This milestone episode marks the first COPE-approved CE activity offered through The 20/20 Podcast in partnership with the New England College of Optometry. Dr. Harbir Sian presents his signature lecture on “The Business of Myopia,” focusing not on clinical refraction techniques, but on the real-world systems required to deliver effective myopia management in everyday practice.
Dr. Sian reframes myopia as an ocular disease with a refractive component and outlines how optometrists must move beyond simple correction toward comprehensive, lifelong management. The lecture walks listeners through the entire patient experience—from online discovery and front-desk scripting to consultation design, equipment decisions, treatment selection, documentation, pricing, and marketing.
Whether you are just starting with myopia control or refining an established program, this episode provides a practical blueprint for building a scalable, profitable, and patient-centered myopia service.
Key Takeaways
- Think Beyond Correction → Think Management
Myopia must be treated as an ocular disease, not just a refractive error. True management spans prevention, treatment, monitoring, and lifelong eye health.
- The Patient Journey Starts Before the Exam
Websites, phone scripting, intake forms, and in-office messaging determine whether families engage in myopia care before the doctor ever enters the room.
- Start Small, Build Systems First
Begin with one treatment modality and focus on protocols, staff training, and communication tools before expanding to multiple options.
- Axial Length Is the Critical Metric
Just as IOP guides glaucoma care, axial length measurement is essential for tracking myopia progression and treatment success.
- Compliance Drives Outcomes
The “best” therapy is the one the child will actually use—treatment selection must be individualized around lifestyle, motivation, and family preferences.
How to Earn Your CE Credit
Listen to the full episode on your preferred platform.
Visit: https://neco.pdx.catalog.canvaslms.com/
Register for the course and complete the short quiz.
Download your COPE certificate for 1 hour of CE credit.
Connect with Harbir:
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Watch the episode here
Listen to the podcast here
The Business Of Myopia – COPE ACCREDITED Podcast Episode
Thank you, as always, folks, for taking the time to join me here to learn and to grow. I’m always so grateful for all the support. As always, I have a huge request right off the top. If you get some value from this episode, please do share it. Send a link to a friend. Send a text message. Put it up on LinkedIn. Put a screenshot up on Instagram. Whatever you do, please let people know, especially because this episode is very special.
This is episode 213. I’m not usually sharing the episode number with you guys, but the reason I’m doing that is that this is a milestone episode. It’s a landmark episode for the show. This is the first-ever COPE-approved episode of the show. That’s correct. You read it right. By tuning in to this episode, you can get yourself one hour of COPE-accredited CE. That is what makes this episode so special. The reason we’re able to do this is because of a brand-new partnership and collaboration with my alma mater, the New England College of Optometry.
I’m so grateful to NECO, in particular, to Dr. Gary Chu there, for helping me put this together. This episode is going to be the first of hopefully many over the coming months, where I’m going to share one of my COPE-approved lectures with you. You’ll be able to, as I said, as you tune in to this, get yourself one hour of COPE-approved CE. A little bit of housekeeping. You can’t just tune in to it and then write down that you tuned in to it. There’s one extra step. You’re going to need to go to the NECO website, fill in, register there, and take a quiz.
They’ll get you a certificate to show that you tuned in to this lecture and that you took the quiz, and then you can get CE credit. In general, if you go to NECOCE.org, you’ll find a whole bunch of webinars there that you can get CE credit from. This lecture, this episode, will be there as well. Specifically, go to the link once you’re done, click on that link, register there, and you’ll get the CE for free. There’ll be other CE lectures there that you could pay for, but this one in particular will be free. You go there, you click the link, take the quiz, and you’ll get that certificate. Thank you.
If you know anybody who’s looking for an hour of CE and they want to get it in the easiest, most digestible way possible, send them this episode. It’s available on Apple, Spotify, or all your usual listening apps, and on YouTube. I would encourage you to go to YouTube because I am going to be sharing my slides there. The slides will also be available on the NECO website. Here we go. We’re going to dive into this lecture, which is my lecture on the business of myopia.
When I say the business of myopia, we’re going to be talking about some dollars and cents in there, but it’s about how you are going to set up a myopia practice in your clinic. It’s not just simply, “I’m going to prescribe this contact lens or eyedrop.” We need to be able to set the groundwork, get our staff trained, and all these things, and make sure we have all the right things in place so that our clinic will succeed. Our patients will get the best care. Everybody wins.
This is the Business of Myopia: Setting Up Your Patients and Your Practice for Success. Let’s go over what our outline is going to be. What is our journey through this hour or so of lecture material? We’re going to start with the patient journey. This is going to inform all of the other aspects of this lecture. We’re going to go through all the steps of the patient journey and where we can implement certain tactics and strategies that are going to help us succeed in myopia management. We’re going to talk about what types of investments are required and what types of equipment we want to buy. Do we need it? When do we need it?
We’ll talk about the different treatment options. We’re not going to speak too much about clinical care. I’m not going to tell you too much about how I diagnose or how I prescribe, but there’ll be a little bit of that. Ultimately, we’ll go over what the available options are, especially exciting now because the US has the spectacle lens option as well as we do in Canada. We’ll go over some protocols for staff and for doctors. Documentation and communication are vital in these types of any type of specialty care.
Is Myopia Management The Right Specialty For You?
We’ll go over some costs, fees, and metrics. We’ll talk a little bit about marketing, a little bit about industry relationships, and how important those will become as we want to lean into any specialty in our practice. Before we jump in, the question I want to ask you is a bit of a rhetorical question. Is myopia management the right specialty for you? This is a question you want to ask yourself, no matter what specialty you’re going into. You can say, “Is insert any specialty the right specialty for you?”
There are a few questions you want to ask yourself to determine if it is. Are you passionate about it? Are you talking about it with everybody? Are you okay talking about it off-hours when you’re at a dinner party? Are you okay talking about it with every patient that comes in and every parent that comes in? Do you have the existing patient base? This is a big one. Whether you’re doing dry eye, VT, or myopia, if there are already patients in the seat in your exam chair, it makes your life much easier. You don’t have to start by doing external marketing. We’ll need to do that at some point, but you can start with the person who’s right in front of you now.
Do you have the time and space to invest in this specialty? Some specialties will require more space. Some will be less. All of them will require time. Some of them will require a bigger financial investment as well. Do you have the time and space? We can’t just say, again, “I’m going to prescribe this lens and not develop the program within our practice.” We have to spend the time to build it out. If you say yes to all of these three things, then myopia management could be the right specialty for you.
Even then, before we go into diving into myopia management, we have to make sure that we’ve done one other very important thing. That is, we need to flip a switch in our mind about how we think about myopia. Do we think of myopia as simply a refractive condition? In that case, we’re just correcting myopia. Do we think about myopia as an actual ocular disease that then has a refractive component? That’s the mindset we need to be in if we’re going to be treating myopia or if we’re going to build a myopia practice.
The term that comes to mind is myopia control. We need to go a step beyond myopia control into myopia management, hence the title of the lecture. What’s the difference between myopia control and myopia management? Myopia control for me is simply prescribing a medication or a lens. Myopia management is the entire oversight of the entire patient journey and their entire lifespan, their entire ocular health journey. That means before they’re even myopic, to when they become myopic, to when we start myopia control, and to when the myopia has hopefully stabilized.
We still need to monitor. We need to change up the plan, but then, understanding that because the patient is myopic, they have a higher risk for ocular diseases in the future, and we have to manage those. This is myopia management. It’s integrating things that are lifestyle choices, not simply prescriptions, but spending more time outdoors and other lifestyle choices that can help inform the patient and make better decisions. This is myopia management. This is what we want to think about how we’re going to approach every myopia patient as we move forward.
I like to use the analogy, and I’ll use it again later. We wouldn’t start a patient on a drug and then not monitor their outcome afterwards. A simple example is putting somebody on an IOP-lowering medication and then not checking their IOP, their visual field, or their OCT. That is glaucoma management. We need to be able to have the same approach for myopia if we understand that it’s an ocular disease and not just a refractive condition. Let’s jump in.
Guiding People Into A Patient Journey
Step one is hashing out, diving into the patient journey. If you are interested in learning a lot more about how to elevate your patient journey, it’s a big topic. I did a whole episode on this with Dr. Wes McCann, who’s the master at this, having as many clinics as he does. He’s refined the patient journey in each of his clinics. If you go back, it could be a dozen. It could be 30 episodes back. If you scroll down and you see an episode about patient journey with Dr. Wes McCann, you’ll find that valuable.
When I had that conversation with Dr. McCann, I asked him, “Where does the patient journey begin?” A lot of us would maybe think the patient journey begins when the patient enters our office. What Dr. McCann said in that episode, and what I want us all to keep in mind, is that the patient journey starts before they enter the office. The patient journey begins when the patient is looking for us. The patient journey begins if they are a patient of ours. Maybe they’re dialing our phone number. Maybe they’re looking us up online and looking up a way to contact us to book their eye exam.
The patient journey begins before they enter the office and when they start looking for a doctor.
If they’re a brand-new patient, they’re searching us via social media, through our website, or straight googling, “Eye doctor near me.” That’s where the patient journey begins. The question is, how do they find you? What have you done to build your website and build your social media presence to make sure that a brand-new patient will find you? What will they see when they end up on your website? Will they see that you are a myopia management clinic, that you specialize in this type of care, and that you offer these services?
When they call your office, what is the staff saying to the patient or the parent over the phone? Are they saying, “We can book you in for a routine eye exam?” Are they offering and mentioning a myopia exam or a myopia screening? Is that something that they’re saying to the parent so the parent understands that this is something that your clinic offers?
The next step is when the patient enters the office. Is there signage around your office that talks about myopia? Is there something in the office that indicates that you see children and that you are interested in treating myopia? What is the conversation that patients are having at the front desk with the staff? Are the staff again mentioning that you have a myopia exam or a myopia screening? Are they asking about family history? Are they asking about whether the child wears glasses? Have they had glasses before?
We go into the pretest area. There are conversations that can be had there that would indicate that you have a myopia management program, looking at the autorefractor and looking at the lensometry. There are multiple touch points and areas where the staff can simply say, “Your child is nearsighted. Did you know that there are ways to slow down the progression of myopia? We offer those treatment options here in our office.”
I mentioned the intake form here. This is something that’s been valuable for us. Based on where you are, it’s going to look very different. I’m going to share with you. Please go to YouTube and check out these visuals that I’ll provide for you. If you go to the NECO website, the slides will be available there as well. I want to share with you our intake form for one of our offices. We outline all of the fees. We’re based in British Columbia, Canada. Here, the government does cover some portion of eye exams.
We have three different levels of eye exams. We have level one, which is the routine eye exam that’s covered by the government. We have a level two eye exam. If you want to have wide-field retinal imaging, that is level two. Level three is what we call our myopia screening. That one includes the wide-field retinal imaging. It includes axial length, topography, a few other tests like that, and the discussion with the doctor in the exam room about the results from these things. We’ll print out, which we’ll talk about later, a report from that myopia screening, indicating the level of risk for that patient to become myopic or progress.
The staff will present this to the parent at check-in. The parent needs to sign this form regardless. The staff will say, “Please fill out this bottom section here. Let us know if you have any questions about the level of eye exam you’d like to have for your child.” Almost inevitably, there will be questions of like, what’s myopia, what’s a myopia screening, or what does that include? A discussion has started. The intake form can be a valuable touchpoint for the staff to have that conversation with the parent.
They’ve gone through pre-testing. They’re sitting in the exam room. I like to ask the doctor now. The doctor is doing the eye exam. I like to ask this question in person. I’ll ask you this, how do you diagnose myopia? Have a quick thought about it. It’s not a trick question. It’s an actual question. Inevitably, the question answers will be something like retinoscopy, refraction, or autorefraction. That’s right, you use those tools. Ultimately, what finding do you see that then makes you say this patient is myopic? That will usually be a minus prescription.
Again, not a trick question. That is the old way of looking at myopia. That is our old way of diagnosing myopia. In that case, we are simply looking to correct myopia. We need to learn a lot more about the patient. We need to then write a diagnosis that is much more in-depth. We wouldn’t just simply say this patient has glaucoma. We are going to define it. It’s primary open-angle glaucoma. We’re going to say, “Is it early stage, mid stage, or advanced stage?” The same with macular degeneration. We wouldn’t simply just say, “AMD.” End of story. We are going to describe it and define it in a much more detailed way.
That’s what I want us to do with myopia. Are we comfortable using the term pre-myopia? Do you simply say the child is hyperopic and leave it at that? What if the child is plus a quarter at age four? Is that simply hyperopic or emmetropic? Is that child at risk of becoming a myope? What if their older brother is a -5.00? This child sitting in front of you is plus a quarter. Do we simply let them go and say, “Emmetropes, see you later.”? Are we willing to define that as a pre-myope, a likely risk of becoming myopic, and have that discussion with the parent?
These are the types of things we need to use to diagnose myopia in the patient. If they are -0.50 at age six, are we just going to say, “They’re just a low myope, not a big deal?” Are we going to say, “This child’s high risk of progressing, high risk of becoming a high myope, high risk of ocular disease in the future?” We have to document all these things, and then we have to have the conversation with the parent. Here’s another opportunity for us to provide information.
What we do in our office is we provide these brochures, these pamphlets here. This is a nice image from Canva. I design them on Canva. Canva provides these images of what the pamphlet simulation of what the pamphlet would look like. At the end of the exam, we’ll hand this to the parent and say, “Your child is nearsighted. There are treatment options.” We’re going to have the child come back for a consultation, which we’re going to talk about a little bit more in a moment here. I hand this brochure. It has some rough pricing on it and has some information about the treatment options.
I give this to the parent and say, “Here’s a chance for you to go home, and please go ahead and research these things if you like. Come back with questions. I want you to know that we offer all of these treatment options in our practice.” We’ll head up to the front desk. We’ll book the consultation. The parent will come back. The patient will come back. This is where we do all the relevant tests related to myopia. In the case where I’ve handed that brochure, we can assume that the patient had come in and maybe just done a routine eye exam. We need to do all these extra tests.
If they’d come in and done a myopia screening, the axial length, the topography, and the retinal images, all would have been done already. The patients are mostly coming back for the cyclo and this conversation with the parent about which treatment option we are going to initiate. We have another handout for that. We don’t use this one as much because usually, parents have come to a decision by this point, but we have if we need more visuals for the parent.
I took this from my good friend, Dr. Sherman Tung. Thank you, Sherman, for letting me borrow, or basically steal this design from you. Their office is deeply entrenched in myopia management. They have all sorts of this literature and these handouts. I took this design from him. It’s a full-page sheet, two-sided. On the front side, we have a place for the doctor to draw, write, and explain what myopia is, or the axial elongation, or maybe talk about peripheral hyperopic defocus driving the elongation of the eye.
On the flip side, we have the four treatment options. Again, a space for the doctor to draw and write. How do these treatment options work? What are the pros and cons? Ultimately, come to a decision with the parent on which treatment option is going to be the best for the patient. We have some questions about, “Do we charge for this consultation, or do we do it for free?” We have both options in our practice. Both have pros and cons.
The same goes for a dry eye consultation. This is something anybody who’s in the dry eye space will have a similar approach, where the patient comes in, you diagnose the dry eye, and you say, “You’ve got to come back for the consultation where we do the whole gamut of diagnostic tests.” There are pros and cons, and we’ve done both things in the dry eye space and in the myopia space. We’ve done it here now, where we have a dual approach. We do have both things at the same time. It will depend on what the patient did or how they found us.
A free consultation is a great marketing tool. If you are trying to get new patients to come in, you can offer a free consultation. It’s worked well, especially in the case of Ortho-K. If they have not had an eye exam with us, we’re going to charge. If they have not had a myopia exam screening, if they’re a patient who did a routine checkup, and they’re coming back for a myopia screening, we’ll charge for it. Often, if a patient has been referred to us by another optometrist, so they’re new to us, we’ll charge for that consultation.
A free medical consultation is a great marketing tool if you want to get new patients to come in.
Through other means, for example, we did a little marketing around Ortho-K. We marketed a free Ortho-K consultation. You can do the same thing with the myopia if you were to do a social media thing, Google ads, or something like that, and you’re marketing a free myopia consultation. What we did there was we would have the patient click through. They would end up on our website, or they would go straight to this booking page. We created a separate booking link for an Ortho-K consultation. We have our routine adult, senior, and child exams. We try to keep it as simple as possible. We got the Ortho-K.
That will lead to a free appointment in our office and no charge appointment at our office. It will show up on our EMR. The staff will know that the patient booked this Ortho-K consultation. We’re going to talk a bit more about the importance of a good EMR in a moment, too. The staff will know what tests to do beforehand. Ultimately, the doctor will end up in the exam room with the patient to have this discussion about myopia or Ortho-K in this particular case. Free or paid consultation, it’s up to you. You may want to experiment to see which is the better option for you.
At the end of the consultation, as I mentioned, we’ll end up developing our plan. At this point, we’re going to go up to the front of the office. We have a consent letter or an enrollment letter. We get that patient and that parent buy-in that we’re going to start this program together, and we’re going to make sure we see it through. At that front desk, we book the follow-ups based on the doctor’s schedule. Do we need to see this patient back in 6 months, 4 months, or 3 months? We make sure we book all the upcoming appointments now, so they’re in the system, and the patient and the parent know we’re committed to this.
I want to show you this enrollment letter. These things are optional. Ultimately, if you are leaning into a specialty like this, these little documents help keep everyone on the same page. This will go straight into the patient’s file on the EMR. Everything’s visible to us. If we have to pull it up, we say, “We agreed to this, to seeing this patient back these many times. You agreed and understood that there were these fees involved here. You understood there was a warranty period with the Ortho-K.”
All of these things are documented. Whichever treatment option we’re moving forward with, the parent will initial under the program fees and the expected visits, and then there’s an acknowledgement at the bottom. The doctor will sign. As I said, we put this in the file. Everybody’s on the same page. It improves buy-in and commitment from the patient and the parent.
Investing In The Right Post-Consultation Equipment
This is the next step of the journey. They found us online. They came to the front desk. They talked during the pre-test. They did the routine eye exam. They came back for the consultation. We have started them on the path, the myopia management journey, here. We need to then do the follow-up appointments. This is where you recheck the refraction. You do the axial length. You update the plan as needed.
If you’re at three months and things are still progressing, then you’re at six months, and things are still progressing. Maybe we need to reevaluate. We have that discussion with the parent. Usually, it takes six months for that treatment option to have the effect that we want and start to see the trend in the axial length that we want to see. If we get to 6 months, 9 months, or a year, and we’re still seeing progression, and it’s not slowing down, then we need to maybe alter our course. Maybe we need to change to a different method of myopia management. Maybe we need to add a second treatment option.
These are the conversations that we’re going to have during these follow-up appointments. That’s the entire patient journey. I want us to keep in mind from when they found us online to got diagnosis to the follow-up appointments. There are all these important touch points along the way. I’ve already shown you some documentation, literature, and information that we could provide to the parent and to the patient. We’re going to talk a little bit more about some other information that we can provide along the way, going back and revisiting some of those important touch points along the way for the patient journey.
One of the first questions that comes up when we’re talking about any specialty is, which equipment should I buy? Do I need this one or that one? Do I need to invest in the whole suite of equipment? Can I just buy one thing? I like to make sure we’ve outlined the patient journey, the protocols, or the algorithm that we need to have in place first, so you understand what’s involved through the entire pathway. You can understand, “Do you need equipment? Where does the equipment fit along that patient journey?”
The most important or the most obvious piece of equipment for myopia management is a biometer for measuring axial length. Do you need a biometer right away? The answer is no. Do you need a biometer at some point? Absolutely, if you want to lean into myopia management. A biometer is going to become a very important piece of equipment. Again, if we think about myopia as an ocular disease and not just a refractive condition, the only tool we have for tracking the disease state is a biometer to measure axial length.
The same way you need for glaucoma, you need to check IOP. You need a visual field. You need an OCT for tracking the disease state. In this case, for myopia, we need the axial length. We need to take retinal images to make sure that the retina is healthy. We need these tools to make sure we’re tracking myopia as an ocular disease and not just a refractive condition. You will need a biometer if you truly want to treat myopia. At some point, you don’t need it. It shouldn’t be a hurdle to you beginning to treat myopia or to beginning your myopia management practice in your clinic.
There are online axial length estimator tools that can be handy in the beginning. They’re not great for tracking myopia, but great for initiating the conversation in your office. A topographer is not mandatory, but can be a valuable tool if you’re going to get into Ortho-K. The topography-guided Ortho-K is an amazing option, a streamlined, low-bar-to-entry for topography-guided Ortho-K. It’s an easy treatment option to bring into your office and to implement, especially if you have a topographer.
I would highly recommend, at some point along the journey, if you don’t already have a topographer, get yourself a good one. We’ll talk a little bit more about what steps are involved in topography-guided Ortho-K and why it’s so valuable. Other investments you want to think about are little things. You’re going to create accounts. You might need to get some training done and certification for certain lenses.
If you do start doing Ortho-K, you’re going to want plungers, solutions, and all these things to make sure you’re all set there. There is training that’s involved. Are your staff going to do the Ortho-K insertion and removal training and things like that? Those are things you’ll want to get in your mind, at least in the beginning, understanding there are going to be steps like that involved. Ultimately, the big one is a biometer for axial length at some point.
I talked about online estimator tools. CooperVision has one. There’s another one out there called Ocumetra. Again, you can go on YouTube. I’m showing all the slides. In a CooperVision online estimator, you enter the prescription, K readings, vertex distance, whether it is a cycloplegic refraction or not, male, female, and then age. It gives you an estimation. There is a pretty large margin of error here. I think it’s 0.3 millimeters. It’s on the website. It will show you so you know.
That’s why it’s not maybe the best tool for tracking, but it’s a great tool for starting the conversation. If you have a patient in front of you who’s six years old and has a 24-millimeter eye or 24.5 on the estimator tool. You can safely say that that’s a much longer eye than you should have at six years old, have that conversation with the parent like, “We’re already beyond where we should be. It’s time for us to implement a treatment,” and help get that conversation off the ground.
The Ocumetra margin for error is pretty much the same as the CooperVision tool. Ocumetra has other resources and tools in their program that are quite useful if you’re starting and you want to provide resources to the patient and to the parent, send emails, send reports, and things like that. We don’t use Ocumetra. I’m not promoting it, but I’ve seen the program. It’s quite useful for anybody who’s starting, even if you’re quite leaning into myopia management already. Those are the investments that would be useful. Biometer being the key one.
You should start your myopia management clinic by implementing a lot of these other things, having the conversations, and starting to offer some of these solutions that we’re about to talk about. As you see that growing in your practice, the excitement is building, and the confidence is building in your practice, then you can think about making that investment. The axial length of the biometer is going to cost a reasonable amount of money. It’s going to be different pricing depending on what type of machine you’re getting. There are combo tools that will do multiple things. There are standalone biometers. You want to see what fits best in your practice.
Four Main Treatment Options To Offer
Step number three is offering some solutions if you don’t already. Depending on where you are in your journey, if you’re brand new to myopia management or you’re just dipping your toes in, the number one thing I want to say is that you should start small. Start small by offering one solution, one treatment option that is going to be the most comfortable for you and the easiest for you to implement and build confidence there. Build the program around it and all the other things that need to be there, such as the information, the brochures, the pamphlets, and the training for the staff.
When you see that it’s working, then you can easily add the next one or the third one. They will integrate easily into the program that you’ve already built. Pick one treatment that you find is going to be the easiest for you. In my opinion, spectacle lenses are probably the easiest option. Given that it’s now available in the US, anybody who’s tuning in in the States now has this spectacle option. It’s the easiest to understand. We’ll talk a bit more about it as well in a second.
Let’s say you’re a big contact lens person. That’s fine. Start doing contact lenses. Maybe you’re not a big fan of any of those options, and you want to start with an eyedrop. Atropine could be your entry point. It was my entry point because when I started, there were no approved contact lenses. There were no approved spectacle lens options. I wasn’t into Ortho-K yet. Atropine was my entry point. That’s all I did for a few years until I started to do some contact lens options and then spectacle lens options.
That’s how I would suggest it. If you haven’t already leaned into anything, pick whichever one you think is the easiest. If you’re already dabbling, then build some of the program around what you’re doing, and then add the second one or the third one. Let’s go through the four main treatment options quickly here. Again, I don’t want to spend too much time in a clinical conversation. I want to make it a bit more of a program design type of conversation.
We need to understand how these treatments work, what their pros and cons are, so we can understand which one we want to implement first, second, or third, and then how we can build a program around it. Atropine is an eyedrop. It’s easy to understand. Sometimes, parents like it because they want something medicated. It can be added on as a combo to another treatment. That’s a nice bonus with atropine. It’s one drop in each eye at night, so prescription and dosing are very easy. It’s a medication. It’s a pharmaceutical agent. That’s a downside for some people or a flip side. Some people like that idea. Some people don’t. They don’t want to medicate their children.
There are potential side effects. Light sensitivity and near vision blur are the two most common ones. In those cases, I always start everybody at 0.05%. If there are side effects, I’ll reduce it to 0.02% or 0.025%. Usually, almost always, the side effects will go down after that. Atropine doesn’t correct vision, so if somebody needs glasses, they’re going to need the eyedrops and the glasses. It needs to be formulated in a specific sterile compounding pharmacy. That’s an important thing to keep in mind. It’s not going to be as easily accessible to everybody, but something I’m going to talk a little bit about in our procedures later is how we overcome that a little bit.
We use atropine now. I used to use it as my first line of treatment, but I don’t anymore. I use it for specific cases. As I mentioned, combo treatment. I use it for those pre-myopes, so the child who doesn’t need glasses right now, but definitely is on the track to becoming nearsighted or the very early myopes. They see quite well, and we just need to implement a treatment. When do we stop it? I usually will assess based on how stable the RX and the axial length are. If they are completely stable, then we’ll take them off. If we’re changing modality, and the parent doesn’t want to do eye drops anymore, we’re switching them over to something else.
No matter what we’re doing, no matter why we’re stopping the atropine, we always need to taper. We don’t stop cold turkey. If you’ve read any of the studies that are out there, there’s enough data to show that stopping cold turkey can result in a pretty big rebound. Tapering has been useful for us. What we’ll do is we’ll taper the frequency of dosing. Instead of every night, we’ll reduce it to every other night for a period of time, then twice a week, and then once a week for a period of time. We’ll have the patient back to make sure everything’s still stable once we’ve discontinued.
The next treatment option we’re going to talk about is soft contact lenses. In Canada, we have a couple of different brands available. Both Cooper and J&J have an option. In the States, it’s maybe only MiSight®. Their design is different, but how we use the lens is the same. Ultimately, contacts are great for somebody who’s looking for freedom from glasses. Daily disposable is great as a modality for kids. The downside is that a lot of parents are averse to having contacts on young kids. As much as we might try to convince them, there’s a bit of a hurdle there. Insertion and removal can be a little tricky for some people.
The main limitation for me is the lack of torque options. There are none, but I’ve seen myself, and I’ve heard from other practitioners who prescribe a lot of soft lenses that the lens design can absorb a fair bit of astigmatism. In some cases, a little bit of residual astigmatism might not be a bad thing. Kids are usually pretty tolerant of a little bit of under-correction anyway. You have a little bit of flexibility like 0.75, even up to -1.00 in some cases, where you can get away with that uncorrected astigmatism.
The next type of contact lens option is the Ortho-K lens. For anybody who’s completely new to Ortho-K, these are custom-designed lenses that you wear at nighttime. They’re changing the shape of the cornea overnight to correct the vision and creating this peripheral blur and distortion that helps to help slow down the progression of myopia. It’s a great option for combined treatment and vision correction. They are available in a wide range of prescriptions.
Once you get above a certain -5.00 sphere, -1.5 cyl maybe, you start getting a bit more into more customized designs. You’re going to be a bit more specialized. You have a better expertise in designing the contact lens, but you still get a pretty large range of patients who do well in an Ortho-K lens. We’re going to talk a little bit about the topography-guided system in a second here.
Cost is probably the number one downside. It’s not cheap, but if you present the value that Ortho-K lenses bring, most parents can see past the actual cost of the lens when they start to understand the value. It’s relatively comparable to your one-day daily disposable myopia control lenses when you start to break it down over a longer period of time. The cost is not that much of an obstacle once we get comfortable with how we talk about it.
You have to wear the lenses every night to maintain the vision correction and the effect. It could take a few days or even up to a couple of weeks to fully correct the vision, depending on the prescription. You end up with this gray zone where the vision’s not fully corrected, but the glasses are too strong now. We’ll find ways around that. Often, we’ll dispense five days’ worth or weeks’ worth of soft contact lenses that the patient can wear until their vision’s fully corrected with the Ortho-K.
This is something that we’ve only integrated in our practice in the last few years, but it has been massive for us. It’s been awesome. Patients have loved it. It’s helped build so much confidence in our practice, in myopia management, because patients come back so happy. Our staff sees that. Our associate doctors see it. Speaking of associate doctors, getting them on board with Ortho-K has become so easy now because it’s such a streamlined process with a topography-guided Ortho-K.
Essentially, your topographer is connected to the software that is used to design the contact lens. We take the topography, simply click a couple of buttons, and enter a bit of information, the prescription, and the horizontal visible iris diameter in numbers that are all measured on the topographer anyway. We upload that to the system. The lenses are ordered within a matter of five minutes. In about a week, the lenses arrive. We start the fitting process. It’s that easy.
All of your decision-making is guided and informed by the topographer. You do topography at each visit. You click some buttons based on what the topography looks like. If adjustments are needed, we upload those. Again, lenses arrive. It has become a great process and a great option for us in myopia management. Even for adults, we have adult patients who wear Ortho-K as well. It’s been a nice way to provide freedom for adults who don’t want to wear glasses at all.
Last but not least is the spectacle lens option. This is huge. I don’t know when you’re going to be reading this because it could be living on NECO’s website for years and years. At this stage in 2026, the FDA has approved a spectacle lens in the US. It’s a big topic now. It’s such an easy modality to prescribe. Honestly, if you’re new to myopia management, going to be prescribing a pair of glasses to a patient, and not super comfortable with initiating any treatment, the very least you could do is write the name of one of these myopia management lenses on the prescription and say, “Go buy this.”
At least you know you’re doing something, but I’d love for you to do more. I’d love for you to have that patient come back and measure all these important metrics that we want to help us maintain this myopia management treatment. Glasses are great because they correct vision. They are also slowing down the progression of myopia. We’ll talk a little bit about lens designs, but not too much here. The downside is that, like soft contact lenses. You have to wear them all day to have the effect that we are hoping to have. If it’s an active child, wearing a pair of glasses could get in the way.
In Canada, we have three myopia lens options. I want to quickly mention them briefly here. I know in the US, there’s only one. HOYA MiYOSMART is the one that’s been on the market the longest, using the DIMS technology. Essilor Stellest is the one that got approved in the US. I think there’s a 2.0 coming out pretty soon here using the HALT technology. You can see the difference in the ring design. The third one that’s coming out is the CooperVision MiSight lens, which uses DOT technology.
The HOYA and the Essilor are both using the idea to induce peripheral myopic defocus. They are defocusing the light, bringing it inside the retina to slow down axial elongation. The CooperVision lens uses this diffusion optics technology, which reduces contrast. It is a whole different approach. The theory here is that reducing contrast helps to reduce axial elongation over time. I am excited to see this lens option hit the market and provide another option for us to help treat our patients.
The big question after all of this is, which treatment is best? I’m going to ask you. I want you to take a second and answer this question. Write it down, maybe. Which treatment is best? Is it glasses? Is it contacts? Is it atropine? The answer to this question is whichever treatment the child would use. Compliance is the answer to this question. Which treatment is going to give us the best compliance? This is the same type of conversation we’ll have with other diseases and treatments as well. Glaucoma, for example.
If the patient is not going to use their drops, maybe we need to do SLT. That way, we’ve gotten that treatment. We’ve gotten the effect of lowering the IRP without having to trust the patient to use their eye drops. The same goes for myopia management. Is the child going to wear their glasses? Are they going to wear contact lenses? If not, maybe atropine is the only option for this child. Is this child extremely averse to eye drops? Maybe they’ll have to wear glasses in that case. We have to decide which option is going to give us the best compliance first. We have to think about all the other factors involved.
I do share this little grid here. It’s very basic, but just to give you some ideas of questions you want to ask the parent, the patient, and yourself. Is the child going to wear contacts? Are they going to use eye drops? Are they averse to that? Do they need complete freedom from all sorts of correction during the day? A swimmer, for example. Does this kid need to jump in the pool five days a week, and you don’t want them to have to think about their contact lenses or their glasses? In that case, maybe Ortho-K is the best option.
These are types of things you want to ask yourself, but ultimately, compliance is the number one thing you want to consider when implementing any treatment. A little recap. We went through the patient journey. We talked about which investments we want to make and which equipment we might want to buy. We talked about what the treatment options are. We talked about starting small if you’re brand new, but then picking up some speed and starting to implement some of the other treatments as you build your confidence.
Setting Up The Right Protocols And Algorithms
All of this is going to be almost useless, but it’s not going to be effective in your practice if you don’t have protocols set up. You need to have an algorithm. If I turn this dial, this thing happens. If I press this button, this thing happens. It’s a cascade of events. We need to have this written down and on display, or at least written somewhere where your staff and your doctors can read it. They understand what needs to happen. If you don’t have a protocol, it ends up being messy. I can tell you from my own experience. It ends up being messy.
You get a lot of questions, “What am I supposed to do next? I forgot what the next step is,” from your staff. It’s inefficient. If you’re a business owner, associate doctors will be afraid to jump in because they’re not sure what the next step is supposed to be. They don’t want to look silly in front of the patient, they don’t want to waste their time, or they don’t think it’s going to be as valuable as seeing a routine eye exam, for example.
Let’s talk about some of the protocols. I want to give you some ideas, some things to keep in mind as you’re starting to build this myopia practice. First of all, standardizing these protocols reduces the barrier to entry. It improves efficiencies and removes the guesswork, but it still allows for that independent decision-making for the doctors who are getting into it. Here are some of the things you want to leave your doctors with so they understand how to make certain decisions.
Number one, going back to how we define myopia. I want my doctors to know I’m not simply saying myopia, end of story. I want to write down the age of onset. How fast is it progressing? What was the first refraction? What is the refraction now? What is the change in axial length? What is the family history? All these things are going to inform us in our decision-making. The doctors, you out there, my associate doctors in my office, they need to make sure they’re documenting all these things.
We need to have a place in our EMR to document as many of these things as we can. Maybe to make it easier for associate doctors, I was showing you as far as the four treatment options. What’s your go-to, maybe a default treatment option that is easy for them to lower the barrier to entry? Providing case examples is always a great idea so they have some ideas of how to approach certain cases.
For staff, we need to standardize protocols as well. My staff needs to know if I’m prescribing X, they need to do Y. If I’m prescribing A, they need to do B. For example, if I have just made a decision in the exam room with a parent that atropine is the right way to go for this patient. I will print the atropine prescription. It prints out at the front desk. My staff will take that paper. They’ll say, “Harbir prescribed atropine. I know what’s next.” The staff needs to pull a list of compounding pharmacies in the area.
I mentioned that earlier. We need a sterile compounding pharmacy for atropine. We have a printed-out list. The staff will put that with the actual atropine prescription. That way, when I come out to the front desk, it’s ready to go. I’ll say, “Here’s a list of 5 or 6 pharmacies within maybe a 5 or 10-minute drive from here that will make your life easier. In fact, here’s one that will even ship it to your door.”
What if we’re doing MiYOSMART spectacle lenses? That prescription will be printed out the same way. The staff at the front desk will see it and hand it to the optician. The optician already knows what the next conversation is going to be. They’re prepared for this. I bring the patient out to the front, hand over to the optician, and the optician’s got the sample lens ready so they can show the patient and the parent. “Here’s what the lens looks like. Here’s an image of some diagrams of how the lens works.” I don’t have to do that in the exam room. I don’t have to spend as much time doing that.
If I’m doing Ortho-K, I’ll bring the patient up to the front and tell the staff, “We’re going to do Ortho-K.” They already know what the next step is. They need to take the patient into the pre-test room and do a composite topography, which is a topography that takes five images in the different zones that make sure I got a nice, wide topographical image of the cornea. They know how to upload and send that off to the lab, and the lenses are ordered. These things are all important. The staff needs to know where to document things and the sign of the consent form before the patient leaves.
These are all standardized protocols that need to be written down. I am still working on it. My staff will still come up to me like, “Harbir, you still haven’t created this type of eye exam.” Thankfully, that part’s done now, but they’ll come and tell me, “You need to do this still or we need to streamline this part of the process. They’ll make this part easier.” It’s always moving. It’s always growing. Your protocols are never set in stone. You’re going to change things and streamline things, but it’s important to have something documented so you at least know generally what step 1, 2, or 3 is going to be.
This is an AI-generated image of a myopia champion. I said, “Create me an image of a myopia champion.” It’s not bad. It’s a lady wearing glasses and a superhero-type suit with a cape. On one hand, she’s holding a sheet that says, “Myopia management.” It’s got a graph on it. On the other hand, she’s a little creepily holding an eyeball with the extraocular muscles attached. The question that often comes is, do we need a myopia champion in our office?
Honestly, if you have one, excellent. Do you need one? No. In bigger practices, it’s probably more valuable to have that one go-to person. Once you say this person needs any myopia management treatment options, you just hand them straight to that one person. The doctor doesn’t even have to help choose the right treatment option. Maybe you have enough trust in this myopia champion.
The doctor will diagnose, but then hand them over to the myopia champion, and they will help come up with the treatment option that’s most appropriate for that patient. That person could be there. We do not have a myopia champion in our office. As I mentioned, we’ve cross-trained or trained our staff accordingly so that I know or the doctor knows when they come out of the exam room who to hand off the patient to so the next steps can be done. Myopia champion can be helpful, but not necessary.
Gather Regular Reports And Maintain Proper Communication Channels
With part of the training and the protocols, you need to have some scripts written down. This is one of the things our staff has come to us with. It’s like, “We stumble on our words when we’re trying to talk about that intake form.” What is a myopia screening exam? Have a script. It doesn’t have to be right in front of them, but something that they have a little bit of a talk track in their mind so they know what to say at the check-in desk or during the pre-test or they know to mention billing to insurance and these types of things.
The same goes with our doctors. Giving the doctor a script to have that conversation in the exam room can lower the barrier to entry, but also help improve the uptake of the myopia management program. Any owners who are tuning in, one of the most common things for any owner is like, “How do I get my associate doctors to get better uptake or to even lean into any specialty?” Often, it’s the owner who’s doing most of the myopia management or most of the dry eye. If you can bring in an associate doctor or train up your associate doctors to lean into the specialty, it’s a huge win for everybody, the owner and the doctors.
Helping doctors broaden their scope and provide more clinical fulfillment is what happens when you lean into specialty care. Lowering the bar to entry for any of these specialty options is an important thing to do. Providing scripts and talk tracks like this can be super helpful. Some of the things, for example, I’ll ask my doctors to try to use these phrases, “It’s not just about correcting vision. It’s about improving the outcomes in the future. It’s not just about refractive error. It’s about ocular disease. It’s about helping your child to be healthier when they’re 40, 50, or 60 years old. Which parent wouldn’t want to do that? Every parent wants to do that.”
Treating ocular diseases is not just about correcting vision. It is also about improving the outcomes in the future.
I provide my silver and gold. I’m giving you my little insights here. I call it my silver and gold statements that I have when I talk to parents about myopia management. The silver statement is, “When we were kids.” Most parents are around the same age as me, but even if you’re a younger doctor tuning in to this and you’re talking to somebody who’s 10 or 20 years older than you, you could still say it. If you’re tuning in to this and you’re an optometrist, you’ve got to be at least in your mid to late twenties at the youngest.
Even then, if you rewind the clock, there were none of these myopia management options available. You could still say, “When we were kids, there were none of these options available. Every time I went to get my eyes checked, I got new glasses, stronger glasses.” If the parent is nearsighted as well, they will easily resonate with that. They’ll say, “That used to suck.” Guess what? We don’t have to do that now. We have treatment options that will help us slow this down. You’ll see the parents leaning in and starting to understand where you’re coming from. That’s my silver.
The gold is saying, “If this were my child, here’s what I would do.” That one sounds a little manipulative, but if you’re coming from a good place, it’s not manipulative. To be honest with you, most parents will end up asking you that question anyway, especially with me knowing I have kids. I have this relationship and rapport with my patients and their parents already. They know I have kids. They’re going to say, “What would you do with your daughter? If this were your girl, what would you do?”
I have three girls. That’s why they would ask that question. I go ahead and say it. “If this were one of my girls, I would do this.” Knowing that she plays sports, knowing that she’s in gymnastics, or knowing that she loves to read, and she is not active. Knowing all of those things, this is what I would suggest. That makes that connection. That parent understands you’re coming from a place of understanding the child and what the child needs.
I will say that, usually, is the last step to the parent committing to that treatment option. They might still want to take some time to think about it. That’s perfectly fine as well. One of the last things I say to all my associate doctors is to make sure you don’t take it personally if someone doesn’t want to do it now. Usually, it’s not that they never want to do it. They just don’t want to do it yet. Don’t take it personally. Don’t let that deflate you or discourage you.
Almost always, that same parent will come back at some point down the road. I have multiple parents who are like, “Ortho-K sounds like an amazing option, but we’re not going to do it right now.” All good. Myopia management in general. “My child should do this, but I’m going to think about it.” You think in your mind, “I put everything in front of you. It should be an obvious decision for you to do something,” but it’s okay. We cannot change a person’s mind. We can simply provide them with the best information.
If they don’t want to make that call now, all good. We just say, “We don’t want to move forward with myopia management right now. No problem. I’m going to see you back in a year. If you would like to do myopia management, here’s what I would recommend. We’re going to see your child every three months because this is moving pretty quickly. The rest is up to you.” We don’t need to beat around the bush. We don’t need to get upset if somebody doesn’t take our suggestion and run with it. Give them the information, and let’s go from there.
Training is extremely valuable. One thing for us, if you’ve got all these documents, scripts, and all these things, you need to be able to teach people how to use them. You can’t just say, “Here are the protocols. See you later.” We hold regular meetings in general. We have weekly meetings. I wrote myopia meeting once a month. We don’t do it quite that often. I would say maybe every 6 to 8 weeks, we have a meeting that’s focused specifically on myopia management. We’re making how we are doing with the protocols and with the intake sheets or is there anything missing.
Sometimes, stuff will come up in our weekly meetings because I ask every week, “Any pain points now? Any ongoing challenges that need to be addressed ASAP?” We’ll talk about those. If it’s not an immediate problem, it will come up during our myopia management meeting because we’ll go through all the steps. This is something that you want to make sure you start to implement, these regular meetings.
As part of meetings and all of this, communication is so important, communication with your staff, your associate doctors, or your colleagues, and communication with your patients, the parents, but also with other professionals. Are there referring professionals, GPs, pediatricians, and people like that, that you need to stay in touch with? Documentation becomes extremely important as you go through building this program. I don’t want this to seem overwhelming. These are all small pieces that you will build over time.
One thing that helps is having a great EMR. We upgraded from a basic EMR that didn’t help us support in a lot of these ways to a great robust EMR. We use one called Optosys. I don’t know if it’s available in the US, but in Canada, it certainly is. Optosys helps us do a lot of these things. We want to write referral letters. We want to write letters to referring doctors to update them. Other things we want to do are provide progression reports to parents.
Your EMR is going to help you streamline these things if your EMR lets you create templates, for example. I have a template for outgoing referrals to specialists. I have templates for letters to referring doctors to say, “Thank you. Here’s what’s up with your patient,” and so on. We have all of those templates made. It takes me, honestly, maybe three minutes to write a referral or a letter updating the doctor who referred their patient.
Providing reports to parents becomes important. Parents of young kids are used to taking their children to a pediatrician and seeing these growth charts like, “Where’s my child on the weight or the height chart?” It’s this percentile or that percentile. They’re used to seeing things like this. It lines up with what they’ve seen for their child, that if they have a 6-year-old, 7-year-old, or 8-year-old child, they’ve seen this stuff. It’s not out of left field for them to see a chart like this. It’s nice to print something out.
What I’m showing you is from the MYAH, which is a Topcon device. We have it in one of our offices. It shows these nice axial length trends. We can print out on the right-hand side. That’s what the printout looks like for the parent. You can put your logo at the top. There are nice visuals. You can write some notes at the bottom like, “Your child is progressing at this rate. The current treatment plan is this,” and so on. They can take that home, or you can email it to them.
Back to utilizing the EMR, it’s a valuable thing I want to recommend to you. If you don’t have a strong EMR, after you talk about buying a biometer and all these other things, that’s another investment that you would probably want to look into. Let’s do a quick recap again. We went through the patient journey, investment, the different treatment options, and developing protocols, scripts, and things like that for your staff and doctors.
Get The Full Picture Of Your Business Expenses
Step five, we talked about documentation, communication, and sending reports. We’re getting close to the end here. I know you’re going to get one hour of CE credit, but you’re going to have to commit a little bit more than one hour to me here to make sure I can get through everything with you. Step six is understanding your fees, your costs, your metrics, and the dollars and cents. If you are blindly doing this, you will not make money. You’ll probably lose money, and then you won’t be able to continue doing this.
When I talk about the importance of setting your fees, it’s not so we’re gouging people. We’re not just worried about lining our pockets. The only way you can provide great service is if you’re being compensated appropriately. Imagine this. You’re in the exam room and you haven’t yet set your fees appropriately. You’re sitting in there and you say, “I spent so much time doing this. I lose money on this or I would make more money if I saw a regular adult patient and sold a regular pair of glasses.”
If you are managing your clinic blindly, you will not make money. Without adequate finances, you will not be able to continue your work.
You’re sitting in the exam room thinking this. Are you going to provide the absolute best care? Are you going to go above and beyond? Chances are no. If we charge accordingly, set our fees accordingly, and make sure you’re compensated, everything’ covered. When you’re in there, then you don’t have to think about those external things. You’re just one-on-one with the patient. You’re dialed in. You’re providing the best care. You’re thinking about the best solutions for this person in front of you, which is what we should be doing as practitioners, as healthcare providers.
It is very important for us to set these fees accordingly. You can’t set your fees if you don’t know what your cost is. Let’s think about your service as a product, almost. If you have a frame on the board and you know that frame costs you $200, you know you’ve got to sell it for more than $200 if you’re going to make some money. it’s very simple business math. We don’t often think about what the cost of the chair is, the exam chair that the patient is sitting in. What does it cost you to turn the lights on, to pay the bills, to pay your staff, and to open the doors so a patient can come and sit in that chair? What does that cost?
We need to calculate our chair costs. It’s not that complicated. I did it monthly, so I’ll go through all my bills for the month. We’re not talking about selling glasses and contact lenses because you’re buying them and selling them, then you’re buying them and selling them. We’re talking about our fixed cost every month. What is your rent? What does it cost for electricity, for water, or whatever utilities you have such as phone lines, internet, your staff, or whatever other costs you can think of. The equipment that you have, whatever technology you’re using in your routine eye exams. Add all of that in. What are your bills for the month?
Divide that number. There are different ways you can look at it. Cost per eye exam, or you can look at cost per chair hour. For the month, how many exam slots do you have? Let’s say a routine eye exam. Let’s say the 30-minute exam slots. How many 30-minute routine eye exam slots do you have in a month? You can break it down to a week if you want, however it’s easier for you. You’ll assign a number. You take that big number, all your costs, and divide it by the number of exam slots you have. Now you know your cost per exam slot. That is what it costs you when a patient is sitting in that chair. I like to do it per hour or per 30 minutes. Either way, you know the amount of time you’re spending is how much it costs you to have that patient sitting there for that long.
You then can start to figure out how much to charge and what your revenue per patient should be. Industry average is a pretty broad average for chair costs. It’s somewhere in that $300 to $500 range per hour. That’s the per-hour number, so per half-hour or per exam slot, it will be half of that, somewhere in that $200 to $300 or $200 to $250 per 30 minutes. It’s an important number to think about. If you have a child who’s doing myopia management, and in a year, it requires an hour of your time to see them for their routine eye exam or their consultation, or their myopia follow-ups. That’s an hour of chair time.
You have to think about, “That’s costing me $300 or $400. That’s my cost to see that patient. What do I need to charge to not only make my money back, but actually make this profitable for my business?” You’re going to start to charge accordingly. The other thing you could look at is, what is my average revenue per patient? If I had a routine exam and I had an adult who then bought a pair of glasses afterwards, that revenue per patient, maybe it’s $300, $400, or $500. You can also compare your myopia to that.
If that 30-minute exam made me $500, 30 minutes with a myopia patient should make me $500 at least. Otherwise, you may as well just keep seeing routine patients. These are important things you want to consider when you’re setting your fees. I tried to break it down a little bit more. It’s $300 cost per hour. It’s $150 for 30 minutes or $75 per 15-minute segment. It’s thinking about how to start charging accordingly. We do per visit. This is what I want to talk about. Some clinics will charge of one-year global fee, so upfront, one large number. You pay that upfront, and then all your fees, no matter how many are all covered.
Some clinics will do a per-visit or per-service fee. There’s no right way or wrong way. You have to find what is right for you. We’ve tried a few of these things. We started with the annual fee. We went to our per-visit fee. I’ve talked to other doctors whose clinics are heavily into myopia management. They said the same thing. I was expecting them to come and say, “Harbir, this is the right way to do it.” Every clinic I talked to has a different approach. You just have to find what is right for you.
For the pros and cons, the one upfront fee is very simple. There’s like, “Here’s your fee.” There’s nothing else. It’s clean. It’s simple. The patient doesn’t feel like you’re trying to add a bunch of fees and get more money from them. The problem is it’s usually a big number. Parents often get a little bit of sticker shock and are not as open to paying that $500, $800, or $1,000, or whatever your number might be. They’re not always so comfortable paying that. We found the per-visit fee has been a little easier for us. We keep it clean.
The reason that per visit fee has been working well for us is that our doctors would say, “I feel weird charging this much money, but I’m only seeing the patient once or twice a year versus charging the same amount of money and seeing the patient 4, 5, or 6 times a year.” We thought maybe it makes sense to do it per visit. Our doctors felt a bit more comfortable. The number is smaller. It’s a bit easier for the patient to understand, “You’re going to pay this each time you come in, but it’s a smaller number.”
That number has to account for our chair cost and make sure that we’re not just breaking even, but we’re making money the same way we would at least when we see a routine eye exam. That’s the way we approach it. We’ve found that’s been working well for our practice. Some clinics will do a per-service, so they break it down. We’re charging you this much for a refraction, this much for axial length, and this much for images. That works in some cases, but in other cases, patients feel a little bit like, “You keep adding line items to my invoice here.” We do that one fee per visit.
Pick The Best Marketing Strategy For You
Whatever the doctor needs to do, whether it’s axial length, retinal images, or whatever, it’s all in that. We’re getting close to the last two things. We’re not going to spend as much time on these last two topics, but I do want to just mention how important these last two topics are. Step seven here is thinking about your marketing. There are different ways of marketing as we know. There’s your traditional marketing. There’s internal marketing and outward-facing digital marketing and things like that.
The first place that is the most important to start is your referral network. Building your referral network is what’s going to help any specialty grow. What does this mean? It means telling anybody you know. Your referral network is your family, your friends, and your kids’ soccer team. This is all part of your referral network. Your referral network is other professionals like GPs, other ODs, and pediatricians. It’s talking to all of these professionals and letting them know you offer this specialty care and why it’s so important.
On this note, what we did is we made another one that’s very similar to the brochure I mentioned earlier, but it’s geared towards ODs. On it, it says, “We’d love to work with you. We want to support our colleagues. If you’re not into myopia management, we love doing it. We will see your patient for the Ortho-K or whatever, then we’ll send them right back to you.” It’s letting them know what equipment and technology we have and what services we provide. I had my staff take that with some cupcakes and hand them out to a bunch of ODs in our area.
Similar thing with GPs, you hand out brochures, talk to their staff, and let them know that you offer these services that they don’t need to be referred to. In Canada, a lot of times in BC, these patients will get referred to an ophthalmologist. It’s not necessary. An ophthalmologist doesn’t need to see a child who’s a little bit nearsighted or even very nearsighted, to be honest. That is not what I think ophthalmology is needed for.
Ophthalmology is needed for the more advanced stuff like things that need to be triaged, the more advanced ocular disease, strabismus, or whatever else you think that falls under their purview. Myopia is an optometry thing. We should be taking care of that. We should educate our fellow professionals that these patients should come to an optometrist and can be well taken care of because we have all of this technology and we offer all of these services. Build that referral network.
Let’s get into traditional marketing. Talk to newspapers and your schools. Again, that’s part of your network. Do the mail-outs and things like that. Let your local community know. Tell your friends that you do this. The old school marketing is coming back. Maybe not so much TV and radio, but old school, traditional boots on the ground marketing is making a comeback. Digital marketing is still very valuable, but the space is getting a bit more crowded.
People are getting bombarded with online ads left, right, and center. They ignore most of it. Think about when you’re scrolling through Instagram, TikTok, or whatever, the ad that comes up on YouTube before the video you want to watch, just skip. Getting in front of them in a more traditional way is becoming valuable again. There’s digital marketing. Social media is huge, though. Don’t get me wrong. If we go right back to the very beginning of this lecture, the patient journey starts when they’re looking for you online. You want to be found. You want to be able to be found. You want when you’re found to be able to show the information that’s relevant to the person who’s looking for you.
Share information about doing myopia management. Share some patient stories. Ask your patients if you can take pictures or success stories of Ortho-K and all these things. Share that information. Make sure it’s on your website. Make sure your website’s coming up, your usual SEO stuff, and lots of blogs. Blogs are back. They’re legitimately a thing again. I’ve been using ChatGPT to type up a bunch of blogs. You’ve got to refine them. You can’t just say copy-paste, but I’ll go to ChatGPT and write a nice, long description of what I want.
I love using the voice command with ChatGPT because then you just talk and say, “ChatGPT, I’m looking to write a blog about myopia management. I’m looking to write a series of blogs. Maybe help me outline a series of blogs that I could write on myopia management, starting with the basics, a blog on what myopia management is. Let’s do one on why axial length is important, what the risk factors and maybe another one on what the long-term health risk of myopia progression is, and so on.”
Outline a bunch of blogs, hash them all out, and then read them through. Honestly, within an hour, you could have ten great polished blogs written. Upload them weekly, monthly, or however often you want. You’ve got lots of content on your website. That’s going to help improve your search results. Again, not to overwhelm, but there are lots of things we want to keep in mind, slowly implementing all these things.
Build Strong Industry Relationships
The last step is step eight. It’s making sure we’re building these industry relationships. There’s so much value that your reps will provide you, whether it’s your contact lens rep, or if you do Ortho-K, your rep at the lab there, if it’s your frame rep, your lens rep, or whoever it might be. They have so much insight. They know more about their product than anybody else. If you have troubleshooting issues or you need help solving a problem for a patient, your rep is going to be the person to talk to.
If you want to learn about what’s been successful for other people, they have these insights. They’re popping into dozens, if not hundreds, of offices. They’re seeing what works well, what looks good, and what doesn’t work. You can glean all of this information from your rep. They’re always going to be happy to share. They’re great with staff training. We do these weekly meetings once every couple of months. We have a rep come in from this company to teach us about the different lens options for ophthalmic lenses, or the contact lens rep comes in and helps us with sales training and things like that.
They have all the knowledge. They have all the ability. They have training programs that have been developed by the companies that are valuable to us. Lean on your reps. Get their phone number. Text them. Email them. They will love it because if you win, they win. Their interest is in making sure your business is successful because then, their business will be successful. I like to end with this. I say that I always used to hide from my reps, but now, I hug my reps. A rep would come in. I would say, “Close the door.” I tell my staff, “I’m busy. I don’t want to talk to them. Take some notes.”
Now, when my reps come in, I walk up front. I’ll give them a big hug, most of them, the ones that I know well. Cathy, who’s our HOYA rep, is amazing. I always say lean on your reps. You don’t have to hug them. You can shake their hand. Lean on them. Take their knowledge and their information. It’s going to help your business, too, a lot better. If you’re not the business owner, and you’re the associate doctor, I still recommend getting out there and meeting with reps. Reps want to sit with associate doctors as well. You can learn so much information. It will help you get better clinically and maybe help generate more revenue for yourself as well.
Discussion Wrap-up And Major Takeaways
A quick recap. Out of all of these things, there are three key things I want you to take away, but obviously, all eight are important. Number one is go through the patient journey. Optimize that. Understand every step of the way and where you can implement something related to myopia management so it becomes integrated. It’s part of your practice every step of the way. Build the protocols. When you pull one lever, all these things will happen. Your staff knows what happens next. Your doctors know what happens next. Everything is more streamlined.
The last big thing is understanding your costs and your fees because if we don’t do that right, you’re going to lose money. You’re not going to be interested. You’re never going to lean into it. You’re never going to find the success and the fulfillment from this. Unless you know that you’re going to make money from it and it’s going to be fulfilling both for your practice financially and for you clinically and personally as well.
Folks, we did it. We got to the end of this. I know it’s a little longer than an hour, but don’t forget you are getting credit for this. You will get credit. If you are looking for CE credit, after you’re done with this, I want you to go click on the link. That’s going to take you to NECO’s website. Go look for this webinar. Make sure you register and then click that you did this. You’ve got to take the little quiz. You’ve got to pass the quiz. You’ve got to get 70%.
It’s going to be easy. Don’t worry. It’s not a hard test. If you tune in to this and take away the key points, you will pass the quiz. NECO will email you your certificate. There you go. You got yourself one hour of CE. Thank you, folks. This has been incredible. I can’t believe we’re finally doing this. I’m grateful to my alma mater, NECO, and Dr. Gary Chu at NECO for supporting this and helping me create the very first COPE-approved episode of the show. I hope you enjoyed this.
I hope you found this lecture valuable. I hope that there’s something that you could take from this that you feel like you could implement in your practice, your business, and your clinic. Go get that CE credit. Click the link. Once again, thank you. Let your friends know. If anybody out there you know is looking for an easy way to get some CE, link them to this episode. Tell them, “Tune in to it, then click the link and go get your CE.” Thank you again for all the support. Even if you’re just a regular reader who’s not looking to get CE. Thank you to everybody once again for tuning in to the show, Canada’s number one optometry show. I’ll see you guys in the next episode.
