With an abundance of evidence, diagnostics and treatments, the bar has arguably never been lower for practices to incorporate myopia control. In fact, some contend there is a diminishing list of reasons for optometrists not to practise some form of management. Insight speaks to three practices about their strategies.
In almost any direction you look in the ophthalmic sector, one can find alarming headlines about the oncoming surge of myopia – expected to reach epidemic proportions on the current trajectory. Although the focus has largely been on the increasing prevalence in children, new data has reminded the sector that myopia progression occurs in adults too.
Recent findings from the Raine Study on a cohort of Western Australian young adults demonstrated that myopia onset occurred in one of seven people who did not have myopia at age 20. Perhaps the issue is bigger than many expected?
Mr Kevin Trac, of Westmead Eyes in Western Sydney – who has practised myopia control for more than a decade – says the fact that people of all ages are becoming more myopic is a significant problem that has been accelerated by environmental factors.
“Anecdotally, we see so many kids becoming more myopic. Now, I’m seeing the same trend in adults too. I also see a lot of doctors that are studying, and they’re still getting myopic at age 30,” Trac says.
With estimates that as many as 55% of people will be myopic by 2050 in Australia, thought leaders and key industry bodies argue it is more important than ever to ensure myopia management is integrated into optometry practise.
Insight talks to three optometrists with comprehensive myopia control protocols who share their insights to equip practices with the tools and acumen to effectively tackle this major societal issue, and to optimise practice and patient outcomes.
Fortunately for optometrists – and according to these experts – good, comprehensive, and effective myopia management does not require much to get started – and optometrists can expect a patient for life if executed well through ongoing follow ups, education, and communication.
Keep it simple
Trac says lifestyle factors are just as important as hereditary factors when identifying patients at risk of myopia progression.
“Everyone’s using a phone and the distance that people are now working is a lot closer; you’re stuck at 50 to 60 centimetres and more people are living in apartments now. So, consider the viewing distance in an apartment compared to a house for example.”
Similarly, Mr Jenkin Yau of Sanctuary Lakes Eyecare in Melbourne has been actively involved in myopia control for nine years. Therapeutically endorsed, he considers his practice to have a variety of management options available.
A catalyst for Yau’s focus in myopia management was when he witnessed a patient – a mother of two young children in her 30s – lose her independence after suffering myopic maculopathy in both eyes. As a result, he is passionate about reducing the risk of pathology later on for patients, especially emerging from the pandemic, where he – like many other practitioners – haw seen an uptick in myopia progression.
“We have seen an increase in myopia as a result of COVID as people adjusted to new work and school conditions and became more reliant on digital devices,” he says.
Mr Mark Hinds, from Mark Hinds Optometrists in Brisbane, has practised orthokeratology (orthok) for 20 years. He incidentally found himself involved in myopia management because of the complex contact lens landscape.
When he began practising orthok, he discovered that his patients would experience less myopia progression over time. Clinical trials and evidence soon followed to support this and explained how it may have occurred.
“The safety profile of an orthok intervention for myopia progression is very well documented to be a safe mechanism in the right hands,” Hinds says.
For a successful myopia progression plan, Hinds says patient communication and education is key. With paediatric myopia management, teamwork is at the core of successful outcomes. He says it’s necessary to adequately educate parents on the progression plan and ensure everyone’s on board.
He achieves this through comprehensive information packs directing parents and patients to the right resources.
Trac agrees, saying that communicating with patients – especially parents of paediatric patients – to ensure compliance, takes time.
“We make sure we give enough consultation time for our patients, so we don’t rush everything. We have a website which always has instructions. If there are any emergencies, patients are welcome to contact us,” Trac says.
When developing dialogue for effective conversations with patients, Yau says confidence is key. Practitioners should take lifestyle factors into consideration such as outdoor time, natural light exposure, screen time, reading habits, physical activity, and near-work activities to communicate the types of treatment options available.
As communication is a team effort when managing paediatric patients, Yau simplifies information as much as possible so it’s succinct, accessible, and engaging – which is especially important for children.
“It’s helpful to have videos and easy-to-understand written communication or cryptographic information, particularly for younger audiences. Also, by having information that is easily digestible and easy to communicate, the quicker you can get the information across,” Yau says. “And always provide an opportunity for the parents to ask questions. That way, the consultation will be more effective.”
For Yau, good myopia management depends on effective communication. A highly effective and reputable practitioner can be identified based on the simplicity of the message they are trying to communicate. He suggests preparing messages and tools in advance.
“Whether it may be videos or mailable written information – have these defaults or emails ready to go,” Yau says.
“While it may be simpler to offer the option that takes the least amount of time to implement or explain, there is much value in compliance and uptake when taking the time to go through the why and the how in myopia management.”
Although myopia control can be considered more time consuming due to greater communication requirements, Yau says optometrists should not be discouraged by the time constraints, as with practise, the message becomes more succinct and effectively delivered.
“It’s something that as you get more competent in delivering the message, the communication aspect becomes quicker and quicker. And that’s why I think it’s important to have the written or digital tools readily available. Do what works for you, so that you can send that message succinctly, competently and convincingly,” he says.
Working together
Independent practise is associated with greater flexibility as optometrists can select special interests, unconstrained by KPIs that are perhaps more commonplace in a corporate environment. Thus, it could be argued that it’s easier for independents to integrate myopia progression plans into practise.
In saying that, in more recent times Specsavers and OPSM have laid out their intentions for large scale myopia management integration into their workflows.
“What has stopped comprehensive management is obviously a time element. These patients do take up more time,” Trac says.
“Some practices need to make KPIs, so myopia management isn’t necessarily as lucrative if the patient can’t afford myopia spectacles and is given an atropine script instead. Now, you also need to review that patient every three to six months. There’s no incentive for an employee who is working towards KPI targets.”
For optometrists wanting to develop their myopia control protocol, Hinds recommends establishing relationships with optometrists who may not have the resources or the time to dedicate to myopia progression plans. They can then refer on to the appropriate practitioner and work as a team.
“Go to conferences and liaise with corporates who cannot do the full suite of myopia interventional treatment such as orthok and are willing to work together for the patient’s best interest,” Hinds says.
Yau says patients and their families can be hesitant in adopting a myopia control plan if they “appear to be fine”. Nevertheless, he recommends providing them with as much clinical information available that encapsulates risk of progression and likely outcomes.
“We tell them what we expect to happen later on down the track. And sometimes it does take six to 12 months before they realise what we said would happen, happened,” he says.
Image: Mark Hinds.
However, non-compliance shouldn’t deter optometrists from implementing myopia control plans in certain patients. These patients, according to Trac, just need a greater time commitment.
“For patients that are non-compliant, we will bring them back more often and then speak to them more closely. They usually end up back on track,” Trac says.
With a multitude of interventions, if one fails then try another, Hinds says. He adds that if practitioners are not confident in orthok, then they should utilise myopia control spectacle lenses. Many major manufacturers have developed products in this space in recent times with proven efficacy.
“With the treatments and options we have available today, there shouldn’t be anyone out there that doesn’t have some sort of myopia progression plan in place in their practice,” Hinds says.
Continuous development
As with all areas of practise, Hinds recommends ongoing professional development in this space, with tertiary knowledge of myopia supplemented. He says working with like-minded, experienced colleagues can help in the understanding of evidence-based research.
He recommends joining associations such as the Orthokeratology Society of Oceania (OSO) and the Cornea and Contact Lens Society of Australia (CCLSA), which are good places to gather information and collaborate with colleagues.
“I have completed and would recommend the international fellowship associated with the OSO (FIAOMC) which was challenging but rewarding. The other state-based conferences have a good coverage of myopia in them,” Hinds says.
To support this, he also recommends the Myopia Profile website established by Dr Kate and Dr Paul Gifford, a knowledge and resource centre with online courses. The site includes articles that answer clinical questions, science reviews, downloadable clinical resources, and online courses.
For optometrists to best stay up-to-date with treatments and research, Hinds says there is great importance to base clinical pathways on evidence-based medicine and analyse peer reviewed scientific journals with sound science and clinical trials to determine the best clinical pathways for patients.
He says: “Although it is nice to be an early adopter of technology, I think that it is critical to follow this philosophy and think: ‘Would I use this therapy or intervention on my child?’
“Although we have been able to measure the axial length of the paediatric patient’s eye for some time with devices such as the ZEISS IOL Master or OCTs, we did not understand what normal growth is and what is pathological or myopic growth.”
He says that knowledge in this area is improving with more devices being commercially available to measure and quantify this. This includes essential software tools that not only measure the refraction but also the change to refraction induced by axial length change.
He believes every optometrist and ophthalmologist should be proactive in helping slow the rate of myopia.
“The benefits of this are well documented and there is no rock big enough to hide under to not be aware of this,” Hinds says.
Everyone wins
Trac says that beyond optimised patient outcomes and practitioner satisfaction, the benefits of embedding myopia management are rooted in opportunities for practice growth.
“In terms of benefits for the practice, it is practitioner satisfaction that you can do a job well. You get referrals from the friends and family that can grow the practice quite significantly,” Trac says.
He also says specialising in myopia allows practices to differentiate themselves from the bunch and stay competitive.
“The practice becomes more professional and it now has a niche which can be distinguished from a standard practice,” Trac says.
Further, Yau says that myopia management is ongoing and doesn’t stop once a protocol has been established with a patient.
“These treatments do need revising. Whether it’s because the child outgrows them or the lenses need to be replaced: It’s a good practice builder,” he says.
But the core incentive is to halt the rate of myopia progression.
Comprehensive myopia progression plans can improve the quality-of-life for children which Hinds says is “one of the most rewarding outcomes for a practitioner”.
He adds: “By successfully managing myopia progression, practitioners can help children maintain clearer vision, reduce their dependence on corrective lenses, and minimise the risk of associated eye conditions, ultimately enhancing their overall well-being and daily functioning.”
Another rewarding aspect is the long-term preservation of children’s visual health and prevention of myopia complications.
“By implementing effective myopia prevention strategies and interventions, practitioners can potentially reduce the risk of serious eye conditions, such as retinal detachment, glaucoma, and macular degeneration, which can have profound implications for children’s ocular health and vision throughout their lives,” Hinds says.
He says the journey with paediatric patients is a lifetime, and it is a privilege to be a part of their treatment and see the difference that can be made in their lives.
“We have seen these patients treated with great success and some of them go on to become optometrists, paediatricians, and ophthalmologists and are now part of the treatment of future generations,” he says.
More reading
What is the ideal concentration of atropine for myopia control?
Myopia management is more than clinical acumen – Matt Oerding
Outdoor light exposure – the first step in myopia management
