This episode is sponsored by Contamac.
Leah Johnson put it best: this news is an emotional rollercoaster.
The American Medical Association has passed a resolution supporting the formal classification of myopia as a disease, along with insurance coverage of appropriate treatment for children and adolescents, more public education, and better childhood vision screening. For those of us who’ve spent years being told we were using scare tactics, that’s a moment.
Then you read the part about insurance coverage, and the mixed feelings start.
Leah is thrilled by the recognition. She’s also wary of what happens when a payer decides that managing a child’s progressing myopia is worth $30 or $40, no matter how much time, training, and specialization a doctor has put into getting it right. Cary sees it differently. In his view, we’ve been stuck in the materials model since his grandfather was selling glasses in a jewelry store, and this is the push the profession needs to finally specialize and get paid for services the way dentistry does. He calls it a renaissance in optometry, one that will take a generation or two.
Then we get to the uncomfortable question. If myopia is treated as a progressive disease, what happens to the ECP who tells a parent, year after year, that there’s nothing to be done? Leah walks through the glaucoma analogy and what standard of care really means. Cary shares his own experience with a malpractice suit early in his career, and makes the case for growing OD-to-OD referral.
We close on education: why so much of a new grad’s passion depends on one attending or externship site, an idea for a myopia CE requirement at license renewal, and the mostly retired doctor who asked Leah at a conference last year whether she was really sure any of this works.
What we cover:
Why the AMA resolution is a milestone, and why it comes with mixed feelings
Medical insurance vs. vision care plans, and whether we’re trading one stranglehold for another
Still selling materials: the case for specialization and services
How Cary restructured his fees in the late ‘80s, and how that made a dedicated ortho-K practice possible
From “you’re going to ruin your eyes” to ortho-K referrals from pediatric ophthalmologists
What changes for the ECP, and the glaucoma model of spotting and referring
Will parents start suing?
Schools, externships, and a possible myopia CE requirement
What the scope-expansion fight can teach us about retraining a profession
Chapters
00:00 — Sponsor: Contamac and Optimum Infinite
02:22 — Intro: the AMA backs myopia as a disease
02:46 — Meet the panel: Dr. Leah Johnson and Dr. Cary Herzberg
04:52 — The abstract (Optometry Times)
06:03 — Leah: an emotional rollercoaster
07:38 — “We are not just refractionists”
08:50 — Insurance coverage, and the mixed feelings
11:37 — Will medical insurance be the same stranglehold?
12:10 — Cary: where this is going, not where it’s been
13:02 — Still selling materials like it’s a jewelry store
14:01 — Myopia as optometry’s “oral hygiene”
14:21 — The gauntlet’s down
15:45 — How does a specialist handle the insurance problem?
16:16 — Medical model vs. vision care plans
16:45 — The late-’80s fee shift
18:03 — Every treatment option listed, ortho-K included
18:43 — From “you’re going to ruin your eyes” to ortho-K referrals
19:42 — “A great time to be alive”
20:13 — What changes for the ECP?
21:07 — The glaucoma model: spot it, refer it
22:11 — Will parents start suing?
22:52 — Standard of care is the bare minimum
24:38 — Cary’s own malpractice suit, and OD-to-OD referral
25:27 — Will schools start teaching this?
26:30 — Why your externship shapes your passion
27:41 — A CE requirement for myopia?
28:30 — “Are you really sure?”
29:32 — Retraining a profession: lessons from scope expansion
31:18 — The gold rush ahead
31:57 — Close
This week’s sponsor is Contamac.
Learn more about Optimum Infinite Ortho-K from Contamac →