“Knowledge is a wonderful thing, at least then you have choice”

A chance meeting with a locum optometrist at one appointment saw Daisy and her mother referred to independent opticians, Central Vision Opticians in Finchley, London, where they saw optometrist and practice owner, Bhavin Shah. The now 12-year-old has been wearing orthokeratology (ortho-k) lenses for the last year. Here, mother, Anna Canty, shares Daisy’s myopia management journey with OT.

 Anna Canty: I first took Daisy for a sight test a couple of years ago – she had told us that at school she was struggling to read the blackboard. She would have been about 10. We went to a multiple and she was prescribed glasses. We returned a couple of times, during which it was noted that the vision in one of her eyes in particular was deteriorating very quickly. It had gone down to -3 in one eye. My husband is -11 in one eye and so I was concerned that she might be going that way.

By luck, on one of the days that we went in for a check-up, we were seem by a locum who mentioned that she didn’t usually work in the practice, but was there for the day, and normally worked at a university. She mentioned that her son child had been seeing optometrist, Bhavin Shah, at Central Vision Opticians, and recommended that I take Daisy to see him. She explained that her son was in ortho-k lenses, and that it had stopped his eyesight getting worse.

I was very concerned for Daisy and her eyesight. Lockdown, as the optometrist told me, has exacerbated this problem for many. Daisy spent three months in her room with her laptop a few centimeters away from her eyes for six hours every day.

It was a complete chance meeting. I had never heard about myopia or ortho-k lenses before. She explained myopia to me, as well as clinical and lifestyle management options and recommendations. She gave me Bhavin’s details, and we made a call and went to see him. That was about a year ago.

Bhavin has been absolutely brilliant. He explained myopia and all of the current management options to me. He emphasised that there are no guarantees with treatment. However, he highlighted that he does find that, in most cases, management is able to not stop the deterioration, but to slow it down.

Whilst he talked me through the options, including soft lenses, I really trusted the locum who shared her experiences about her son with me, and I really wanted the same management for my child. I trusted her, she was amazing and had said it had been so good for her son. As a parent, all you want is a recommendation.

It was noted that the vision in one of her eyes in particular was deteriorating very quickly. It had gone down to -3 in one eye. My husband is -11 in one eye and so I was concerned that she might be going that way

I had never heard of myopia before speaking to this optometrist. And no one I speak to now has ever heard of it.

Daisy has been in ortho-k lenses for just over a year now. We have been to see Bhavin quite a few times. It hasn’t been completely straightforward and we have had a few problems arise. But Bhavin is great, so we just nip back and see him when we need to.

It took her about six weeks to get used to wearing them totally. Now it is not a problem. She takes them in and out with ease. As my husband has hard lenses, he was also able to support her with it.

In terms of how she felt about wearing lenses, she was more freaked out by the thought that she could go blind. She wanted this and has been involved at every appointment.

Daisy is very mature, she’s tidy and she’s organised. She knows to always tell me if there is a problem. I wish we were given more information about myopia and started management earlier. Knowledge is a wonderful thing, at least then you have choice.

I had never heard of myopia before speaking to this optometrist. And no one I speak to now has ever heard of it

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Optometrist and practice owner, Bhavin Shah, shares his experiences of offering myopia management

When did you first meet Daisy and how did you raise the conversation of myopia with her and her parents?

Daisy was first noted to be myopic in September 2020 at a sight test at one of the multiples. On her follow-up in May 2021, she had progressed significantly. The optometrist who saw her didn’t have myopia management options in that practice but knew that I was a specialist and had helped her own son so she asked Anna to contact me for advice. I spoke to her over the telephone and we talked about myopia, the reasons for progression at Daisy’s age, and the options that we had for management. Her dad is highly myopic and is already an RGP contact lens wearer.

Together, why did you decide to fit Daisy with ortho-k and what has been the result so far?

As Daisy likes to play sports and swim, we felt that between daily lenses and ortho-k, the latter would provide more freedom during the day. At that point, I booked Daisy in for a consultation and a fitting for ortho-k lenses. The success has been brilliant, she took to the application and removal of lenses quickly, and it made a big difference to her life almost immediately.

The success has been brilliant, she took to the application and removal of lenses quickly, and it made a big difference to her life almost immediately

When did you start offering myopia management in your practice and why?

I first started offering myopia management contact lenses in 2016, but before this I had noticed (anecdotally) that some children whom I had been working with vision therapy had reduced progression of their myopia compared to their siblings. As a problem solver, technophile, a pioneer in visual development and a myope with a desire to make a long-term positive impact to my patients, I knew how myopia management would help so many children. I also knew how much children would benefit from contact lens wear in terms of playing sports and self-esteem. Combining contact lenses with the ability to protect my patients’ eyes from the risk of blindness made my journey with myopia management extremely exciting and gratifying for me.

Why do you think myopia management is something practitioners should be offering?

Myopia management is one of the most rewarding parts of my practice, I can spend time with my patients and their families and know that I am making a difference to their lives. It’s ok if a practitioner is working in a practice that doesn’t offer myopia management, but they must have a conversation with the parent of every myope they see and explain that there are safe and proven methods to slow the rate of deterioration that will reduce the risk of blindness in later life. Practitioners need to advise parents to do their research about options for myopia management. I believe that the overwhelming evidence means that it is negligent if we don’t advise all parents that there are options for the management of their myopic child.

What are your three top tips for raising the conversation about myopia management with a patient and their parent?

1. Ask empathetic questions about the parent’s understanding of short sightedness/myopia, the effects, and subsequent risks, this helps to launch the conversation
2. Ask parents if they know anything about myopia management to move the conversation to the subject
3. Make sure you have enough time to answer questions honestly and confidently.

Bonus tip: I made up the following mnemonic: “I Can Treat Every Terrific Myope Confidently.” In other words, be aware of the following about myopia: I (Identity: what is myopia?) Can (what are the Causes of myopia?) Treat (what are the Treatment options?) Every (Effects of myopia) Terrific (Timeline of myopia: how do we expect it progress?) Myope (Management: how can we manage myopia rather than treat it?) Confidently (what are the Consequences and risks of myopia?).