As an optometrist, there’s no escaping myopia management. Hannah Maher urges young eye care practitioners to tackle it head-on.
Given the increasing prevalence of myopia in the younger population, one aspect of optometric practice that every optometrist faces is myopia management. Whether you work full or part time, in an urban or rural area, corporate or private practice, myopia is ever present.
My practice colleagues… have been excellent mentors and cheerleaders for my professional development
I was extremely fortunate that my first job after graduating was at EyeQ Ramsgate, which has an excellent reputation for myopia control and ocular health management. From day one of my work life, I was exposed to myopic patients. While every patient presents differently, the line, “I’m having trouble seeing the board at school” quickly became all too familiar. My practice colleagues share a keen interest in myopia management and have been excellent mentors and cheerleaders for my professional development.
NEGOTIATING TREATMENT OPTIONS
Myopia management requires extensive patient communication and negotiation. When a progressing myope presents, I begin the discussion with both patient and parent about what myopia is, the risk factors including genetics and environment, and the typical progression.
Once this is sorted, we need to decide upon a treatment option. Our treatment paradigm can involve orthokeratology (OK), atropine, soft multifocal contact lenses or myopia control spectacle lenses.
Myopia management is a dynamic field. There is always emerging research and a new pipeline of products, including new soft contact and spectacle lens designs. Taking that knowledge and putting it into action requires planning and effort. Equipment can also be a limiting factor, for example, OK requires a corneal topographer. I’ve been fortunate to work at a practice with a Medmont topographer.
The various myopia control treatment options have different efficacies. Presenting the options to the patient and parent requires balancing the effectiveness of these options and correlating it with the patient’s level of myopia, rate of progression, and of course, their personal preference. It is a negotiation, and every patient is different.
My personal preference for managing myopia is OK, which solves two problems, eliminating the need to wear glasses while also slowing myopia progression. The biggest barrier with fitting OK is the price; not everyone can afford it, and that’s okay. That’s where atropine comes in. The research is constantly changing. When I first started practicing, 0.01% was the norm, whereas I now typically prescribe 0.05%. The biggest challenge I encounter when prescribing atropine is compliance. I’m shocked how often I’ve had patients return and they have not used their atropine in months. Upon discovering this, I make a concerted effort to educate the patient about the implications of non-compliance.
Lately, in rapidly progressing patients, I’ve been initiating multiple methods of myopia control simultaneously. While the evidence for dual control methods is still emerging, adding atropine nightly to a patient wearing OK, multifocal soft lenses or myopia control spectacles, can be invaluable for helping slow those tricky progressing patients.
EARNING A PATIENT FOR LIFE
For me, the most rewarding part of myopia management is twofold. Firstly, reviewing patients after I’ve fitted them in OK – they can see without glasses! Their enthusiasm is infectious. I have the additional comfort of knowing that OK provides excellent myopia control efficacy. Secondly, I enjoy the relationship I build with the patient, since management typically requires six- or at the most 12-monthly reviews to ensure that the treatment is effectively slowing myopia progression. Managing myopia demands vigilance and a tenacious following of the latest research and literature. I enjoy the challenge of taking that knowledge and actioning it for my patients.
Myopia is a challenging but highly rewarding part of clinical practice. Balancing patient needs with the broad range of treatment options requires confidence and effective communication. Ultimately, starting a patient on their myopia management journey requires us to foster a trusting therapeutic relationship. Despite the many nuances, intricacies, and challenges, I find it the most rewarding area of clinical practice, as you earn a patient for life.
Hannah Maher BVisSci MOptom practises at EyeQ Optometrists in Ramsgate, Sydney. Having graduated from QUT in 2016 with first class Honours, she pursued her interest in paediatric optometry, completing an Advanced Certificate in Children’s Vision at the Australian College of Optometry. Ms Maher is passionate about building relationships with patients to provide quality eye care for life.
