The myopia management journey

Working for a large therapeutic and contact lens specialty practice in Edinburgh, Bruce was already fitting many children with contact lenses and considered offering myopia management a “no-brainer.”

“If we are fitting children with contact lenses, why are we not fitting them with lenses that might slow down their progression?” Bruce shared.

“It felt like something that was meant for optometry,” she said.

Bruce added that she could see first-hand the effects of high levels of myopia among the older patients who attended Cameron Optometry with macular pathology.

Optometrist and colleague, Ian Cameron, shared that it was only “a slight sideways step” to move from fitting children with contact lenses to offering myopia management.

“It’s quite novel. There are few other things we would do in optometry that are so preventative,” he said.

Tailored solutions

Cameron Optometry started its myopia management journey with off-label interventions in 2015.

First, the practice offered soft, centre distance, multifocal contact lenses before extending its range to include orthokeratology (ortho-k).

Today the practice offers a range of options to meet the needs of different patients. “The key thing is that we are correcting people’s vision in a way that is optimal for them,” Bruce explained.

“We have glasses options, we can correct for astigmatism, we have contact lens options for night-time and day-time wear. There is something in each category that we felt was robustly tested,” she said.

The key thing is that we are correcting people’s vision in a way that is optimal for them

The practice purchased a Myah optical biometer and corneal topographer to support its myopia management offering.

If patients contact the practice expressing an interest in myopia management, they are offered a 45-minute appointment – covering the sight test as well as a discussion about myopia management options.

If it becomes apparent that a patient could benefit from myopia management during a regular sight test, then they are offered a follow-up appointment. The practice measures axial length at all initial General Ophthalmic Services (GOS) appointments.

“We take that as a loss leader because ultimately it helps us to give better care further down the line,” Cameron explained.

Payment for myopia management services is done by a regular Direct Debit payment.

While the initial appointment is often GOS, follow-up appointments that focus on myopia management are private.

When the practice first started offering myopia management, Cameron gave a presentation to all practice staff explaining what it was, how it works and why it was being offered both from a practice and patient point of view.

“I think that was helpful for making people enthusiastic about myopia management,” Cameron shared. He emphasised that myopia management is very much a team effort at Cameron Optometry.

“Myopia management can simply not be done by an optometrist on their own, no matter how good you are,” he said.

Focus on patient care

Specsavers Haverfordwest first began offering myopia management in 2018, after being selected as a pilot practice ahead of a national roll out of MiSight 1 day and Miyosmart by the multiple.

Optometrist and practice director, Andy Britton, is a –13.00DS myope married to a –8.00DS myope. At the time he started offering myopia management, his son was five years old.

“I felt it was critical that I was prepared to offer the best of care to my own family, as and when the time came, along with my patients,” he said.

Britton shared that he initially spent time researching myopia management and understanding the evidence base.

Ahead of the introduction of MiSight 1 day, both clinical and support staff completed online learning and participated in two training sessions.

Training and accreditation were also completed ahead of the roll out of Miyosmart.

Britton highlighted that all team members at his practice were made aware of the rationale behind introducing myopia management options.

He described the initial launch of myopia management as “low-key” with optometrists and dispensing opticians identifying parents and patients who might benefit from the intervention.

“While some parents were quick to grasp and understand the benefits, others needed time to process and digest the not insignificant information with which they were presented,” Britton shared.

Details of myopia management conversations are included in clinical records, with the potential for the conversation to be continued at a later date if a parent or patient did not wish to proceed at the first opportunity.

“We needed to ensure that myopia management was embedded within the practice, so we kept a log of all myopic children encountered and detailed the discussions that had occurred,” Britton said.

The practice also prepared leaflet packs with information on the available myopia management interventions so that parents could take this information away and a follow up call could be arranged to discuss next steps.

Lynne Fernandes Optometrists began introducing myopia management across its Bristol practices in 2016. Director and optometrist, Lynne Fernandes, shared that alongside completing research and training on myopia management, she developed a standard operating procedure ahead of introducing the intervention across her business.

Fernandes highlighted that this helps to provide a high standard of care and ensure consistency of practice among different clinicians.

“It also means your team will be fully informed and know what to expect, along with the parents and children,” she said.

Fernandes added that the standard operating procedure can be developed and adapted as understanding evolves.

Other groundwork that Fernandes completed included creating an informed consent form, coming up with a plan for how myopia management would work financially and choosing management options.

When selecting new myopia management options, Fernandes considers the evidence behind the product, the parameters, the effectiveness as well as talking with other myopia management practitioners about their experiences.

“Each year, we have new offerings available to choose from,” she said.

As Fernandes felt that it was important to measure axial length to predict and monitor outcomes, she purchased a Myah optical biometer and corneal topographer for each practice.

She created a monthly Direct Debit fee structure, taking into account how much it costs per hour to see a patient and how many appointments an average patient would need.

Done well, myopia management involves the entire team

Practice staff talk to all myopes who are progressing about myopia management, as well as parents or grandparents who are myopic about whether their family members could benefit from myopia management.

Fernandes emphasised the importance of keeping up to date with the latest research on myopia management.

“It is crucial as a professional to be fully informed and up to date about myopia, myopia measurements and management options, alongside risks and benefits so that the parent and child are fully informed and understand what is happening,” she said.

“It is also essential the whole team is behind myopia management and understand and know how to support and book those appointments,” Fernandes added.

Team effort

For optometrist, Craig McArthur, who owns Peter Ivins Eye Care in Bearsden, the catalyst for beginning myopia management in earnest was getting to know Professor Brien Holden – a good friend of his colleague Peter Ivins.

“He inspired me to stop dabbling in myopia management and become an expert. He was the real motivation to take myopia seriously,” McArthur shared.

Since beginning myopia management in 2010 with off-label use† of ortho-k and multifocal contact lenses, McArthur shared that a “plethora” of options have emerged on the market.

“Our aim is to have all the options available to us as a practice, then pair the child with the product best suited to their unique circumstances,” McArthur explained to OT.

The practice offers three pricing bands within an all-inclusive monthly fee structure. His myopia management clinic provides three to six monthly follow up appointments, where a range of tests are performed, including axial length monitoring and corneal topography.

McArthur shared that every child who attends the practice is initially considered to be at risk of developing myopia.

“We are therefore educating every family that attends the clinic about myopia, myopia progression and myopia management,” he said.

If a child has an axial length that is increasing at a faster than ‘normal’ rate, or showing signs of pre-myopia, practice staff will go into more detail about what is offered through the myopia management clinic.

McArthur highlighted that the practice has utilised both in-house and manufacturer training on myopia management.

“Done well, myopia management involves the entire team. It is our expectation that all of the team should be able to answer questions on myopia, myopia progression and myopia management treatment options,” he shared with OT.

† CooperVision does not endorse off label prescribing of interventions for myopia control.