Optometrist Jagrut Lallu was an early adopter of myopia management. In this article, he shares insights about his clinical approach to myopia and explains why all optometrists should be working in accordance with the Standard of Care for myopia management recently developed by the Child Myopia Working Group.
Have you adapted your business strategy and clinical approach to ensure myopia management is integral to your daily practice?
Australia is expected to have 4.1 million high myopes and New Zealand over 600,000 high myopes by 2050, unless myopia management is widely implemented
If not, why not?
I hope when you finish reading this article you are encouraged to rethink your approach. And if you do, that you turn to the Child Myopia Working Group’s new Standard of Care for myopia management for guidance. The standards have been developed with the practitioner in mind. They provide a framework to ensure that every patient receives the best management option for them.
But let’s start from the beginning.
Why Start Myopia Management?
Myopia is not just a refractive disorder – it is a disease with the potential to cause permanent vision loss.
New Zealand and Australian parents are now 26% more likely to have a child diagnosed with myopia than they were in 2018, when the likelihood was 21%.1 Concerningly, for every one dioptre increase in myopia, their risk of myopic maculopathy increases by 67%.2
While this complex, multifactorial condition may cause some to feel hesitant about getting involved, we are all very capable of managing myopia.
We just need to ensure that we are all practising to the same Standard of Care.
Taking the First Steps
Your first step should be to familiarise yourself with the current evidence-based research and literature on myopia management, and ensure you are comfortable with it.
Step two should be to familiarise yourself with the recommended Standard of Care for myopia management developed by the Child Myopia Working Group.
Together this information will inform your myopia management options and practice protocol.
Adopting this approach will move myopia management to a service offered by a wide range of eye care practitioners. Only then will the full public health benefits of reducing the prevalence and impact of myopia be achievable.
Now you need to commit.
Starting Out?
My advice when starting out in myopia management is:
Train Your Support Crew for the Journey
This is critical. Make sure they understand what your practice used to do and how your management approach has changed. There are many myopia management educational resources available that are regularly updated to reflect the latest knowledge and best practice, such as courses from the Brien Holden Vision Institute and on-demand training via the CooperVision Academy.
Training of other colleagues is equally important. Inform them about your chosen myopia management options and how they tie in with your business vision and values.
Review Costs
Review your practice cost model and involve your team in discussions about how you might charge for myopia management services moving forward, and the Medicare rebates available (in Australia). Seek their input and address their feedback to encourage them to support this new way of working.
Prepare for Patient Communication
Seek help so that you and your team can effectively educate and engage in conversation with parents about myopia. Although the level of awareness is slowly increasing, only 20% of New Zealand parents and 29% of Australian parents (with children aged 17 and under) recognise the health risk that might develop later in life from myopia.3
Be prepared to encounter parents who differ in their views or disagree with each other on your recommendations for myopia management.
Resources for parents are accessible from childmyopia.com and include myopia fact sheets, myopia reports, videos, and a myopia vision simulator.
Seek Mentorship and Support
Reach out to your colleagues who have been managing myopia for a while – they will be willing to support your growth and journey.
Review and Refine
Do one thing this month and then review, and from there build on your myopia practice incrementally. It may feel different or even overwhelming, but the fact that you are beginning is what is important.
Benefits to Patient
In line with our professional competencies, optometrists have a role to promote eye care in their practice, and, if we are going to practice myopia management, we have a professional obligation to adopt the new Standard of Care.
Take a proactive, preventive approach! As we all know, the likelihood of developing myopia, particularly high myopia, increases when one or both parents are myopic.
So, don’t forget to ask your next myopic adult patient if they have children and if they do, encourage them to come in for an eye examination.
Benefits to Business
When run well, your myopia management practice will be a big business builder. It can help to drive financial growth for your practice and help drive lifetime loyalty from families who will be grateful that you took the time to explain myopia and implement a management program with the family.
Still Unsure?
Australia is expected to have 4.1 million high myopes and New Zealand over 600,000 high myopes by 2050, unless myopia management is widely implemented.4 We can’t manage this tsunami alone – so let’s all work together to be part of the solution.
If you have any barriers to getting your myopia management journey started, connect with your peers via online groups, such as the Child Myopia Working Group LinkedIn group.
To download a copy of The Australia and New Zealand Child Myopia Report 2022/23 – Reducing the Risk to Vision visit childmyopia.com.
Jagrut Lallu MSc is a practising optometrist at Rose Optometry in Hamilton, New Zealand with a special interest in myopia management and keratoconus fitting. A clinical senior lecturer at Deakin University and a Teaching Fellow at the University of Auckland, Mr Lallu is a founding member of the Australia and New Zealand Child Myopia Working Group. He is the Past President of the Cornea and Contact Lens Society of New Zealand and served 10 years on the Orthokeratology Society for Oceania as the New Zealand Liaison. [email protected]
References
1. Myopia in Australia and New Zealand: 2022 Consumer Perceptions Survey, commissioned by CooperVision ANZ and conducted online by YouGov Research between 16-22 June 2022. Sample comprised 1,039 Australian parents with a child/children aged 17 years or younger living at home.
2. Bullimore M.A., Brennan N.A., Myopia Control: Why Each Diopter Matters. Optometry and vision science : official publication of the American Academy of Optometry. 2019;96(6):463-5.
3. Myopia in Australia and New Zealand: 2022 Consumer Perceptions Survey, commissioned by CooperVision ANZ and conducted online by YouGov Research between 16-22 June 2022. Accessible at www.childmyopia.com.
4. Holden, B., Fricke, T., Wilson, D., et al., Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 to 2050. American Academy of Ophthalmology.
