination procedures and equipment
  • Available treatment options
  • Scheduling appointment times and length
  • Billing for myopia management consultation and products
  • Insurance coverage (if any)
  • Follow up schedules
  • Information to include in patient packets

A positive experience

Surveys of patients have shown that a positive experience with staff helps to increase patient satisfaction when they are able to engage with patients in an authentic manner.3

When staff are able to demonstrate the proper knowledge, skills and attitudes around myopia management, patients’ experiences will build confidence in the practice and its expertise in managing myopia, leading to increased patient, staff and practitioner satisfaction.

References

  1. Gifford KL, Richdale K, Kang P, Aller TA, Lam CS, Liu YM, Michaud L, Mulder J, Orr JB, Rose KA, Saunders KJ, Seidel D, Tideman WL, Sankaridurg P. IMI – Clinical Management Guidelines Report. Investigative Ophthalmology & Visual Science. February 2019; 60: M184-M203. doi:10.1167/iovs.18-25977
  2. Teel P. Five top challenges affecting healthcare leaders in the future. Beckers Hospital Review. February 13, 2018. https://www.beckershospitalreview.com/hospital-management-administration/five-top-challenges-affecting-healthcare-leaders-in-the-future.html
  3. van Vuuren T, Roberts-Lombard M, van Tonder E. Customer Satisfaction, Trust and Commitment as Predictors of Customer Loyalty within an Optometric Practice. South African Business Review. 2012;16(3):81-96.

Managing myopia as a disease represents a

Dr. Sally Dillehay, Myopia Meeting Correspondent
Brien Holden Vision Institute

The American Academy of Optometry Annual Meeting and the 3rd World Congress of Optometry were held recently in Orlando, Florida (October 2019). On offer was 16 hours of continuing education on many aspects related to myopia and in addition, there were poster presentations on emerging issues related to myopia and its treatment.

There were also some varied and interesting topics such as “Barriers to the Business of Myopia Control” (Nagra) and “Myopia Control in the Astigmatic Patient” (Kinoshita et al). The large attendance at all the sessions indicated a widespread interest.

The speakers universally addressed the importance of tackling myopia citing the potential risks of high myopia such as cataract, glaucoma, retinal detachment, and myopic macular degeneration and said that the risks increase exponentially with higher levels of myopia.

During the “Myopia Super Session,” Dr. Mark Bullimore discussed the risks versus benefits of myopia control, with benefits clearly outweighing the potential risks. Bullimore emphasized that we have a duty to recognize the increased risk of potential diseases later in life from myopia, and that the risk of microbial keratitis with contact lenses is potentially very small in comparison.

Several speakers mentioned that Myopia Control is emerging as the new standard of care from a clinical standpoint. Manbir Nagra presented data for the future predicted prevalence in USA to be about 59%, higher than predicted previously, with 15% predicted to have high myopia.

In the future, there will be a considerable need for eye care practitioners (ECP)s in regions with increasing prevalence and fast progressors; however, the scope of practice for optometry varies considerably throughout the world and therefore for effective myopia management, multiple stakeholders will need to be involved and engaged.

During the “Myopia Super Session,” Dr. Mark Bullimore discussed the risks versus benefits of myopia control, with benefits clearly outweighing the potential risks. Bullimore emphasized that we have a duty to recognize the increased risk of potential diseases later in life from myopia, and that the risk of microbial keratitis with contact lenses is potentially very small in comparison.

Finally, they said that the role of peripheral refraction in myopia onset and progression remains unclear. Although animal studies clearly demonstrate a relationship, human studies fail to do so. However, it is clear that that the central and peripheral retina are involved in myopia development. There is also scant evidence for handheld devices causing myopia.

Dr. Mark Bullimore and Dr. Noel Brennan presented on Twelve Evidence Based Things That We Should Know About Myopia, with age being the most important factor that determines the rate of myopia progression. At ages 7-8, myopia progresses over 1.00D per year; at ages 10-11, it progresses about 0.50D per year.

For all age ranges, Asian eyes progress about 50% faster, and therefore average progression rates must be qualified against age and race. They did not find evidence that binocular vision or accommodative status influenced myopic progression. Parental myopia does not influence the rate of progression, it only increases the likelihood of developing myopia at an earlier age. More time outdoors delays the onset of myopia, but evidence that it slows the progression in already myopic eyes is limited.

Bullimore and Brennan suggested that the gold standard for describing efficacy of myopia progression control treatments should be the Cumulative Absolute Reduction in Axial Elongation (CARE), which is based on axial elongation as compared to an age and race match control. The highest level of CARE they have observed in the literature is 0.44mm or 1.2D over a period spanning several years. They also said that that rebound is a potential factor with all myopia treatments, and more needs to be understood. For atropine use, the concentration of most benefit remains unclear and is further compounded by varying compounding pharmacy approaches and the instability of the molecule with regards to pH.

Finally, they said that the role of peripheral refraction in myopia onset and progression remains unclear. Although animal studies clearly demonstrate a relationship, human studies fail to do so. However, it is clear that that the central and peripheral retina are involved in myopia development. There is also scant evidence for handheld devices causing myopia.

Dr. David Bernsten presented on optical control strategies, including potential spectacle options, as well as ortho k and multifocal contact lenses. No hint of the BLINK study data was presented, but he reported that the study finished this past summer and that they are working on a publication.

In the Joint Session held by the American Academy of Optometry and American Academy of Ophthalmology, Dr. Don Mutti presented on prevalence of myopia. Considering the different numbers within the Vitale et al paper, he thought that the US prevalence is more accurately represented by 31%, and it was 33% previously; therefore, it really has not increased. He reiterated that 30% is still high and that every myope should be treated.

Prevalence has greatly increased in Asia and it is worthy of calling an epidemic, or as Mutti stated, “Asia is where the real story is.” His presentation was followed by Dr. Judy Kim who presented a series of interesting cases. Extremely high myopia makes surgery difficult as the instruments are made for axial lengths of about 24mm, and she often has to operate on eyes that are 36 mm in length.

Dr. David Bernsten presented on optical control strategies, including potential spectacle options, as well as ortho k and multifocal contact lenses. No hint of the BLINK study data was presented, but he reported that the study finished this past summer and that they are working on a publication.

Dr. Michael Repka presented on atropine and went through the first ATOM study on 1% atropine through to the ATOM3 in premyopes as a preventative strategy. He discussed that the FDA declined to approve pirenzipine in 2003 due to adverse events, which occurred in 26% of subjects.

Dr. Michael Repka presented on atropine and went through the first ATOM study on 1% atropine through to the ATOM3 in premyopes as a preventative strategy. He discussed that the FDA declined to approve pirenzipine in 2003 due to adverse events, which occurred in 26% of subjects. He then went through the LAMP studies and compared ATOM vs LAMP results. He presented a partial list of atropine studies currently underway, most of which involved 0.01% but many also considering 0.05% or 0.1%.

Dr. Jeff Walline concluded with statements that myopia is a disease and needs to be treated as such. Some of the audience queries were: “How to manage a 2 year old with ROP.” Per Repka, ROP myopia appears to stabilize after about 2 years, and therefore no treatment is warranted.

The many presentations were excellent, and thought provoking in terms of what evidence is available and our understanding at this point in time. A key take-away message was to carefully review the methods and the data in published articles as the methods often influence the results and provide insight as to why studies often present conflicting results. Overall, it is an exciting time to be working in the eye care field, when there is so much interest and new developments to tackle myopia.

The consensus within the international eye care community represented at the meeting appears to be that treatment for myopia is warranted in order to decrease the potential long-term risks for diseases associated with the progression of myopia.

On offer was 16 hours of continuing

Dr Monica Jong

Dr Monica Jong, PhD B Optom
Brien Holden Vision Institute

Good communication is crucial to success in myopia management. This builds trust in you, the eye care professional, as patients undergoing myopia management will be under your care for a decade or longer.

It is important that the patient and their parents have the confidence and loyalty to follow you in this journey.

Online visibility

Communication begins even before the patient steps into your office. Ensure that you have a simple- to-navigate and easy- to-understand website that can assist with patient education – with clear explanations on myopia, the need to manage myopia and the available options.

A good website is a worthwhile investment, as the majority of parents will turn to Google or other internet search engines initially. Your website can help create interest and support patient education, making it easier for your patients to take the next steps.

Are your staff well trained to answer emails and phone calls from parents wanting to find out basic information on myopia management? Good frontline staff are the key to instilling confidence in potential patients and presenting a professional image.

Staff training

Are your staff well trained to answer emails and phone calls from parents wanting to find out basic information on myopia management? Good frontline staff are the key to instilling confidence in potential patients and presenting a professional image.

In the consultation

Communicating myopia management simply and clearly during the consultation is critical to allow your patient to make an informed decision. Firstly, take a thorough case history. Apart from the standard consultation questions, ask about:

  • family history of myopia
  • questions about lifestyle, for example, the amount of daily time outdoors,
  • amount of near work
  • use of digital devices
  • hobbies and interests.

Results of the consultation in conjunction with patient’s age will help you to formulate the myopia risk profile. The myopia risk profile will allow you, to make the appropriate recommendations when it comes to the treatment options; for example, spectacle versus contact lens versus pharmacological, and lifestyle counselling.

The myopia risk profile will allow you, to make the appropriate recommendations when it comes to the treatment options; for example, spectacle versus contact lens versus pharmacological, and lifestyle counselling.

Choosing a treatment option

After you have performed your consultation and assessed the patient’s myopia risk profile, you need to be able to explain myopia, why it is important to manage it (such as risk of future ocular complications and vision impairment), and the different options available.

Discuss each option, the expected range of slowing of myopia, the pros and cons of each treatment such as lifestyle benefits, expected vision, any adverse effects or risks of a particular treatment.

In some countries, some myopia treatments are considered off-label. For example, in the United States some are not yet specifically FDA-approved for myopia control and this needs to be explained.

Informed consent

An informed consent form can be used to help guide the discussion with the parent/guardian on all the options, risks and benefits, and the visit schedule. Provide an opportunity to ask questions at the end of the consultation. Consider delegating the discussion of informed consent, as well as other questions to trained staff.

Online tools

There are free online tools that can help with communication. Evidence based tools include the BHVI calculator which can be used to visually compare the estimated progression of myopia for a child with no treatment, and with each different treatment option.
https://globalmyopiacentre.org/myopia-resources/myopia-calculator/

Taking the time to educate your patients and parents about the need for myopia management is critical, and will ultimately assist in their compliance and treatment success, and overall satisfaction in the care provided.

Expectations

Providing realistic expectations is important to avoid future disappointment. Explain that individuals can respond differently. At various stages your patient may require adjusted prescriptions, other treatment modalities or combinations.

Explain clearly how many visits are required, the length and duration as well as the fee schedule, and whether the treatment product is included.

Taking the time to educate your patients and parents about the need for myopia management is critical, and will ultimately assist in their compliance and treatment success, and overall satisfaction in the care provided.

Good communication is crucial to success in

Learn about all aspects of Managing Myopia

This package includes all three courses in the Myopia Education Program.

The Myopia Education Program uses the latest research, clinical procedures and business expertise to help you manage myopia, including more complex cases. You’ll also learn how to fully integrate myopia management into your practice from a business perspective.

The Myopia Education Program includes three courses, each of which is fully online and takes around 6 hours to complete.

  • Course 1: Managing Myopia
  • Course 2: Complex Cases
  • Course 3: The Business of Myopia

Each course is continuing education approved by COPE, OA, ODOB (NZ) and GOC.

You can enroll in each course any time that suits you over the 12 months following registration. Once you choose to enroll in each course, you will have six weeks to complete that course. As an example, you could complete course one in month 2, course two in month 4 and course three in month 7.

I have learned so much from this online course. I feel more confident in treating patients and speaking to them about the current studies. Thank you!

– Laura

Congratulations to the BHVI team for creating this excellent educational course. It certainly exceeded my expectations!

– Dwight

Why learn with the
Brien Holden Vision Institute?

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to bring vision to everyone everywhere…

This course was excellent in terms of