Photo credit: Getty Images
Options for families that can’t afford myopia management.
By Pamela Miller, OD, FAAO, JD, FNAP
Jan. 24, 2024
Myopia that is left to progress can lead to more than having to wear glasses or contact lenses. Myopia puts patients at greater long-term risk for disease conditions like open-angle glaucoma, cataracts, retinal tears and myopic maculopathy or myopic macular degeneration.
With sight-threatening risks to unchecked myopia, what should a doctor do when a patient needs myopia management, but, as a treatment that is not covered by vision care or major medical insurance, the patient’s family cannot afford it?
Here is what you can do.
Educate About Treatment Options, But Understand Family’s Challenges
Talking about atropine drops, Ortho-K and myopia management via soft contact lenses is good to do. However, that can’t be all you tell a patient’s family that immediately indicates they can’t provide treatment to their child that their insurance doesn’t cover.
The reality in many practices is that at least some of the patients sitting in your chair are on state assistance or have limited funds.
Even if covered by state insurance through Medicaid, or something similar, there may be a requirement that the patient have a minimum level of myopia before treatment is covered. If the patient is not at least 75 plus or a certain level of diopters, they probably won’t meet that threshold required for coverage. Whatever coverage they have also may not cover contact lenses and may not cover bifocals, and probably won’t cover progressive spectacle lenses and atropine.
The child and their caregiver also may not be able to give you a comprehensive, accurate family history of whether either or both parents are myopic, and if so, how myopic. Getting a good family history can be hard if the child is being cared for solely by a grandparent, or only by one parent, or is in foster care.
Talk About What Parents CAN Do
Don’t use terms like astigmatism and myopia without explaining what those things are.
Talk to parents about creating a game plan and what the family can do: “I’m very concerned about how nearsighted Johnny is because he’s likely to get more and more nearsighted, or ‘myopic,’ especially because you and dad are pretty nearsighted. I think there are some things we can do, though, that may slow the worsening of the nearsightedness.”
Limiting Digital Device Use
At a minimum, give lifestyle advice, visual health advice and guidance that includes significant information. Recommend less time on computers and handheld devices—no more than about two hours a day.
20-20-20 Rule & Using Devices as Safely as Possible
Teach patients and their families the 20-20-20 rule: Every 20 minutes look 20 feet away from the digital device for 20 seconds.
In addition, parents and children can be taught to keep computers at least a foot away from their face, if possible. I also advise on the best lighting for children to use when working on their computer, explaining that LED lighting should be avoided.
Other Articles to Explore
More Time Outdoors
Encourage patients and their parents to increase the amount of time spent outside—where it’s safe. You have to know the patient’s neighborhood when making that recommendation. If the patient’s neighborhood isn’t safe for outdoor play, you could provide nearby alternatives that the parents could take them to, such as a playground or park in a safer area that is still close enough to be practical, or even utilizing the YMCA/YWCA.
There also may be no-cost charities like the Boys and Girls Clubs of America with programs that get children outdoors and away from digital devices.
Healthy Lifestyle
I emphasize the importance to eye health, and overall health, of making sure parents themselves, in addition to their children, get a good night’s rest and eat healthily. I ask about the child’s daily routine, including when they get to bed every night, how well they sleep and what kinds of foods they eat.
If the family can’t afford fresh fruits and vegetables, you can see if there is a reliable food pantry, another charity, or their religious affiliation, that can help.
Talk About What YOU Can Offer that is Doable for Patient’s Family
In some cases, it may be beneficial to maintain a prescription for myopia that is at the lowest level that gives the patient the best vision needed for their lives. You also may be able to prescribe a bifocal that is covered by Medicaid or another state insurance.
Lastly, you can decide to do a limited amount of pro bono work. A patient with myopia may need to be see the doctor every six months to be monitored, but state insurance may only cover an annual visit to your office. You could then decide to offer the other visit at no expense to check to see if the myopia is progressing. If the family has no insurance, and is on a very limited budget, you can also choose to provide the correction for no cost or a very limited fee, or even offer a low-cost payment plan.
Be gentle with parents, limiting the guilt factor. Speak in terms that show the parent that you and they are in this together: “When I saw John last year, this is what we saw in prescription and this is what we’re seeing now. His nearsightedness is getting worse. What do you want to do? Here are some things we can try that are at no cost to you, or which your insurance will cover.”
A New Option for Patients Who Could Not Receive Myopia Management Otherwise
CooperVision announced an initiative recently that may give your patients who come from families that can’t afford myopia management more options for treatment.
The company will initially partner with optometry school faculty, residents and students to identify and treat children in need, as well as engage other multidisciplinary community partners. The program structure is designed for scalability, potentially allowing more schools to participate over time.
In its initial phase, the program is offering MiSight 1 day soft contact lenses and Paragon CRT orthokeratology contact lenses at no cost for as long as participating children require myopia management.
Pamela Miller, OD, FAAO, JD, DPNAP, has a solo optometric practice in Highland, Calif. She holds a law degree and a therapeutic license, is California State Board-certified and glaucoma-certified to prescribe eye medications, and offers comprehensive vision care, contact lenses, visual therapy and low vision services. To contact her: drpam@omnivision.com
