Q&A

Optometry has secured its place as the profession of primary eye care providers, with a particular focus on protecting the ability of children to excel in life, and has become a part of a new preventive health care system. As such, myopia, which is hitting epidemic proportions, is top of mind for our profession.

The incidence of childhood myopia among American children has more than doubled through the last 50 years, reports the Multi-Ethnic Pediatric Eye Disease Study (MEPEDS). The study reveals that myopia is particularly apparent in African-American children, followed by Asian-American children, Hispanic/Latino and non-Hispanic white children.

Heredity and lack of time spent outdoors have been definitively implicated. It also has been suggested that too much “screen time” (smart phones and digital tablet use), which requires a great deal of near work, is playing a role.

For the next couple months, I talk to optometrists, internationally, who are on the front lines of myopia control, about their treatment strategies, most memorable cases and more. Enjoy!

Jack Schaeffer, O.D., F.A.A.O.,
Editor-in-Chief
O.D. Scene

MYOPIA CONTROL EXPERTS WEIGHS IN . . .

GARY GERBER, O.D.,
LANGIS MICHAUD, O.D., M.SC., F.A.A.O. (DIPL.),
& NICHOLAS ONKEN, O.D.,

Q: HOW AND WHY DID YOU GET INVOLVED IN MYOPIA CONTROL?

GG: With the number of myopic kids in the United States already at more than 10 million and growing (about 25% of all kids), three established treatments to help these kids and no one doing solely myopia control, myself and my co-founding partner decided the time was right to once and for all put a stake in the ground to help these kids. So, we founded Treehouse Eyes, which is the first practice in the United States dedicated exclusively to myopia control in kids. We have two locations in the Washington, D.C. area.

LM: In the Montreal area, there were not a lot of offices offering orthokeratology. Two of our clinical instructors were highly skilled in this area, so they became overwhelmed with cases, and I decided to get more involved. It was a true revelation for me and, since then, myopia control is a real driver of my practice.

NO: I have always loved working with kids! Along with amblyopia, strabismus, functional visual dysfunction and visual processing dysfunction, myopia control is a natural and necessary aspect of complete pediatric eye care. Having myopia myself, I feel a personal sense of urgency with every child I meet who displays progressive myopia.

Q: WHAT IS YOUR MOST SUCCESSFUL TREATMENT STRATEGY FOR MYOPIA?

GG: We have two main categories of treatment. Pharmacologically, we use atropine in whatever concentration is best for a particular patient. Optically, we use custom-designed soft multifocal contact lenses and custom-designed overnight RGPs to deliver the same type of optics. Our order of treatment and when we use it is based on our patent-pending Treehouse Vision System.

LM: The real question is, ‘Which of my tools is better suited to help the patient in front of me?’ Orthokeratology can be successful when practitioners understand that patients do well when the ‘right’ lens design is chosen. I strongly believe that myopia control strategy should be customized for every patient. All eyes are different and, consequently, all options may play a role at a given time. There is no silver bullet to control this pathological disease.

NO: I have had equal success with multifocal contact lenses and orthokeratology, both in patient adoption and in the slowing of myopia. I, typically, save atropine as a last resort due to possible side effects. (I’ve seen both allergic reactions and pupil dilation on 0.01%). Additionally, we have not used atropine for this length of time in children before, so I am concerned about long-term effects. That said, I certainly use it as an add-on to contact lenses when lenses alone aren’t working well, or when contact lenses aren’t possible, but urgency is high. Right now I’m limiting my atropine treatment length to about two years. Time will tell whether that changes.

Q: HOW, SPECIFICALLY, DO YOU GENERATE REFERRALS?

GG: We have a mix of social, digital and more conventional marketing that we use to generate new patients. The branding company we worked with did some consumer research to ensure we delivered the right message at the right time to the right prospective parent of a myopic kid. Also, we don’t have eyeglasses in our centers and don’t do primary care. So, that gives us the ability to genuinely say, “We won’t ever steal your patient.”

LM: We are lucky enough to fill our myopia control clinic through word-of-mouth referrals from patients and private practitioners who do not offer this type of service. In fact, 90% of the patients I meet are referred by other patients or parents who did their homework and know that they must do something for their childrens’ vision.

NO: Most myopia control referrals come from other doctors in the practice I work. I am easily at the disposal of more than a dozen doctors.

Q: WHAT IS YOUR MOST MEMORABLE CASE AND WHY?

GG: It’d have to be when a refractive surgeon brought both of his own kids (I guess that’s two cases . . .). Getting refractive surgeons to understand what we do and, ultimately, have us treat their kids gets us a step closer to our goal of eradicating myopia from the face of the earth.

LM: About 18 months ago, I started low-dose atropine treatment on a two-year-old boy, whose vision was -8.00D OU. A recent visit to my practice revealed the boy’s axial length is now under normal growth (around 0.1 mm/year), and his myopia had not progressed.

NO: My first orthokeratology patient. Despite the fact that his Medicaid wouldn’t pay for the contact lenses and the fact that he and his family did not live close to my practice, his mother understood the importance of myopia control and was committed to giving her son the care he needed.

Q: WHAT CAN O.D.S DO TO INCREASE AWARENESS OF MYOPIA CONTROL?

GG: Keep talking about it — every patient, every day! Myopia and its consequences won’t be a big deal until we say it is. Regardless of the amount, we need to remember that we’re not supposed to be myopic in any degree.

LM: We should talk about myopia control and present strategies to parents. Second, we should talk to the teachers and other professionals who are working in our neighborhood’s schools.

NO: We will all need to be committed to this cause. It won’t catch on if only some of us talk about it.

Q: WHO ARE THE MEMBERS OF YOUR FAMILY, AND WHAT DO YOU LIKE TO DO FOR FUN?

GG: Outside of Treehouse Eyes, I’m the Chief Dream Officer at the Power Practice, an optometric consulting company. We have a weekly radio show, The Power Hour. Also, I play keyboards for Joe Lynn Turner, the singer from Deep Purple and Rainbow. The time commitment is challenging at times, but totally worth it.

LM: I have been happily married for 15 years to Maryse. We are blessed to have two beautiful girls – Anne Sophie (14) and Elisabeth (12). My wife is an urban planner and works for the City of Montreal. My girls are involved in swimming competitions, so we “taxi” a lot. For fun, we go to festivals, special events, ski, bike and travel.

NO: My wife, Jamie, and I have been married for more than 13 years. Our son, Andrew, is eight, and our daughter, Sadie, is 7. We recently rescued a year-old Beagle mix named Bowie. We are very involved at our church. Recently, I’ve been on a huge board game kick.

Q: WHAT IS YOUR FAVORITE BOOK, MOVIE AND ADULT BEVERAGE?

GG: Book: anything by Clive Cussler; Movie: “Top Gun.”(My son is named Maverick, though not because of the movie); Band: The Who; Adult Beverage: expertly brewed hazel-nut coffee.

LM: Book: novels, particularly related to politics and international trading; Movie: “Le declin de l’Empire Américain” (The Decline of the American Empire); Band: Pat Metheny. Adult Beverage: Wine. I like paring wine with food.

NO: Book: “The First Man in Rome” series. Movie: “Jurassic Park;” Band: classic Metallica. Adult Beverage: Does a root beer float count? OM