Article

THE BUSINESS OF MYOPIA CONTROL

How to get the ball rolling when you want to provide myopia control services but don’t know how to start.

There is worldwide, population-based consensus that progressive axial myopia is at near-epidemic levels and is increasing in incidence and magnitude yearly.1 Research institutions on every continent are rapidly producing high-quality, evidence-based papers that show the devastating impact (both on patients and society) of untreated progressive myopia. Identification and intervention of the at-risk population is critical. We believe that every single eyecare practitioner needs to heed the warning sirens to treat and educate these individuals and their families…now.

We know what we need to do; the big question is: How do we integrate myopia control into our practices? We know that it will help our patients, but will it hurt our bottom line?

The good news is that incorporating myopia control will not negatively impact your bottom line—it will actually have just the opposite effect. When implemented properly, myopia management will, first and foremost, help patients; and, secondly, it will create a new and vibrant income stream.

Regardless of the financial benefits, this is a pediatric population consisting of at-risk kids of most-likely worried parents. Our job is to do the correct thing. We have a duty to do so.

IMPORTANT INFORMATION TO COMMUNICATE TO PATIENTS

Can practitioners tell patients and their parents/guardians that myopia control is U.S. Food and Drug Administration (FDA)-approved/cleared? No, they cannot. In fact, practitioners must tell patients and parents/guardians that myopia control is not approved/cleared. In the United States, there are currently no contact lenses, glasses, or medications that are FDA-cleared/approved for the management, reduction, or cessation of progressive axial myopia.

However, while devices, such as contact lenses, and medications are not specifically FDA-cleared/approved, that does not mean that the FDA is not very much aware of myopia control. On Sept. 30, 2016, the FDA, in conjunction with the American Academy of Ophthalmology, the American Academy of Optometry, the American Association for Pediatric Ophthalmology and Strabismus, the American Optometric Association, the American Society of Cataract and Refractive Surgery, and the Contact Lens Association of Ophthalmologists, Inc., convened a public workshop titled “Controlling the Progression of Myopia: Contact Lenses and Future Medical Devices.” As eyecare practitioners, we can generally use medications and devices for intentions outside of their FDA approval or clearance. However, we must not promote them for an off-label use, and we must clearly inform patients and/or their parents/guardians.

MYOPIA CONTROL­ IS NOT A SPECIALTY, IT’S A NEW STANDARD OF CARE

Progressive axial myopia is very much on the rise, and increasingly more practitioners understand that we cannot stand by and do nothing. So how can practitioners integrate myopia control into their practices? When we hear the term “myopia control,” many of us picture a complicated subspecialty requiring significant additional training and resources. Nothing could be farther from the truth; most practitioners who are reading this have the clinical skills to not only correct myopia, but to manage its progression. Correcting myopia in traditional ways was satisfactory when the only methods that we had to do so were single-vision eyewear and contact lenses. But these traditional myopia correction methods may encourage myopia to progress faster, and today we have tools that can not only correct, but can manage the condition.2-4

Standards are changing. Practitioners and industry are going from being able to just correct myopia to being able to influence its progression. As eyecare practitioners, it’s vital that we own the methods behind myopia control, practice them, and educate our patients on our abilities to do so. Arguably, managing myopia and not just correcting it is quickly becoming the standard of care. The knowledge and resources that practitioners need to perform this new standard of care are readily available. It is highly beneficial to patients, appreciated by their parents, and profitable for the practice.

Parents who needed vision correction as children have been conditioned to believe that myopia progression is just a part of life. Their memory is that every time they went to their eyecare practitioner, their vision was blurry and their prescription gradually increased. They experience this with their children and assume that this is just how it has to be. As a result, most parents won’t even know to ask you whether anything else can be done. The research and science behind myopia control is relatively new and has been poorly disseminated to the public; therefore, it is our duty to increase public awareness by talking about it to all parents of myopic children. Myopia control is a severely unmet medical need in communities, is greatly appreciated by concerned parents, and helps reduce the risk of eye disease later in life for patients. What responsible parents wouldn’t be interested in at least learning about myopia control options for their children?

Finally, myopia control is not something for which practitioners should refer patients to someone else. As an evolving standard of care, myopia control should become a part of eyecare practice. Eyecare practitioners can ensure that they keep their young myopes by practicing myopia control themselves rather than willingly referring patients out for myopia control services.

COMMUNICATION IS KEY TO BUILDING A MYOPIA CONTROL SEGMENT

Many resources exist within your practice to build a myopia control business. First and foremost is your existing patient base. Let patients know that you can help manage myopia progression by providing them with a printed folder or pamphlet to take home and peruse that describes the new paradigm in treatment and management and what their options are. Remember, most parents assume that nothing can be done about their child’s changing vision; when you educate them, not only may they request myopia control for their children, they may talk about it in their social circles. Myopia control patients can generate a number of referrals in this way. Remember to emphasize the new thinking that myopia isn’t just a refractive error­—it’s a disease. Some people understand this, but many don’t. Change the way that they think. When viewed through the disease “prism,” patients and their parents are usually more likely to choose myopia control over standard refractive care.

Consider showing parents one of the myopia estimators/calculators that are available. One from the Brien Holden Vision Institute at calculator.brienholdenvision.org allows you to input a child’s age, refractive error, ethnicity, and myopia management choice to obtain a predictive estimate of how that child would progress with and without myopia management. Another is mykidsvision.org by Drs. Paul and Kate Gifford, which asks parents about their child’s age, whether the parents are myopic, whether the child already wears glasses for nearsightedness, and how much time is spent on near work and outdoor activity; it then tells parents whether or not their child is at risk for developing myopia. These tools serve as a highly compelling demonstration for concerned parents.

Educate your staff so that they can answer parents’ questions over the phone about myopia control from a position of knowledge and confidence. Send out customer communications via customer communication software and practice e-newsletters. Host seminars, talk to community groups, meet local primary school nurses, and attend health fairs. Get involved with local youth organizations to tell your story. Ask patients who have benefited from myopia control to tell friends and family, and perhaps offer a referral incentive.

Create content about myopia and measures that can be taken to prevent its onset or slow its progression for your website, blog, and social media channels. As the standard of care for management of myopia changes, be sure to stay on top of it.

BECOME AN EXPERT

The best investment in your business is an investment in yourself. Invest in becoming an expert in myopia management. Dabbling won’t suffice. Becoming an expert involves not only a solid foundation of the clinical skills that are required to fit optical solutions and to prescribe medication, it also involves learning a substantial amount of material on how to successfully present, deliver, and market myopia management. This mastery is crucial to have a successful myopia management aspect to your business.

For the majority of practitioners, myopia management was not a topic that was covered as part of our formal education, let alone the business aspect of it. While detailing each is outside of the scope of this article, we can take stock of the potential resources in building a successful myopia management business. These resources include advice from peers, mentors, conferences, vendors workshops, online certifications, online forums, and articles in publications such as this one.

Conferences bring people who have similar passions together. A specialty conference that focuses on myopia management is ideal for improving your business acumen. It is absolutely inspiring to be around people who love myopia management. Network. Make friends. Find a mentor. The first-hand knowledge that you can obtain from those who are doing it often and well is the ultimate supplement to all of the other sources. This means reaching out to the authors of the articles that are published and talking with the experts who present on myopia management or whom you may have heard are providing this modality at a higher level compared to most.

It’s been thrilling to see the many courses on myopia management presented at recent major conferences. Several over the last year placed particular emphasis on myopia control content. The recent 2019 Global Specialty Lens Symposium in Las Vegas featured an entire track of preconference sessions on myopia management in addition to both general sessions and breakout sessions on this topic. At Vision By Design, which is presented by the American Academy of Orthokeratology and Myopia Control (AAOMC), myopia management practice management experts provide several courses to help with the business aspect of myopia management. Also, Supercharge, which is held at night during the conference, is a business-focused offering that covers how to develop fees, formulate packages, present myopia management options to parents, and how to handle the numerous questions that are bound to be asked.

In addition to the information at these meetings, a continuing education meeting held last month, The Myopia Meeting, focused solely on the rising prevalence of myopia and what can be done to control its progression in young patients. Business and practical aspects of myopia management were included.

Conferences are not the only place where you can get advice and tips from like-minded colleagues. It was not too long ago that we questioned the validity of being able to form meaningful relationships online; but, we now know that being part of an online group has given us many of the same benefits as when we meet with peer groups face-to-face. We have found that the most business-minded people are posting in the more specialized groups. On Facebook, the Myopia Profile is one such group. Much clinical information is presented, but if you ask a business question—or are in need of a business resource—this group will be of great help. The AAOMC has a very active member email forum; sage myopia management business advice is shared regularly, and the members are some of the most helpful practitioners that we have ever known.

Through any of these peer interactions, you will form friendships! Go visit your friends. If possible, be a fly on the wall and observe how they practice myopia management. The value of seeing success firsthand should not be forgotten or underestimated. It’s all too rare that we allow ourselves to step out of the office and into one of our friends’ offices. It is impressive and inspiring to see myopia management being performed at a high level. Get a visit on the calendar now.

DON’T LET THIS PASS YOU BY

Myopia management will add a very beneficial service to many of your young patients. When implemented with a sharp business acumen, it will also add substantial profit to your practice. Getting the word out to your patients, investing in your skills by attending courses at conferences, and having a group of online and offline peers who can assists in your myopia management business decisions will provide you with such. CLS

REFERENCES

  1. Holden BA, Fricke TR, Wilson DA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016 May;123:1036-1042.
  2. Hiraoka T, Kakita T, Okamoto F, Takahashi H, Oshika T. Long-term effect of overnight orthokeratology on axial length elongation in childhood myopia: a 5-year follow-up study. Invest Ophthalmol Vis Sci. 2012 Jun 22;53:3913-3919.
  3. Walline JJ, Greiner KL, McVey ME, Jones-Jordan LA. Multifocal contact lens myopia control. Optom Vis Sci. 2013 Nov;90:1207-1214.
  4. Chua WH, Balakrishnan V, Chan YH, et al. Atropine for the treatment of childhood myopia. Ophthalmology. 2006 Dec;113:2285-2291.