Persistence is needed to educate parents on symptoms, progress they cannot see

Dry eye patients come in complaining about dry eyes. After treatment, they report, “My eyes feel great!”

With a bag full of previously unsuccessful contact lenses and substandard acuity, keratoconus patients visit you — their last hope before corneal surgery. After you’ve fit them with scleral lenses, they often shed tears of joy saying, “I haven’t seen this well or had contacts that feel this comfortable for years!”

After vision therapy, kids do better in school.

All of the above specialties have three points in common:

1. Patients are obviously symptomatic.
2. They may not understand the cause of their symptoms when they see you, but they understand them when they leave.
3. After seeing you, their symptoms are gone or greatly reduced.

NOTHING IN COMMON

Myopia, possibly more prevalent than all the above conditions combined, has none of those three things associated with it. If you reject the premise that myopia patients are not symptomatic, that’s likely one reason your own efforts to bring myopia management into your own practice might be faltering. That’s because myopia management isn’t visual acuity management.

Significant pathology events (for example, myopic maculopathy) occur because eyes are too big, not because prescriptions are too high. Yes, the two are associated. But the discussion here inevitably comes down to explaining myopia to an asymptomatic myopic parent.

Historically, most kids in myopia management have at least one myopic parent. Even when that parent is -9.00, they often view their own myopia as “asymptomatic” since they can see well with correction. It’s common to hear, “Yes, my vision got worse every year when I was a kid, but I just got stronger glasses and I could always see.” Worse, many say, “I’m not nearsighted anymore because I had LASIK surgery. So, I’ll just wait until my -1.75 nine-year-old daughter graduates college and she can have LASIK.”

This leads to the second point above addressing how myopia management is different than other specialties. Even after an explanation of axial myopia to myopic parents, many still don’t understand and fewer internalize the scope of their child’s potential future problem.

As possible problems from childhood myopia are more likely to happen when these kids grow up, the third point above comes into play. When kids are in treatment, their nonexistent symptoms (axial elongation isn’t a symptom) are still an amorphous and hard-to-comprehend entity that parents won’t view as having been “fixed.”

BEYOND THE BLUR

Your practice is already good at correcting the symptom of blurry vision from myopia. It’s easy because it addresses all three points. Configuring your practice as one that works to slow down axial length with myopia management is more challenging. To succeed, and have it be a sustainable in your practice, each point above must be addressed with parents.

1. Be crystal clear that myopia is a disease state caused by an eye that is too big. The symptom of the disease, nearsightedness, is blurry vision.
2. Take time to carefully explain the consequences of axial length growth not just as they relate to blurry vision but potential future pathology.
3. Parents have to understand that treatment is a process that occurs over time. The results of treatment won’t necessarily be apparent via reduced prescriptions but rather a slowing down of axial elongation.

Carefully explaining all the above to parents whose bias is “It’s no big deal” isn’t easy. It takes persistence on your part. OM

DR. GERBER is the president of the Power Practice, a company specializing in making optometrists more profitable. Learn more at www.powerpractice.com , or call Dr. Gerber at (888) 356-4447. Dr. Gerber is also co-founder of Treehouse Eyes, the country’s only practice dedicated exclusively to treating myopia in kids. For information, visit treehouseeyes.com .