How optometrists structure their myopia management fees will affect this specialty’s implementation and success for both the patient and the practitioner. To ensure buy-in from the patient (and parent), it’s helpful to present a fee they find affordable while simultaneously placing it at a level that makes it worthwhile for the practice.
Here, we check in with leaders in the field of myopia management on their experiences—and why they choose charging a global fee or a la carte or, in most cases, a hybrid of both.
“A strategically developed fee schedule should reflect the full scope of services, including clinical expertise, diagnostic monitoring, and long-term risk mitigation.”
Dwight Akerman, OD, MBA, FAAO, Dipl. AAO, FIACLE, global ambassador for the International Myopia Institute
First Figure Fees
Experts agree that before approaching the typical debate of whether to use a global fee vs. a la carte when it comes to charging for myopia management, first determine the overall fee itself. Carefully review what goes into offering myopia management before determining what amount the practice needs to get out of it to make it worthwhile.
Because “undervaluation of myopia management services may compromise both perceived value and financial sustainability,” says Dwight Akerman, OD, MBA, FAAO, Dipl. AAO, FBCLA, FIACLE, global ambassador for the International Myopia Institute, “a strategically developed fee schedule should reflect the full scope of services, including clinical expertise, diagnostic monitoring, and long-term risk mitigation.”
Nathan Bonilla-Warford, OD, of Bright Eyes Family Vision Care and Bright Eyes Kids in Tampa, agrees with the recommendation that optometrists consider all these factors before determining the full fee to charge for myopia management. “Myopia management can be time-consuming, and it requires specialty materials,” he says. “If one is not charging appropriately, it is possible to become a drag on the performance of the overall practice.”
Therefore, it is necessary to first determine the overall amount to charge in order to make offering myopia management viable for the practice, and then the best way to structure it for the patient can be determined.
Global Fees Evolve into a Hybrid Structure
“When I started doing myopia management over 10 years ago, it was a la carte,” says Michael Dittman, OD, of Dittman Eyecare, with three locations in Pennsylvania, “but I struggled talking to patients and getting people to convert with confidence. So, we went to a more global fee structure, charging one fee no matter what treatment we did for myopia. Their child’s myopia was managed at the best level, not based on cost but based on the best treatment. That gave patients a lot of comfort knowing that anything would be covered.”
“In my current office, we charge a hybrid, one global fee based on the treatment, which a lot of practices are going to. If they’re doing atropine, there’s a global fee. If they’re doing soft contact lenses, there’s a different global fee.”
Michael Dittman, OD, of Dittman Eyecare
Now, as with many other practices, that solely global fee structure has further evolved after Dr. Dittman sold his practice to AEG Vision in August 2024. It is now more of a hybrid with global fees differing depending on the treatment.
Watch for our exclusive follow-up article coming next week: “How AEG is Working to Build a Standardized Myopia Management Program.”
“In my current office, we charge a hybrid, one global fee based on the treatment, which a lot of practices are going to,” says Dr. Dittman about the new AEG standard fees. “If they’re doing atropine, there’s a global fee. If they’re doing soft contact lenses, there’s a different global fee.”
Susan Resnick, OD, FAAO, practices at Drs. Farkas, Kassalow, Resnick & Associates in Roslyn, NY, which has followed a similar trajectory from a la carte to global fee to hybrid. She sees buy-in by the patients and parents as the biggest benefit to the global fee she charges for nearly all modalities. “It gives a sense of shared responsibility, and patients are less inclined to cancel or postpone,” she says. “At the outset, it provides a mutual agreement between us and the patient and the patient’s parents. They understand this is something special, that there’s more involved than just your general eye and eye health exam. It helps us advocate more consistent and closer follow-up.”
Being able to put everything in writing is another benefit of charging a global fee, according to Dr. Resnick. “We’re able to provide a written fee schedule,” she says. “We also document additional points, saying what our expectations are of the patient as well as what they can expect to receive from us.”
The Atropine Outlier
For Dr. Resnick, atropine is the outlier, the exception to the global fee rule.
“When I do atropine, sometimes I don’t use a global fee,” she says. The reason: “With atropine, the global fee is not as high as it is with contact lenses because there’s no material fee involved, and the patients are responsible for procuring the medication and paying for it themselves. The global fee is a little lower because we are subtracting out the material costs.”
A La Carte Still Works for Some
Some optometrists still choose to charge patients on an a la carte basis, individual fees for each service or material. “We find the a la carte per visit fee to be more budget friendly for parents, less sticker shock,” says Jeff Goodhew, OD, owner of Abbey Eye Care, an optometry practice in Oakville, Ontario, which specializes in myopia management.
“A global fee can get quite pricey,” he continues. “For some parents of young families with two or three kids, oftentimes there are multiple myopes in the family, which can get very expensive. So, we decided to charge per visit to spread that spend across a bigger timeline and make it more palatable for patients. We find it works for us. Patients are super loyal.”
Insurance’s Influence
Of course, as myopia management evolves, so too does how vision insurance covers it and therefore how eye care practices structure their fees in response. As more insurers cover these treatments, professional services, and materials, patients’ (and parents’) contributions are also changing.
The AMA recently adopted a resolution recognizing myopia as a significant and increasing public health concern and supporting broader education, childhood screening, and insurance coverage for evidence-based myopia control.
Still, most myopia management costs are private pay. However, that is changing—and is likely to change more as a result of the American Medical Association recently adopting “a resolution recognizing myopia as a significant and increasing public health concern and supporting broader education, childhood screening, and insurance coverage for evidence-based myopia control,” according to recent news coverage by Insight Media. Refer to the sidebar below to see how AEG Vision is addressing these changes in insurance coverage.
Ultimately, whichever fee structure is established—global, a la carte, or hybrid—make it accessible and affordable to ensure patients receive the care they need while developing it strategically to ensure success for the practice as well.
“Alignment between fees and clinical value supports both patient trust and practice viability,” says Dr. Akerman. “Transparent and well-structured pricing models facilitate informed decision-making and reinforce the medical necessity of myopia management.”
COMING NEXT MONTH: Stay tuned for Step 5 of Insight Media’s Myopia Masterclass Series: Choose Your Treatments. This installment will break down the expanding treatment options available for myopia management, from spectacle and contact lenses to orthokeratology and pharmaceuticals, including how to match treatments to individual patient needs and lifestyles.
VIEW all of the Myopia Masterclass series features HERE.
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