Myopia Masterclass: Determining Which Patients to Treat

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Whether launching a myopia management specialty in your optometry practice or growing one you have already started, it is beneficial to determine early on which patients you will treat.
Some experts in the field recommend preparing every child for the possibility of myopia management even before onset, while others narrow their focus to those who are just beginning to exhibit symptoms.

Preparing All Patients for Myopia Management

“We recommend that you talk about myopia with every child of any age coming in for primary care,” says Matt Oerding, CEO and co-founder of Treehouse Eyes, a leading provider of myopia management in the U.S., having treated more than 20,000 children, according to the company. Introduce the concept early, Oerding suggests, even in children as young as three to four years old who are not yet myopic—and check axial length as part of your pre-test routine.

Initiate Treatment for Young Myopes

Practitioners just starting to implement myopia management can narrow down their patient pool by targeting young patients who are already exhibiting myopia, says Thomas Aller, OD, a myopia management leader and published author whose inventions have received multiple patents. “Anybody who is already nearsighted from five to ten years [old] is at risk for a high level by the time they reach adulthood and relative stability,” explains Dr. Aller, who has worked with experts in the field such as Drs. Brien Holden and Earl Smith.

“There’s really no age where you cannot start, but I would say you’re going to have the [biggest effect] with the younger patients,” agrees Jeff Goodhew, OD, owner of Abbey Eye Care, an optometry practice in Oakville, Ontario, specializing in myopia management.

That slightly narrower category can be further focused into groups whose myopia is likely to progress more rapidly, which leads to the question: How do you determine who will be a fast progressor?

Axial Length as an Indicator

Depending on the patient—as well as which practitioner you ask—past progression may not predict future progression. While a simple refraction can help determine if a patient is myopic, measuring and monitoring axial length is preferred to monitor progression.

By measuring axial length for every child at every stage, practitioners can determine a baseline upon which they can measure future progression. “It takes 20 seconds to add axial length to the pretest routine and doesn’t take any OD time,” Oerding says. “That way, if and when the child does become myopic, you have a clinical record of axial length measurements over the years to make it much easier for you as the clinician to decide whether or not to intervene much better than refractive error will.”

However, measuring axial length requires a biometer, an instrument not all practices have or can afford. Not having a biometer should not be a deterrent to implementing myopia management.

One strategy is to utilize software from Ocumetra that enables the use of refraction and axial length centile charts to determine the likely progression of a patients’ myopia. Optometrists can also collaborate to use a local ophthalmologist’s biometer.

Which Children Are Most Likely to Become Myopic?

Regarding patient demographics, statistics show that Asian children are far more myopic than other ethnicities.

“Asian American children exhibited faster myopic progression than Black, Hispanic, and Native American children,” according to a 2021 study on juvenile-onset myopia progression.

Also, myopia prevalence in Asia has skyrocketed in recent decades, according to the American Academy of Ophthalmology. “In countries like China, Japan, Singapore, South Korea, and Japan, up to 80–90% of teenagers and young adults are now myopic.

“The biggest split is Asian versus non-Asian,” agrees Dr. Aller. “Then the number of parents who are myopic would be the other predictive parameter.”

Start with Your Existing Patient Base

Experts in the field agree that myopia patients are already there among the existing patients in your practice. 

“We recommend they start with their existing patient base,” says Oerding, since the practitioners already have a relationship with those families. “For myopia, your highest ROI is from those patients already in your practice,” he adds, suggesting an email marketing campaign as one way to target your existing patient base.

If and when you need to attract new myopic patients into your practice, Oerding recommends a variety of methods. “Patient communication platforms such as Demandforce and Solutionreach, local business-to-consumer outreach, and paid social media search, which can be fairly effective in high-density urban populations,” he says.

For less populated rural communities, Oerding suggests partnering with local schools and reaching out to other healthcare professionals for referrals.

Ultimately, your existing patient base is your best first source of myopic patients. “There are enough myopes in all optometric practices to at least get started,” says Dr. Goodhew.

COMING NEXT MONTH: Stay tuned for Step 2 of Insight Media’s Myopia Masterclass Series: Inform Parents and Patients. Now that you know who you will treat, how do you educate the patients and parents about the long-term risks of untreated myopia—and the various treatment options that are available? Sign up for the Myopia Masterclass newsletter here.