You and Eye: Myopia cannot be viewed as a specialty in today's practice setting

In this episode of the You and Eye podcast, Miriam Korik, OD, and Justin Kwan, OD, FAAO, delve into the evolving landscape of myopia management within optometry, reflecting on its transition from a niche specialty to a crucial component of primary care. Drawing on their experiences and insights, they discuss the growing prevalence of myopia and the pressing need for more optometrists to integrate effective management strategies into their practices. Kwan shares practical advice for new graduates and seasoned practitioners alike, emphasizing the importance of collaboration and support when introducing myopia management techniques. They explore various methods for starting this process, even in practices without advanced technology, while also highlighting the value of utilizing available resources and consultants. This dialogue underscores the significance of proactive eye care in addressing the myopia epidemic and equips optometrists with actionable steps to enhance their practice.

Podcast transcript

Miriam Korik, OD:
I mean jumping right in. I feel like when I was in school, which wasn't too long ago, I graduated in 2020, myopia management was considered more of a specialty. And how do you feel it has shifted in recent years to kind of become more primary care optometry.

Justin Kwan, OD, FAAO:
Yeah, Miri, I think part of that stems with our faculty having grown up with ortho-k in the 90s. And then there were some FDA approvals of ortho-k, and then it was sort of like almost happenstance, that they're like, we don't need to flatten these base curves and it seems their myopia has slowed down. And then as the science, and, you know, larger bodies like the International Myopia Institute, having published more and more, we found out from faculty today that they started formalizing it into the curriculum around 2016 so I think you were just entering into your school years.

Korik:
Yeah, I was. That's when I started.

Kwan:
And then lately, you know, as you look at the census and try to measure the size of the myopia problem, both in children and adults alike. We kind of take that Brien Holden [Vision Institute] estimate and try to bring it closer to home. So yeah, the global number is what it is, but here in North America, nearly half of the population will have myopia by 2030 so that's about five years away, a lot sooner than that 2050, year that you typically hear about. So I think to answer your question, man, myopia can't be a specialty because it's too big of a problem for just like a few 100 doctors to focus on like we literally need 10s of 1000s of optometrists and a good chunk of our ophthalmology colleagues to be all in hand, all hands on deck. Otherwise, we can't help these 19 million children.

Korik:
I agree. I mean, it's so prevalent. Like, think about a typical day in clinic. How many myopes do you see? And you know, if you're, especially if you're doing pediatrics, like, how many myopic kids do you see? So now that it's considered more primary care, how do you feel that new grads, or even long-time practicing optometrists, [should] get started with introducing myopia management into their practices?

Kwan:
Just like anything new, it can feel challenging or hard; it definitely feels different to do something you haven't done before. But I think also with most things, the mindset and mentality matter a lot. And might be a little cliche to say, like most of it's in your head, but I think we definitely can do new things better if we don't do it alone, right? And and so whether it's one staff member, the owner, OD, anybody, as long as they kind of get where you're going and why you deeply care about these children with myopia, and kind of bring that evidence-based and standard-of-care support, I think can be much easier. So you don't have to do all things when you get started. You can start with MiSight 1-day, you can kind of learn how to do atropine; ortho-k has changed a lot in the past couple decades as well. The key is to just get started.

But I think a big part of that is we have to set our fees. So that that often is the first hurdle to clear. And definitely, all of these wonderful companies have reps and consultants that can train your staff and help you with your first few patients at no charge. And that's, I think the beauty of the profession is that we all can work together in this space.

Korik:
So stemming from when you said, like, first introducing [myopia] to the practice, how do you recommend a practice [gets started]? Because, like me, coming from New York, you know, there's a lot of opticals here that might not have a topographer. How would you recommend a practice without a topographer start? Like with just atropine and soft contact lenses? Is it possible to do ortho-k with just Ks [keratometry] from the auto refractor?

Kwan:
Yeah, I think possible and good are, you know, maybe two different answers. It's certainly possible to start with the auto Ks. And, you know, I think most of the profession are using larger diameter ortho-k lenses now, because you're like, "Oh, the HVID ruler doesn't give me a great estimate, and my topographer would be more accurate." But as long as you use like an 11.0 diameter or larger, and you work off your auto Ks, that's a great starting point, but you really would do your patients a better service [to use a topographer], in case you need to troubleshoot, let's say, two out of your 10 patients, but in large part, the technology has gotten so good that you could probably get started with one patient without a topographer, and then make sure you definitely plan to acquire one in the near future.

Korik:
Got it. And I feel like you can always, like, send those readings out to a consultant, like, email them, and they can kind of like help you troubleshoot a little bit?

Kwan:
Absolutely. And I think the consultants definitely appreciate as much data as possible. Now that we have our iPhones that do stills and short videos of the fluorescein pattern, and then making sure we get that overrefraction over the ortho-k lens is a critical piece as well. But yeah, our consultants are well set up and so experienced. Obviously, they do thousands of fits a month that they can kind of speak from that experience to help us with our onesies and twosies.

Korik:
Right. I feel like nowadays there's so many creative ways to do it, like how you said, you know, taking a video, even on the iPhone.

Kwan:
Oh, a quick tip on that is, I learned, you have to use portrait mode if you're going to do stills and video there. Yeah, yeah.

Korik:
That's an awesome tip.