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HomemitechnologyTechnological Investment Pays Dividends

Technological Investment Pays Dividends

The acquisition of new technology always comes at a cost, but as Sally Atkins found, the investment of time and money has brought reward.

Our Myopia Master (Oculus) arrived to great excitement in mid-2021, a welcome relief and diversion to the COVID lockdowns of that time.

Even back then, during the early stage of COVID lockdowns, we were experiencing an increase in children presenting with recent onset and progressing myopia due to increased device and technology use for online learning and less outdoor play.

As a consequence, our practice had been becoming increasingly involved in myopia management, embracing all available therapies of orthokeratology (OK), dual focus daily contact lenses, defocus incorporated multiple segments (DIMS) spectacle lens designs, and atropine therapy.

As interest in myopia grew, the relevance of axial length measurement for ongoing myopia control management became increasingly relevant. Although we had been sending our patients to local ophthalmologists for axial length measurements, this was proving costly to our patients and sometimes delayed our care and management programs. And so we felt the Myopia Master would be an asset to our expanding scope of practice.

THE BENEFITS

Our practice has found investment in innovative technology has helped us differentiate ourselves as independent optometrists.

We decided on the Myopia Master because it was multifunctional with auto refraction, optical biometry axial length, and keratometry. It was also compact.

The Myopia Master combines the most important parameters to make myopia management easier and more reliable. It incorporates the Brien Holden Vision Institute (BHVI) data for estimating future myopia progression and was the only machine to have multiple databases of age, gender, and ethnicity (including East Asian ethnicity), features which aided our decision to choose this instrument over other available machines.

We now have the ability to create personalised reports detailing the child’s current myopia status and predicted outcomes to adulthood; a valuable tool to explain why a treatment may be considered. We can also provide a graph of changes to axial length over time – and I love the option of highlighting, in colour, when a treatment commenced.

The report, which can be printed or emailed to parents, has our logo on top and includes all the results and recommendations with information and scientific background on myopia management.

The report also includes percentile charts, which determine a child’s specific risks versus their peers. As parents are familiar with growth charts depicting height, weight, and length measurements, it makes the discussion and sharing of information much easier.

I find the interactive questionnaire, which includes a near work risk calculator, a valuable tool when discussing a child’s risk factors. Additonally, our child patients remember the hot air balloon target they see on the screen during consults and are happy to be involved with their own therapy and results.

These factors all work towards providing a ‘wow’ factor for both parents and clinicians.

ACCEPTANCE IN PRACTICE

I have been impressed with my Myopia Master and the ease of implementing it into our practice.

The team from Designs for Vision has been instrumental in ensuring our successful implementation of this exciting device. They provided training and helped us navigate some initial stumbling blocks.

Of course, we had initial operator error difficulties, which would have been ironed out earlier if not for the lockdowns, but we have found the Myopia Master to be both a patient and practitioner-friendly instrument.

I am so glad to be involved with helping our young patients in their visual journey with such advanced technology and a high level of data support in my practice.

A SECOND INVESTMENT

Our immersion into myopia management deepened in 2022 when our Medmont E300 corneal topographer began to show its age, and we got the news that it could no longer be calibrated. We needed to act quickly to ensure continuation of care for our OK and rigid gas permeable contact lens patients.

Our previous E300 had served us well in establishing an orthokeratology clinic and advancing our contact lens fitting and diagnostic skills with a valuable suite of instruments.

However, we decided it was time to further enhance our technological advancements, and opted to upgrade to the Meridia Advanced Topographer professional model. It seemed an appropriate move to complement our Myopia Master.

The professional model incorporated more features than our E300; we now have a larger colour field of view topography with multiple imaging options, anterior and fluorescein imaging, as well as meibography with dry eye scales and tear meniscus height, and pupil measurements.

It was immediately apparent that the limbusto-limbus capture area was of high resolution and colour, and it was overall much easier and faster to operate.

This is especially attractive for our youngest patients who, at age six years and upwards, are often fidgety and have short attention spans. The cone design fits much better when performing topographical measurements with prominent brows and small eyes, so our patients are more comfortable during the process.

The Medmont Meridia integrates easily with the custom made contact lens company Eyespace, and we are able to export our data to order contact lenses from Gelflex ACL and Menicon.

We have found the instrument has a high level of accuracy and repeatability, and is extremely easy to use. The capture buttons are located at the base of the instrument and the joystick is within easy reach.

My patients have been impressed with the meibography scans, which have a high level of detail and clarity. This helps them understand and see for themselves their meibomian gland dysfunction, and has the knock-on effect of promoting a high level of compliance. We are also able to provide reports to our patients regarding their dry eye status, which is invaluable.

I have definitely found this to be an excellent tool to ensure patient education and compliance and assist in guiding our treatment strategies for better patient outcomes.

The topographical maps give us the confidence to determine patient suitability for OK, to design lenses, and to evaluate fitting. Additionally, anterior, fluorescein, and video imaging is a great tool in conjunction with our slit lamp. With all of this information held in one file for each patient, it is easy to refer to when they return for reviews.

Overall, our new investments have been an exciting and valuable addition to our practice and have renewed our enthusiasm in providing a high standard of care for our patients with a unique experience that provides multiple ‘wow’ moments.

Sally Atkins BOptom(Hons) is the owner of Atkins Optometry, a full scope practice in Gordon, on Sydney’s Upper North Shore. She is a member of the Corneal and Contact Lens Society of Australia, the Australasian College of Behavioural Optometrists and the Ortho-K Society of Oceania. Ms Atkins received no remuneration for this review.

A Myopia Management Case Study

In June 2020, Molly,* a 10-year-old female patient, presented for review of her prescription. She had been dispensed her first pair of spectacles at another practice in January of the same year. Of East Asian ethnicity, Molly’s father is a high myope. She described herself as a bookworm, often hiding under the covers at night to read.

Her entering prescription was R: S/V R and L: -1.25.

Her subjective prescription was R: -1.50 and L: -1.75.

At the initial consultation we discussed myopia control options, including specialised spectacle and contact lenses, OK, and atropine. Molly’s mum was interested in myopia management, which hadn’t been discussed with her previous optometrist. We provided information packs and referred Molly and her parents to the Myopia Profile website.

At the second consultation, they decided to commence OK, as they felt this may also encourage better sleep patterns.

Baseline corneal topographies were taken, and we discussed baseline axial length measurements to be taken by an ophthalmologist, as we did not have access to biometry at the time.

At Molly’s first week review visit in July 2020, her uncorrected visual acuity (UVA) was R: 6/4.8– and L: 6/4.8–. Both Molly and her parents were pleased with the result and her sleeping hours had already improved.

In September 2021 we measured our first axial length with the Myopia Master. Molly’s parents were pleased not to have the 20-minute drive to the ophthalmologist for this measurement.

Over time, the graph of Molly’s continuing axial length measurements demonstrated our success with OK and stabilisation of axial length.

The additional benefit of being able to visualise her axial length as a percentile rating provided a tool for discussion, and we were all excited to see the downward trend and flattening of the axial length on the graph. From our first axial length measurement in September 2021, the right eye increased 0.01mm and the left eye 0.01mm.

We have had to alter the OK lenses once in this time and continue to have pleasing results. The Myopia Master helps reduce parental concerns about what Molly’s prescription may be now, by correlating changes in axial length to possible prescription changes.

Molly’s sister has since also commenced therapy and we were able to provide a myopia report and baseline axial length measurements, as we had the Myopia Master at the start of her treatment.

The Myopia Master has greatly enhanced this family’s experience during their treatment and enabled them to feel well informed throughout the journey.

*Patient name changed for anonymity.