In partnership With CooperVision
“The research, the technology is there to manage myopia,” states Dr. Lyerly at the top of the episode. “The hardest part becomes talking to parents and changing that mindset for what is status quo for prescribing.” Our guests on this episode are Dr. Justin Kwan, Senior Manager, Myopia Management at CooperVision and Dr. Stephanie Tsang, practice owner at Golden Vision San Francisco Optometry. Both Dr. Kwan and Dr. Tsang have been practicing myopia management for a decade prior to any FDA approvals for myopia control options, and like Dr. Lyerly they’ve seen that while the available technology has exploded, the patient awareness of this possibility has lagged behind. How do we educate patients and parents effectively?
“It’s very rare in healthcare to be able to provide an immediate benefit, and also a long-term benefit to the patient,” states Dr. Tsang about her passion for prescribing myopia management. As a private practice owner she cares for her patients from childhood through adulthood, and seeing the long term impacts of keeping prescriptions low and reducing the risks of side effects of high myopia including retinal detachment, glaucoma, and myopic maculopathy has fostered a strong sense of duty1. “Myopia management is not new; there are decades of research available,” she tells patients, “What’s new is how accessible the technology is.”
Challenges that Doctors Face When Presenting Myopia Management
Dr. Tsang shares that when you enter an existing practice, sometimes the biggest hurdle is simply change. Practices typically have been approaching eyecare with glasses and contact lens options for decades, and to take a dramatically new approach by talking about slowing down myopic changes takes a total mindset shift from patients, staff, and the other doctors in the practice. She talks to parents and her colleagues with a focus on what’s happening to the eye’s shape instead of simply the diopter value of the prescription. Axial length is a foundation of her conversations, and showing parents a picture of a normal eye compared with an elongated eye with just a basic diagram is extremely meaningful. Her approach to parents is very simple: “prescription increased, and this is concerning because the axial length is now longer.”
Dr. Kwan advises against any negative framing of the conversation that could cause fear or discomfort. Throwing out retinal detachment and glaucoma risk factor data can scare patients which actually leads to lack of trust in the doctor/patient relationship.
What do you do when a parent pushes back? We talk through examples of how you would navigate these common exam room convos:
“Myopia isn’t a big deal; my kid can just get LASIK when they are older.”
“Our goal is to make sure your child is a candidate to get LASIK. If the prescription gets too high, LASIK won’t be a treatment option. We need to help slow things down so that they are the best possible candidate for LASIK when they are old enough!”
“My kid is too young to wear contact lenses.”
Dr. Tsang, Dr. Kwan, and Dr. Lyerly all share that a great approach is to talk to parents about the young patients in the practice that have been successful wearing contact lenses. CooperVision has also created great video content on the MiSight® YouTube channel featuring real patients sharing their contact lens insertion and removal tips. These videos are a useful tool to share with parents so they can see kids as young as 8 are very capable of wearing lenses successfully! And kids seeing other kids that are successful with contact lenses goes a long way.
“Does this really work? Explain the science to me because I’m skeptical”
Creating pamphlets that highlight clinical studies is another great tool to equip parents to do their own research. This encourages them to read more and see the science for themselves. Dr. Tsang explains what is happening with myopia management contact lenses as “we’re using lenses to put the image in front of the eye, instead of behind the eye.” In Dr. Lyerly’s practice she’s found limited success in trying to explain peripheral defocus, and instead uses a picture of MiSight® 1 day lenses with an artistic rendition of the ring design. “One part of the lens makes the eye see clearly, the other part slows down the rate of eye growth in age-appropriate children,” Dr. Kwan explains.
“I think we should wait a little longer to see if it settles on its’ own.” How do you drive urgency without fear?
“Your child is growing, and their eyes are growing, so instead of waiting a whole year where the changes might have been too dramatic, let’s check back in sooner,” Dr. Kwan says. “Every unit of stretching matters, so we want to intervene sooner rather than later because we have a finite window of time to do the best good we can.” Scheduling parents that want to wait on myopia management to come back in 6 months instead of 1 year can help underline that the amount of change you are seeing is outside of normal and will need closer follow-up.
What’s new for MiSight® in 2022?
Every doctor and optometric student are eligible to get certified to fit MiSight®. There is also going to be a live certification program at SECO this year. Lenses can be ordered directly through CooperVision and through any authorized contact lens distributor so ordering is no different than any other CooperVision lenses. Lenses are now available in both 180 packs (6 month supplies) and 90 packs (quarterly supplies) for patients that want to order in smaller units. Contact your CooperVision rep for more information!
- Flitcroft DI. The complex interactions of retinal, optical and environmental factors in myopia aetiology. Prog Retin Eye Res. 2012;31(6):622-660.
Indications for use: MiSight® 1 day (omafilcon A) soft (hydrophilic) contact lenses for daily wear are indicated for the correction of myopic ametropia and for slowing the progression of myopia in children with non-diseased eyes, who at the initiation of treatment are 8-12 years of age and have a refraction of -0.75 to -4.00 diopters(spherical equivalent) with ≤ 0.75 diopters of astigmatism. The lens is to be discarded after each removal.