The Myopia Management intermediate family is concerned with determining and following up on a treatment plan intended to slow the progression of myopia for a patient. These treatment plans can only be used while the patient’s eyes are still growing; consequently, you will only see children scheduled for these types of appointments. There are two types of intermediates in this family: Myopia Management Consult and Myopia Management Follow Up.

Myopia Management consult

Concept

The Myopia Management Consult is the first of these types of appointments that will be scheduled for the patient, and unlike most intermediates, it is scheduled in a 30 min slot and only at our Lewis Center office so that an axial length measurement (length of the eyes) can be obtained. During this appointment the Doctor reviews the different treatment plan options available and offers their recommendations based on ocular history and the patient’s/parents lifestyle. To prepare for this appointment, the doctor may at a prior appointment have given the patient the following myopia management and/or atropine therapy brochure.

The different options available are:

  1. Multifocal Glasses: if the patient chooses this option, the doctor will likely recheck their refraction and finalize it with an ADD power.

  2. Low-dose Atropine therapy: if the patient chooses this option, the doctor will send in a prescription for 0.01% Atropine in to Arena pharmacy for the patient (reference the medication cheat sheet in the OA helpful things folder), perform pachemetry, and the OA will complete retinal photos.

  3. Multifocal soft contact lenses: if the patient chooses this option, the appointment will change to a cl fit and proceed accordingly.

  4. CRT contact lenses: if the patient chooses this option, the doctor will take several measurements and schedule the patient back for a CRT fitting.


Workup Order

Complete axial length scan, topography, autorefraction, visual acuity, expedited medical history, and inquire if the patient received the brochure and if they had any inclination toward a specific treatment plan option.


Charting Checklist

  • Layout: Intermediate.

  • Hx/Meds: Forward and update

  • Workup: Enter myopia as the chief complaint. Fill in VAs, pupils, and EOMs. Enter the autorefraction into the refraction table. If the doctor completes a refraction, enter this into the table as well, but inquire if they would like it finalized or only entered as a BVA.

  • Exam: Forward anterior and posterior findings (delete the posterior findings if the doctor does not complete). Forward Myopia in the plan and make it the #1 diagnosis for the appointment. Update the Myopia entry to reflect the new plan of treatment.

  • CL/Ref: If the patient decides to pursue soft or CRT lenses, the doctor may decide to initiate the fit that day. If so, add a “cl/ref” tab and enter all cl info and fit findings.

  • Testing: Create an axial length entry on the testing tab and input findings. Create topography entry and import imaging. Create entry for Pachemetry if the doctor performs. Create a photos entry if completed.

  • Routing: Enter “Myopia Management Consult today: $200” in the additional notes section (which will indicate the $200 fee for the consult) regardless of treatment plan decision.

    • If Multifocal glasses were prescribed, enter “Prescribed update to eyewear w/1st-time PAL” in the glasses box along with any follow up that needs scheduled in the additional notes box.

    • If the patient decides to pursue MF cls or CRTs then enter “schedule CL fit advanced” or “schedule CRT fit” in the cl box. The $200 for the consult will go towards the fit and contacts.

    • If the patient decides to pursue Atropine Therapy then enter “Schedule 1 mos, 3 mos, and 6 mos f/u” in the additional notes box along with “please post Atropine Therapy fee”; this fee will be $600 total (the $200 consult will go towards the $600) the first year. Subsequent years of treatment will be $500 (billed at the exam) with only a 6 month follow up (see example below)

      • Exam > MM Consult (decides to pursue Atropine) > 1 mos MM f/u > > 3 mos MM f/u > 6 mos MM f/u > > > > > > > Exam > > > > > > > 6 mos MM f/u.

        ^ ^ ^ ^ ^ ^

        $600 (total) atropine tx covered covered covered $500 atropine tx posted covered

Myopia Management Follow UP

Concept

Everyone who is undergoing Myopia Management treatment will, at minimum, have a six month follow up annually to recheck axial length in Lewis Center (anyone who opts for either soft MF cls or CRTs, especially in the first year, may have more frequent contact lens checks to ensure they are in the correct fit/type of cls; and atropine therapy patients in the first year will have a one month, three month, and six month follow up). These appointments are just what they sound like, the doctor is following up on the patient to see how well they are responding to the decided upon treatment option. The doctor will perform a refraction and recheck of axial length during this appointment and compare both to previous findings to see if the rate of change has slowed/halted. If there is no change in the rate of progression then the doctor might recommend an alternative, additional method of treatment.

Workup Order

Complete axial length scan, autorefraction, visual acuity, expedited medical history, and if the patient is on atropine therapy, inquire how consistently the patient has been with their drop regimen.

Charting Checklist

  • Layout: Intermediate.

  • Hx/Meds: Forward and update

  • Workup: Enter myopia as the chief complaint. Fill in VAs. Enter the autorefraction into the refraction table along with the doctor’s refraction as a BVA.

  • Exam: Forward Myopia in the plan and make it the #1 diagnosis for the appointment. Update the Myopia entry to reflect what the doctor recommends moving forward.

  • Testing: Create an axial length entry on the testing tab and input findings.

  • Routing: Enter “Myopia Management Follow Up (already posted)” in the additional notes section if the patient has already paid the $300 for the 1st year ($150 for the 2nd+ year). Reference the ledger to verify payment. Enter any cl or glasses recommendations in the appropriate boxes. Indicate when the patient’s next scheduled appointment should be in the additional notes box.

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