Myopia control management

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Written by Ross Grant, owner ToolBox, November 20, 2017 

Myopia control is an embryonic field in eye care. The pressure is on to find ways of managing it in practice because of the very fast increase in myopia world wide. It seems that nowhere is immune and the more developed and indoor-living a community, the higher the prevalence of myopia. While myopia itself is a concern, perhaps a bigger one is that in later years myopes face a higher probability of a group of conditions such as retinal holes and detachments, cataracts and glaucoma, increasing on an exponential scale with the degree of myopia.

The upshot is that we should be putting as much effort into managing myopia early to prevent it or slow it down if we don't want our patients facing the consequences and our hospital eye services inundated with avoidable work in the future. As the approach is preventative, we shall be selling something that does not have a tangible short-term reward, such as a pair of glasses or contact lenses, but the idea of stopping or slowing something down without necessarily eliminating it altogether. Looking at our record of managing obesity and diabetes in the community, we have some way to go with these skills.

Ross Grant

After qualifying in the UK as an optometrist, Ross Grant obtained post-graduate qualifications in contact lenses and management. He has worked in general, hospital and specialist contact lens practice, and in academia. 

It requires education and understanding both for the practitioner, and for the parents of the children. As with many preventative measures, the earlier you start, the better the prospects of a good outcome.
The causes of myopia increase have been outlined and are being explored extensively elsewhere. However, how do we charge for something whose outcome is something not happening over quite a long time - studies are showing reduction effects after three years of application, and this will probably extend with time. Hospitals, where staff are salaried irrespective of the work that they do would seem ideal, but they are often not as accessible as an optometry practice and adding many children for long-term monitoring would seem to defeat the object of keeping their workload manageable. Logically, the service should be offered as primary care in the community.

In countries with generous state-sponsorship or insurance cover to support child vision care the costs will be covered. In places that are not lucky  enough to have such support the practice will need to charge the parents. The practices that will have the most trouble will be the ones who are not in the habit of charging realistic professional fees, relying instead on inflated profits from the sale of glasses to subsidies their clinical activities. It looks odd if you charge more for a child than you do for an adult - it goes against our mentality from almost every other commercial experience in which children cost less.

Where you have to charge, subscription services, as already adopted by many practices for the supply of contact lenses, would seem to be a good approach. The parents pay so much a month and that covers periodical checks and changes to the child's prescription, and any additional contingency appointments. It also allows the eye care practitioner to put the costs and benefits to the child into perspective with other regular costs such as internet or telephone subscriptions. Much of this has still to be worked out.

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