Key milestones

Making a difference with myopia management

Optometrist and independent practice owner, Bhavin Shah, discusses his journey into myopia management and shares advice for others thinking about introducing it

Bhavin Shah

01 I first began offering myopia management to my patients at the end of 2016 through the use of dual focus, distance centre multifocal contact lenses.

For a long time, I have worked in behavioural optometry and I had begun to notice that some management options and exercises I was doing with patients were having an impact on myopia in those patients as well. As a clinician, I had become interested in myopia as a topic and started reading up on studies on the subject. This coincided with information released by the World Health Organization that reported that 90% of 18-year-olds in Korea and Singapore were short-sighted. Whilst I was aware that they were ahead of the UK on that curve, it felt like myopia management was something that I should be offering. Due to the similarities in the behavioural optometry conversations I was already having with patients in practice, introducing myopia management into practice was relatively simple.

The conversation is about making sure that you are all on the same side – it’s ultimately about helping the child after all

 

02 One particular success story is of a nine-year-old who came into practice and his vision had increased by a dioptre within a year.

The patient’s parents were both short-sighted, at -4 and -5. Their child’s vision had jumped so much in a year that they were really concerned and wanted to see what could be done to slow it down. As parents, they were proactive and keen to source a solution. I spoke to them about dual focus contact lenses and subsequently fitted the child. We had an initial fitting appointment, two insert and removal sessions, an end of trial appointment after three months and a follow up after six months. The parents didn’t have any concerns about their child wearing contact lenses – it of course took him a few weeks to be completely comfortable with handling and during that time I spoke to them regularly to provide advice.

The outcome has been that this management has slowed down the rate of change in this patient’s vision. In the space of three years, his prescription has changed by one dioptre, which is around a 50% reduction in progression rate.

03 In August 2017, I started fitting CooperVision’s MiSight 1 day contact lenses as an early adopter in the second phase of its UK pilot.

Around this time, I amended the management of this particular young patient and put him into MiSight 1 day contact lenses. I made this decision as a clinician because it is a one-day product and could offer him more enhanced optical properties than the standard product.

What I offer a patient as part of a myopia management programme differs depending on their needs. For this patient, being in contact lenses rather than spectacles has not only helped with his vision, but also with his confidence in taking part in sporting activities in school. Whereas I have a 12-year-old swimmer who has moved from contact lenses to ortho-k because that better suits her lifestyle of being in a pool five days a week.

Introducing myopia management into practice takes a level of commitment from the practitioner. You have to put the time and effort into acquiring the skills and learning what you need to do

 

04 When raising myopia management with parents, I talk about the importance of treatment and the risks associated with myopia progression.

I am short-sighted myself, so I share my experience, as well as success stories that I’ve had with patients. The conversation is about making sure that you are all on the same side – it’s ultimately about helping the child after all.

As with anything, when you first start something new, it takes a little more time. However, within a couple of months of doing things again and again, you build up your skills and understanding, and it becomes easier.

Similarly, with time, confidence in having these conversations with parents builds as you become able to answer and respond to parents and patients’ questions.

05 To clinicians who are thinking about introducing myopia management into practice, I would encourage them to be informed and read up on the studies and resources that are available – there is a big community of people who can support you.

Introducing myopia management into practice takes a level of commitment from the practitioner. You have to put the time and effort in to acquiring the skills and learning what you need to do.

Speak to your peers about what works and does not work for them. Make sure that you have the right tools and equipment in practice, and commit to it as a service that you provide. You can’t just dabble in it or offer it half-heartedly, you have to commit to it.

• As told to Emily McCormick.