In the second installment of this myopia management series sponsored by Hoya Vision Care Canada, Dr. Devan Trischuk shares his EXPERT insights into how he built the myopia side of his busy optometry practice.
In this episode, we dive deeper into treatment protocols and how to prescribe different forms of myopia management.
If you’re looking for a more introductory level conversation, be sure to check out the first installment of this series in the interview with Dr. Gary Matter.
Stay tuned for the next two episodes in this series as we continue to shed light on the importance of myopia management and how all ECPs can be part of the solution.
Thanks again to Hoya Vision Care Canada for their support in this series.
Watch the episode here
Listen to the podcast here
Myopia Management EXPERT – Dr. Devan Trischuk
Welcome back to another episode of the show, Canada’s number one optometry show. Thank you so much for taking the time to join me here. I’m super excited. I am here in Quebec City for the 38th Congress of the Canadian Association of Optometry. We are here at the conference. If you’re watching on YouTube, there are lots of people behind us. I didn’t plan this as well as I thought I had. There’s a lot more noise than I was expecting but we will speak loudly and clearly. I’m sure you’ll be able to hear us fine.
Before we get started, I want to say a big thank you to Hoya Vision Care Canada for supporting this interview. This is 1 of 4 interviews that we are doing on the topic of myopia management. Thank you to Hoya Vision Care Canada for your support on this topic and for bringing this education and insight to our audience and colleagues who are reading.
I have a master in myopia management, Dr. Devan Trischuk, who is an optometrist and a clinic owner based in Saskatoon, Saskatchewan. He’s the Owner of Family Focused Eyecare, which is a big optometry practice of seven doctors. Devan himself is specializing in myopia management. Our first interview that we did with Dr. Gary Matter on this topic was more of an introductory conversation.
How can we get into myopia management? Why is it important for us to think about it differently? With Dr. Trischuk, we’re going to go a little deeper and talk about more from an expert’s perspective. What are the treatments? How should we be applying them? How should we be differentiating ourselves or our practices using myopia management? Devan, thank you for joining me on the show.
Thanks for having me, Harbir. This is great.
It is my pleasure. I forgot to mention. Gary, who was on, is a father of 3 as am I, and Devan is a father of 4. Devan’s lovely wife, Jen, is here as well. She’s an optometrist as well. She’s going to be in the background talking to us and saying, “Don’t talk about that.” She will be calling Devan out when he is off base a little bit. We both speak on this topic. We lecture on it and talk to our colleagues about myopia management. The number one thing is I feel like we are trying to encourage our colleagues to have a bit of a mindset shift. As far as looking at myopia, what is it that we need to look at differently?
In the past, myopia has been mainly refractive error and correcting someone to see well. As you bring in the axial length side of it and that eye gets larger, it’s more of those long-term ocular health risks. That’s where it is. That mindset shifting is that myopia is more looked at as a disease and I’d agree with that. It is a disease. That eye that gets larger becomes fragile. You run into those ocular health risks. When you’re older, those risks keep increasing. The distance blur is a side effect of that that you manage. You help them to see well and function but it’s more the eye getting bigger. That’s the issue.
Myopia is a disease. The eye gets larger and larger and becomes fragile.
An interesting way to look at it is the distance blur is a secondary thing. Myopia is a disease, not just a refractive condition. In my case, if you look at this 7, 8, or 9-year-old child in front of you and you say, “You have a disease,” I have to look at that person differently. It’s one of those things you can’t unsee once you’ve seen it.
You’re going to treat that child differently knowing that they have a progressive condition. We’re going to talk about tools and treatment options available to us to help slow down the progression of that disease and hopefully reduce the impact of that disease on that child’s life. For me, it’s important. Tell me about what you do in your practice as far as myopia management. Which of the different treatment options do you prescribe?
I do a little bit of everything. I probably started with ortho-k several years ago. It was where I first got into it. That was what we had at the time. These last couple of years, we’ve seen good soft contact lens options, atropine, and with the Hoya MiYOSMART in the last few years. These are good spectacle options. It was the last piece of those different treatment modalities. I do a little bit of all of those.
Roughly, if you split it, are you doing 25%, 25%, 25%, 25%?
The fact I started in ortho-k, I still have a lot of patients that are still there. They’re still young myopes at risk. I’d maybe say 50% ortho-k, 25% spectacle, 20% soft, and a small number of atropine. Atropine is sprinkled into the rest of those more in-combo treatments. There is where atropine comes in.
That’s a great point to make, the combination of the treatments. Atropine can be used in all of the other three as a combined or additive component. Let’s talk about atropine a little bit first. That is where I want to start this. I’m getting into atropine but the mindset part of it, how and when you approach the conversation about myopia management, is a more important thing to talk about.
How early are you getting in there? This is a bit of an obvious question or answer for you but are you getting in there when a child has gone from a -1 to a -2? Are we getting in there when they’re only a -0.25? Are we getting in there when they’re not even a minus yet? When does that conversation start?
As soon as possible. I have a few kids that are still in low pluses that I put on atropine. We were chatting about it before the lab two study. It has shown that. Especially when those kids are young, that’s when they’re going to progress the fastest. If you can have an impact then and slow down progression, that bodes well for the future that they’re not going to have those fastest progressing years. You’ve slowed them down.
Not a ton of kids are starting right there. It’s usually kids of Asian background in lower plus than you’d expect pretty early onset. They’re 6 or 7 years old. They’ve got parents or older siblings that are high myopes. You know they’re going in that direction. You have a pretty good idea. For a 9 or 10-year-old, that’s +0.25 or +50. I’m probably not too worried yet but it’s those risk factors that I’m going to say, “This kid, I’m going to start early with.”
I like how you broke down those factors. Ethnicity is a factor. Family history with the parents or siblings is nearsighted already. Age of onset. I like how you said less plus than you might expect. A lot of us and our colleagues are looking at how minus or myopic are they. What if they’re not myopic yet but they’re less plus than they should be? What does that look like? Can you give men an example of a child where you’re like, “They’re not yet nearsighted?”
That’s the term pre-myopia comes in. It is almost like a pre-diabetic or that type of thing. We have those aged match normals of where they should be. At age 7, you’d expect a kid to be at +0.75 or so. If they’re less than that, then you probably know they’re already on that path. They’re progressing and moving in that direction.
Getting comfortable having the conversation at that moment, that’s an important conversation point here as well. From my conversations with our colleagues, not everybody’s ready for that or comfortable with that yet to speak to a parent whose child is a +0.25. It’s like, “Your kid’s not nearsighted. Your kid doesn’t need glasses but we got to do something.” How do you have that conversation or how would you encourage somebody to start having that conversation with you?
For those couple of patients where you’ve got all those risk factors there going, usually, mom and dad are probably tuned into things already. They were high myopes. Our office is called Family Focus Eyecare. Usually, we’ve been seeing these patients at our office for a while. You’ve seen Mom and Dad as patients. They’re myopes. They bring in their kids for their 12-month check or age 3 check.
Hopefully, I’ve planted that seed years ago saying, “Mom and Dad, you’re both nearsighted.” We would’ve touched on the lifestyle things of making sure you’re getting outdoors as your child gets older and making sure they’ve got a good working distance. Hopefully, in years past, I’ve already said, “There’s a good chance your kid might become myopic. They’re +150,” which is fantastic as we read them at age 3, 4, 5, or whatever it is. Once you do hit that point, then it’s an easier conversation. If you’re starting right there, then it is.
Your kid, let’s say they were +1 a year ago. You see them a year later and they’re Plano. You can say, “Your kid moved -1 in that year. We expect that’s going to keep going.” Whether we start treatment at that point, if those other risk factors are there, maybe we do. Maybe you’re going to watch that child more closely but maybe you’ve sent Mom and Dad home with some information. You’ve started to talk to them about it. You see that kid in 6 months and 12 months and watch them more closely.
Having that conversation is the most important thing. It is getting comfortable in speaking with the parents. It is to understand that when the first few times we have that conversation, it may not be as streamlined as we’d like it to be. We’ll maybe get pushback from parents and that’s normal. It will help us gauge where people are.
For example, there were two brothers, 8 and 6 roughly. The eight-year-old is myopic but not that highly myopic. He is -1 or something. He’s in spectacle correction with the myopia lens. His younger brother is +0.25 at age 6. His parents, I was sitting there talking to them and was like, “He doesn’t need glasses but I would recommend using atropine because the studies are showing it helps,” but they weren’t comfortable with it.
They might not be. You’ve planted that seed again. You watch that kid and then work from there. Sometimes, that does take 6 months or 12 months to get there.
One of the things that I often will say is that it’s our obligation to educate in that scenario. It’s not appropriate to be like, “They probably wouldn’t want to do it. I won’t tell them.” If they go hear it from somewhere else, first of all, it doesn’t look good on you. As medical healthcare providers, we want to make sure we’re providing the best information we can for those patients. If they decide not to go through it at that time, that’s fine.
We don’t do ortho-k in the office. Often, I give the same amount of information on ortho-ks. It could be MiYOSMART or atropine. If the parent decides that orth-k is the right way to go, I refer them off to somebody else who does that. That is a better way to approach it. You’ve already touched on combined treatments. You do a lot of ortho-k. Are there some patients that you have doubling up the ortho-k and atrophy?
Most patients usually need corrections. They need something to help them see in the distance. Usually, my first line is to figure out, “Are we doing spectacles, soft contacts, or ortho-k?” It’s going to correct their distance vision but it’s also going to give us that treatment effect. I’m starting there. There are a few patients that I’ve started with combo right off the bat. Their parents are high myopes. They’re very young. All those different things are playing into it so I’m going to start with peripheral defocus by one of those options and atropine right off the bat.
For the majority of patients, I’m starting with ortho-k soft contact lenses and spectacles based on their age, even their axial length, or their family history. I’ll make a note in my chart that they are maybe moderate or high risk of fast progression so I may need to add atropine at 6 months or 12 months. As I’m touching on the treatment options with parents too and you have that risk profile in your mind, you get a good sense of we put him in glasses or soft contact lenses and that’s going to be as much as they need. That one treatment should do a good job.
Maybe this is going to be a kid that’s probably going to go faster. You might not be doing a combo but you mention to Mom and Dad, “If we don’t like the results at 6 and 12 months, we’re going to slow it down but it still might go a little faster than we want. We can then add atropine to this.” It is almost getting them ready if you think you might have to go that route. I’m surprised that sometimes, a kid with one treatment will work fine for them. They’re a kid that’s going to progress fast. For a kid who is going to need 2 treatments, I start with 1 and they’re fine with that 1. I don’t have to add more.
In most cases, you’re starting with one and then adding atropine.
It is the majority of cases.
In the odd case, you’re like, “This is a very high-risk combination. I’m going to do both.”
Those young myopic kids or low-plus kids, usually, their moms and dads are well-versed on the topic already. They’re coming in asking for treatments so they’re ready to go and do as much as they can. They sometimes even want both right off the bat. They want to do as much as they can immediately.
In that scenario, let’s say you are doing a MiYOSMART and atropine right off the gate. Do you pull the atropine out after a certain point? Have you done that previously?
I’ll watch and see how things go. It’s usually those young kids that progress the fastest when they’re young. It is those 7, 8, 9, or 10-year-olds. That’s probably the group that I’m going to do combo the most with. I usually give parents a rough idea that I’d say, “Probably until age twelve, we’re going to do both. This is the timeframe when the child is most likely to be progressing the quickest so we have to be the most aggressive.” We then watch what happens as they get to 11 and 12.
If the refraction is stable and the axial length is slowed down and going at a normal rate, then I’d say, “We’ll look at dropping atropine and then keep going with glasses.” Similarly tell them, “We’ll probably do this at age 15, 16, 17, or 18.” We then let the axial length dictate whether we are seeing that plateau naturally and then we stop treatment.
You have touched on axial length. We know myopia, in general, is a concern about axial elongation. You measure the axial length in your office. A question that comes up a lot is, “Should I have a biometer? Should I be measuring axial length? Do I need that?” You don’t have to answer all these questions but these are the types of questions that come up. They’re like, “Do I need it now if I’m getting started in myopia management or is it something I should get down the road?” How important is axial length measurement? When did you start to implement that into your practice?
I got an axial length before all the fancy machines came out. I have a secondhand IOLMaster that works very well. It is accurate but it doesn’t do all the other fun stuff that the new ones do. It’s probably been a few years since I’ve had it so I was doing myopia management before. Start now with your myopia patients. Don’t wait until you have an axial-length device. There are kids that you know are at risk for fast progression so start a treatment with them. You don’t have to wait. If you enjoy this area and you see yourself doing more and more of it, then is that budgeting for a device or looking at it and figuring out, “How am I going to work getting this into my office?”
Definitely start treatment now with your myopia patients. Don’t wait until you have an axial length device.
Probably where axial length has helped me the most, and since I have it, it would be very hard to not have it, is creating your approach or that risk profile initially with a patient. You could be pretty surprised that sometimes a -1 eight-year-old is a 23-millimeter eye. Sometimes, you get a -1 eight-year-old that’s a 24-millimeter eye. You’re going to treat those patients pretty differently based on how big that eye is, to begin with. You’ll be more aggressive with that bigger eye because as you get to that 25 and 25.5, that’s where those long-term ocular health risks escalate. You get an idea of how much room you’ve got. That almost speaks a bit to one treatment versus combo treatment.
If it’s a 23-millimeter eye, I’ve got a lot of room to work with so maybe we do one treatment. We say, “Let’s keep that refraction as low as possible as well. That child is not at risk of hitting 26 millimeters.” Whereas if you’re big, to begin with, then I’d say, “I got to be more aggressive with this child.” That’s probably the first place where it’s nice.
The second place where axial length is nice is as you follow that child being an objective measure. It is very accurate to 0.02 millimeters. It is five times or more accurate than refraction, which, with kids, can be variable. It’s not fun to cycle a kid every six months or every year. As I brought in axial length and saw it was accurate, I said, “I don’t feel like I’m having to cycle these kids.” I cycle them usually at baseline and then only if things aren’t making sense down the road. Usually, the axial length gives me a good idea of how things are going.
That leads me to the next thing I wanted to ask you. Which measure do you think you maybe rely on more? Imagine it’s a combination. It sounds like maybe axial length is going to have a bit more weight in your decision-making process.
When they’re getting pre-tested and coming to my room, that’s the first thing I look at. I pull up their axial length and then what we’ve done 6 months ago, 12 months ago, or 18 months ago. I then get an idea of that rate of change and then compare that. It’s nice. We’ve got almost normal rates of change that an emmetrope would progress at versus what a myopic kid would go at. You can compare to that and say, “Is my treatment effective? Do I have to change? Am I happy with it?” It is that type of thing.
That’s super valuable looking at it that way. For anybody who is doing myopia management or wants to get into it, you see the value in having a biometer or something that can measure the axial length because it gives you those extra data points. Refractions sometimes can be a little unreliable. Have that more precise measurement and the normative data that we can compare to for progression. There’s value in having that and axial length measurement. When do you use that? When do you start to measure axial length on a child that’s coming in for an eye exam?
We would have a child come in for a routine exam. At that exam, if they’re myopic or going in that direction, we usually have a quicker conversation with Mom and Dad, about 3 or 5 minutes. I’m touching on what we talked about that when we’re young, this eye is growing fast. We don’t want that eye to go too quickly because structurally, it becomes weak and then touches on you. They’ll also get a distance blur when that happens.
We do bring them back for a myopia assessment, which is a longer appointment than we’re going to do. We’re going to cycle their axial length and Quantel imaging. We do a little bit more to get those good baselines. That would usually be our first axial length. Each myope is a little bit different but at minimum, I’m seeing them every six months. They’re going to get an axial length at every visit there. In some kids, you might see it sooner. If you are probably those faster progressors, you’re more worried that you need to watch a little closer. Maybe you’re bringing some kids back at 3 or 5 months but the majority are at 6 and then doing it each visit.
Looking at even the six-month data is sometimes hard to make a decision. It is sometimes not enough time but then at twelve months, you get a pretty good idea of what’s happening over the previous year. Even sometimes, in seasonal changes, you see kids being outdoors more in the summer versus indoors, or in the dark that we get in Northern Canada. I keep that in mind like, “These last six months were through the winter.” When I compare it to six months, it was through the summer months. Sometimes, it seems to follow that. Sometimes, it doesn’t. I don’t know if that’s definitive but they’ve looked at that in studies a little bit too.
There’d be some correlation there. You’re not doing axial length on every child as part of their routine exam. You’re having them come back for a specific myopia workup. We’re going to eventually get into the fee structures and things. We’re not going to talk about specific numbers. I’ve always wondered about that. I always make analogies to dry eye.
We talk about this meibography, for example. Should I have patients come back for a dry eye workup and get their meibography done then or should we do meibography on every adult that comes in the door? That’s because I have then the results right there in the exam room to present to them and state my case for why they should get their dry eye treatment done. I was thinking the same with myopia then. Should we do axial length on every single child?
We’ve thought about that. It would be awesome to do that. There are probably a couple of things that have held us back, being a big office. We’ve got 1 axial length device and 3 pre-test rooms. Not every kid is going into that room. Sometimes, I wouldn’t allow it that way. Also, we can’t bill for it. Are you charging every patient for it? You use it as a screening or something as you support your case of, “Your child needs this.” We have pretty good success that when you look at those other risk factors, you talk to Mom and Dad about it. You present that they need that assessment and then usually, go forward from there.
I do find that parents generally are more motivated when it comes to this and you’re having this conversation. If I’m making that dry eye analogy and I’m speaking to an adult about the fact that they have dry eye, meibomian gland dropout, and all this, if I compare the level of motivation for that patient than compared to the level of motivation a parent has when you talk about myopia, it’s quite different. The parents of kids who are myopic or at risk of becoming myopic are like, “Tell me what you need and what we need to do. Let’s do it. Extra testing? Sure. Do we need to upgrade our lenses to different types of lenses?” We try to think about these different treatments.
They’re much more likely to take you up on what you’re suggesting compared to a dry-eye type of conversation. That’s also one of the reasons why I like this space. People want to help their kids. They’re going to listen to you at the very least when you’re making these suggestions. It probably makes sense to structure it the way you’re doing it. What I’m getting at is maybe we don’t need to have all of that data in front of us right away to state our case. We just need to say, “Here’s what we see.” People generally understand what nearsightedness is. Even if the parents are not nearsighted, having the kids come back for that workup makes sense.
I’m going to come back to the workup plus follow-up structures, fee structures, revenue of eye regeneration, and all of that. That’s an important thing to talk about too. A lot of colleagues wonder, “Is it worth my time? Am I going to make money by going into this?” Before we get into that, thinking about the treatment options that we have, you mentioned you do ortho-k. We talked quite a bit about atrophy and spectacle lens options. The MiYOSMART lens, you do a fair bit of that lens.
What I’m excited about there that I wanted to touch on a little bit here was the tech changes in the advancements in the technology. It feels like these spectacle lens options came out but already, there are some new advancements coming out. I wondered if you would be comfortable talking about what’s come out. We’re recording this on July 6th, 2023. In June 2023, Hoya came out with the MiYOSMART SUN. I believe they call it the MiYOSMART Chameleon but they’re going even beyond that. I thought I’ll let you go ahead and talk about that.
It is great. Even poly carb has UV protection to it but it is more of that comfort outdoors for kids. Parents do want a transition option for their kids. That’s where the Chameleon is nice. It gives you a lens that darkens outdoors. Some of those kids that are on atropine, usually, if they’re symptomatic, you’re adjusting the atropine or playing with it. That’s one more thing to give you better success with it or less likely to become symptomatic.
Having the MiYOSMART these past few years, parents have routinely asked, “Can we do this through a darkening lens? Is there a SunRx option with this?” They want to know if it’s available for their child and if they can do it. It’s exciting to have. It makes sense that when they launched it, they couldn’t come up with everything all at once. We are seeing these nice features that you can add to it if you’d like.
The evolution of that technology is nice. You’re right. That was a common thing. Let’s say you have a -4. That kid is not going to be able to function without their glasses. If they’re wearing sunglasses, they have prescription sunglasses that are not correcting myopia. If they’re out all day or it is summertime, they’re wearing sunglasses a lot. You don’t have that myopia correction control aspect to it. To have the Chameleon, which is that photochromic lens, and the second thing that’s coming out soon, the polarized option is going to be the next level of that options to offer to our patients. That’s going to be helpful.
If we are encouraging our colleagues to get into the myopia management space, one of the things that my colleagues will push back on or ask about is, “Is this going to be profitable? Is it worth the time to put into adopting this new specialty in our office?” We have to make sure anytime we go bring a specialty in, whether it’s dry eye or myopia management, that we have some kind of structure around it. You already talked about the fact that you have children come back for their myopia workup and then you expect to see them back a certain number of times for their follow-ups. How do you set your fee structure to make sure that all of those visits are profitable for the office and for you to do all of that?
If we even go a step back from that from how I got to where I am, I was trying to do it all at the same time. They’d be booked for a routine exam. You don’t know what’s coming. They end up being myopic. For those of you that have started doing this, usually, Mom and Dad have lots of questions. There’s a lot to go over. You are running behind.
It wasn’t working. My staff wasn’t happy. You’re getting stressed out as your day is running behind, that type of thing. That’s when we did change to a structure of, “We’re going to bring this child back.” That has been helpful. You send Mom and Dad some information. You give them that quick information about why this is important and why we need to do it. What happens is they do come back for that myopia assessment. It is something that they do pay for.
In Saskatchewan where I am, children’s routine exams are covered, some other cycloplegic refraction, and those types of things, like small amounts that we can bill for. If we did what we could bill for partials, cycloplegic refraction, and the amount of time we spend with them, it wouldn’t be profitable. If you compare it to seeing an adult patient or that type of thing, then you would struggle to make it work.
We have an initial assessment fee that covers that first assessment where you’re usually spending the most time with them. A nice part with sending them information is usually, they’ve gone through that a little bit so you can get into the treatment options a little bit more. That initial assessment will cover their testing, axial length, topography, imaging, and what you need. That covers them for the year.
Most kids, we see every six months. It might be three visits in that first year. Some kids, you might see more depending on how closely you need to watch them. There’s an annual fee they pay that covers the testing that you need as you go forward. Each child is going to be different. You are going to need topography with ortho-k patients. Every kid is getting axial length. Sometimes, you’re going to do imaging more often if you’re seeing things happen at the back of the eye. That’s how our structure worked.
There’s an initial assessment fee. That fee covers the first year of follow-ups. Every year after that, there’s a different annual fee, which I imagine is a little bit lower.
It is a little bit less than that initial first year.
That covers all. It will be no matter how many follow-ups they have. It’s a global fee, whether it’s 2 follow-ups or 6-follow ups.
There are different structures out there. Some offices do it that way where you pay per axial length measurement or per time you’re in the office. I feel like this has made it easier and simpler, if you can, for parents.
Every clinic and doctor is going to find something that works well or better for them. This is one of the reasons why I ask these questions because this is a new space for a lot of us. Many of us are trying to figure out, “How do I even approach this? How much should I charge? How do I even go about figuring out how much to charge?” It is getting it out there.
Someone might read this and say, “That’s different than how I’m doing it. Maybe I should try that,” or, “That’s not going to work in my office. I’ll find something different.” It’s a matter of having the conversation and getting the information out there. That’s good to know. I’m listening to what you’re saying here and that might be something that I need to adopt. I am often spending too much time in the exam room on that initial comprehensive eye exam or routine eye exam. I’m saying, “Let’s talk about myopia management. Let me tell you about all the options.”
There is too much in that.
Maybe I need to set that fee for that initial assessment. That would be helpful. It is making sure that when you are setting your fees for all the other follow-ups that it is profitable. Something that is a template that I’ve heard is if you see what your average revenue is going to be for an adult eye exam, their exam fee plus whatever glasses they might have purchased, what’s that revenue going to be? Think about how much chair time these myopia follow-ups are going to take and the equivalent of that adult getting the exam.
Try and average it out. Get a rough idea.
You’re at least not just breaking even. You’re making sales. We can continue to provide care to our patients.
You’re going to stop doing it if you’re losing money doing it. If you’re running behind and getting yourself stressed out, you’re going to stop altogether, which isn’t what we want.
Ultimately, we want to help these patients but we have to make it sustainable for ourselves and our practice. Would you say, in a yes or no way, that this is a profitable specialty for colleagues to bring in if it’s done right?
Yes. Not only that but it can be profitable in itself. Also, there is that bond you build with that family that they trust you. You’re their optometrist. You’re taking such good care of their children. Parents are going to come to see you. You don’t have to do marketing. They are sending everyone from that kid’s sports team from their activity to you to do it. It pays off.
That’s good to know. Word-of-mouth referrals are so important to grow your business and practice. If they’re talking to their school friends, teammates, or the parents are talking to them, it’s going to bring in new families to your office, for sure. That’s great. There are two questions I’d like to ask every guest before I wrap up. Before we get to that, do you have any final words you want to share on myopia management to encourage our colleagues to get into the space?
It’s the standard of care. We know that we should be doing it. It’s the right thing to be doing for these kids. Doing it yourself or referring is okay if there’s an office that sees a lot of myopes and then enjoys that area. It’s an area that you can enjoy. You get to see those kids and families a lot. You get to know them well. It’s rewarding. That’s what I’m looking for myself.
There are two things you said there that I have to expand on. 1) We forgot to say this right in the beginning. Part of that mindset shift is looking at myopia management as the standard of care. In the same way that we have that mindset shift to looking at myopia as an ocular disease, myopia management is the standard of care. We have to think of that. Prescribing a pair of glasses is not the standard of care for myopia management.
For me, myopia management is a broad concept of correcting the vision, prescribing the control, whatever this treatment is but also talking about spending time outdoors. What’s their lifestyle going to be like when they’re an adult? That’s myopia management. It is looking at that overall long-term view for that patient. 2) Referring to your colleagues. Something that’s important for us is understanding maybe myopia management isn’t your thing.
Refer to your colleagues who do it or somebody who is passionate about it. Let’s make sure we’re supporting our profession as a whole and strengthening our profession by letting our patients know that our colleague has the same degree as us or that another optometrist can provide the services. We don’t have to go to ophthalmology or maybe somewhere else. Within optometry, we can take care of all of our patients and make those referrals. It’s a win-win. Our patients get the care they need. Our profession is strengthened by those referrals. We have a better relationship with our colleagues as well because of it. Thanks for pointing that out.
The last two questions I ask every guest are a bit personal. We’ve been talking about clinical and myopia management but these are more personal. Number one is if you could hop in a time machine and go back to a point in your life or your career when Devan was struggling with something, you’re welcome to share that moment if you’d like. More importantly, what advice would you give to Devan at that time?
Life or career?
It is at some point in your life that you were having a tough time. It could be work or something else.
I’d probably take myself back to my school years. I’d say, “Get back in the library and get your head in those books.”
I’d give myself that similar advice. That’s fair. That’s good advice that somebody out there needs to use. The second question is everything that you’ve achieved in your personal life and career. How much of it would you say is due to luck and how much is due to hard work?
It is 98% hard work and 2% luck. You got to work hard.
Success is 98% hard work and 2% luck.
Thank you very much, Devan. I appreciate you coming on. Before we wrap up, I should say thank you again to Hoya Vision Care Canada for supporting this episode. This is part 2 of a 4-part series that we’re doing to discuss myopia management to hopefully encourage our colleagues to get into it and help our young patients. Thank you to Hoya Vision Care Canada for the support. Thank you for coming on, Devan.
Thanks for having me.
It’s been good to get to know you for the last little while. I feel like we’re almost partners in crime in different parts of the country here trying to get everybody on board to get into myopia management. Thank you very much.
Thank you to everybody who’s reading this show, Canada’s number one optometry show. I will see you guys in the next episode.