The discussion

Making myopia matter in practice

Optometrists and practice owners, Indie Grewal and Lynne Fernandes, talk to OT  about introducing myopia management into practice and how to talk to patients about the service

Lynne Fernandes

In 2016 a study performed by researchers at Ulster University reported that nearly one in five teenagers in the UK were myopic.

However, some optometrists have expressed a nervousness about offering this form of treatment to their young patients.

Two practices that have been offering myopia management successfully for a number of years are Lynne Fernandes Optometrists in the south west of England and a St Albans-based Leightons Opticians franchise practice that is run by optometrist Indie Grewal.

Practice director, Lynne Fernandes, told OT that she decided to introduce myopia management into her optical business around five years ago, after listening to a particularly “compelling” talk by Brien Holden at a British Contact Lens Association Clinical Conference and Exhibition.

The lecture explored “the huge worldwide increase in the prevalence of myopia and its consequences,” Ms Fernandes explained.

Create robust, clear protocols and train your teams well. Providing any new service takes an investment of time, effort and probably money

Lynne Fernandes, optometrist and practice director of Lynne Fernandes Optometrists

As a result, after considering the research and speaking with practitioners who were already performing myopia management in their practices, the business owner decided that she “wanted to be able to offer patients the option of slowing their rate of myopia progression.”

Mr Grewal’s reasons are similar. In 2008, he introduced myopia management to his practice after learning about “the significance that myopia can have on a patient and the potential solutions that were becoming available.”

“The information emerging was very intriguing,” he told OT.

Introducing the service

For Ms Fernandes, the process of introducing myopia management into practice was a three-staged approach. She created a protocol, designed a clinic and trained her teams.

Clinical staff saw the new service as a professional development opportunity, Ms Fernandes shared. “All of our optometrists have developed areas of specialist interest, from dry eye to complex contact lenses, from specific learning difficulties clinics to independent prescribing and myopia control,” she explained.

Non-clinical staff were also briefed on why the business had decided to offer the service, who it would be offered to, and the structure of it. 

Recalling when he began offering myopia management in practice 12 years ago, Mr Grewal highlighted that as an independent, it helped him stand out from the crowd. “There wasn’t really anyone else doing it on a big scale at the time. It certainly wasn’t High Street multiple territory, it was something for the independent,” he said.

In terms of preparing his practice for the new service, Mr Grewal focused on educating his support staff about what the service involved because “ultimately they are the people on the frontline who answer questions from patients,” he said.

“Most importantly, they also carry on the conversation that I may have started in the consulting room,” he added.

Consequently, support staff were encouraged to read some of the myopia research papers that Mr Grewal had himself been reading and ask him questions on them. This benefited him also because: “By asking questions, it made me think about how I would answer similar questions from patients and it reinforced my educational understanding on the topic,” he explained.

Preparing parents and patients

Since introducing myopia management, Ms Fernandes has noticed some reoccurring themes in the key concerns that parents raise most frequently. They include: why management is not offered under the NHS, the cost and the evidence base.

For Mr Grewal, concerns most frequently encountered when discussing myopia revolve around contact lenses rather than myopia per se, he said. “There is a perception that children are too young to wear contact lenses,” he explained, adding: “In these situations, we tend to reference clinical studies that demonstrate how capable young children are with contact lenses, and share the experiences of children of a similar age who we have been fitted very successfully.”

I was nervous when I first started offering myopia management. But after you have fitted a few patients and had successes, you become more confident

Indie Grewal, optometrist and Leightons franchisee owner

What to say and how to say it

Dealing with a wide range of myopia patients over the last decade, Mr Grewal has come to learn what conversations are most effective in the testing room and what to avoid saying.

“You must explain to the parents that with any myopia management strategy, the first thing it does is correct vision. Secondly, it is there to help slow down the progression of myopia. You must highlight vision first,” he emphasised.

“After explaining why a patient needs treatment, the third part of the conversation should be based on educating the parents about how myopia can lead to complications later in life,” he added.

When it comes to what to avoid, Mr Grewal told OT: “Parents don’t like it if they feel bullied into it. You can mention the significance of myopia in the pathology, but don’t labour it. Provide them with information, answer their questions, and let them digest and consider this new option. In my experience, they are more likely to return in these instances,” he said.

For Ms Fernandes, “honesty, integrity and time to think,” are the most important things to remember when talking to a patient and their parents about myopia management.

And do not “make out that the evidence is stronger than it is,” she advised.

Her optometrists will share a leaflet on the topic with the patient and their parents, and suggest that they book in for a consultation to discuss their individual case in detail, if they are interested.

Ms Fernandes highlighted that as myopia becomes an area that the public are more aware of, practitioners should not be surprised when parents proactively seek a practice out.

“We had a patient recently who had searched the internet trying to find someone experienced in myopia management for their child. They were delighted to find us on their doorstep; parents are very keen to be proactive in managing their child’s level of myopia,” she added. 

Is it right for you?

To practices considering introducing myopia management, Ms Fernandes emphasises: “Create robust, clear protocols and train your teams well. Providing any new service takes an investment of time, effort and probably money.”

She also urges practitioners to: “Do your research,” highlighting resources such as the Brien Holden Institute, and clinical conferences such as the BCLA.

Mr Grewal reflected: “I was nervous when I first started offering myopia management. But after you have fitted a few patients and had successes, you become more confident. Plus, there is nothing better than being able to use your own experiences to parents when talking about fitting their child.”

The impact that it can have on a business should also not be underestimated, Mr Grewal concluded. “Myopia management now makes up 35% of our contact lens business.”