Myopia. Presbyopia. We may encounter them all day, every day, but are we correcting these conditions or managing them? We would argue that some of our colleagues are correcting them. So, what’s the difference? The answer is the OD’s focus (no pun intended), and it matters. A lot.
Correction is contingent on asking, “Which is better, one or two?” Or us answering, “What add power does this patient need?”
Management depends on us answering several questions born out of research on both the causes of myopia and presbyopia and patient preferences: “When should I see this child again?” “What is the risk of their myopia progressing?” “How quickly might their myopia progress?” “What can I do to intervene?”
Regarding presbyopia: “How does this person want to see?” “What do they need from their vision at work, at home, and everywhere in between?” “What options can I offer to optimize their vision throughout their presbyopia journey?” “Is the answer glasses, contact lenses, therapeutic drops, or surgery?” Yes, yes, yes, and yes.
Two very different refractive states, yet one fundamental shift in the OD’s focus.
“But parents aren’t asking me about myopia management. Their plan is to get their children LASIK when they’re old enough,” some ODs will respond.
“But my presbyopic patients are perfectly happy with the five pairs of readers they bought from a big-box retailer,” other ODs may reply (never mind that the 44-year-old is wearing +2.50 D!).
The parent of a myopic child doesn’t know all the options available to both correct their refractive error and control their child’s axial elongation.
Similarly, the presbyopic patient is often not aware of all the choices they have that don’t require removing and replacing different pairs of spectacles throughout the day.
They don’t know what we know. We are the experts. As a result, let’s provide these patients with education on the various solutions and ask probing questions to determine which may be the ideal choice. Examples of such questions: “How would you feel about wearing overnight contact lenses?” or “How would you like to wear one pair of glasses that enables you to see at various distances?”
“But I don’t want to sell things to my patients,” some ODs will respond.
Guess what? Neither do we. And we don’t. Do you know why? Because we don’t actively persuade any of our patients to purchase something they may not need. Selling is, “I have something I want you to buy.” Expertise is, “I know something you deserve to understand.” What patients do with that knowledge is entirely up to them. But giving them the knowledge? That’s up to us. And that knowledge is one of the reasons they chose us as their eyecare providers.
Speaking of knowledge, these pages provide the ultimate myopia and presbyopia playbook.
Optometrists have always been uniquely positioned to care for patients over a lifetime. We see the 8-year-old myope become the teenager, the young adult, the emerging presbyope, and, eventually, the parent bringing their own child into our exam rooms. We don’t simply prescribe for moments in time. We build relationships across decades.
Let’s stop only asking what prescription a patient needs now and start asking what the patient needs tomorrow, a year from now, and 10 years from now. That’s management.
Modern Optometry
ModOptometry
co-Chief Medical Editor
Walter Whitley, OD, MBA, FAAO
co-ChIEf Medical Editor
Selina McGee, OD, FAAO
Modern Optometry
ModOptometry
co-Chief Medical Editor
Justin Schweitzer, OD, FAAO
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