Glenda Moheeputh, OD, who has an independent practice inside a Walmart in Hialeah, Florida, has seen a growth in contact lens use due to mask mandates since she reopened her practice to routine care, but another significant area of growth has been her myopia management patient base. “Two years ago, I fit my first myopia management patient. Now I have more than 50,” she says. “For every 30 parents of a myopic child I talk with, I get one patient, so having 50 patients is very significant – especially as we went through COVID-related slowdowns.” Dr. Moheeputh’s practice for myopia control is now firmly established and continues to grow.
WHY NOT IN A WALMART?
Dr. Moheeputh’s passion for myopia control was sparked in her first job out of optometry school– a high-end private practice in New York. When she attended the Vision By Design annual conference on myopia management, she was met with skepticism. “People said, ‘I hope you’re not going to be doing this in corporate optometry,’” she says. “Every person I told that I am practicing in a Walmart asked, ‘How is that going to work? I’m not seeing how patients will come because it’s so high-priced.’ They were apprehensive.”
Dr. Moheeputh was not dismayed by her colleagues’ attitudes, though. Her mission-driven mindset brought her through the doubts. Although her practice is primary care for all ages, she says, “I feel that every child should have access to this option,” she says. “There should be no child left behind when it comes to treatment. There is no reason why patients who go to Walmart should not have access to treatment.”
She has also turned the conventional wisdom on its head. Many people think that a myopia management practice is most successful in affluent areas, in private practices and in primarily Asian American communities because of the higher rates of myopia in the Asian population. “I’m in an underprivileged community and in a Walmart setting,” she notes. Dr. Moheeputh has worked actively to end stereotypes about myopia management.
Dr. Moheeputh fights the prevailing attitudes by hosting webinars and local networking events. She has established the first southern Florida chapter of the American Academy of Orthokeratology and Myopia Control and a women’s professional networking group, Optometry Divas..
Dr. Moheeputh offers a variety of treatment options for myopic children: atropine, soft multifocal contact lenses and orthokeratology. She also counsels parents about lifestyle changes, such as reduced screen time and more outdoor playtime, which can have an impact on myopia progression. She offers orthokeratology and soft multifocal lenses at the same set fee for the first year of treatment; second year fees are lower. She doesn’t want parents to choose one modality over another because of a cost differential. Those decisions should be based on what fits into the family’s lifestyle and schedule better. Atropine treatment carries a lower annual cost, and she currently has patients in each of the treatment regimens.
She has supplemented the standard lane equipment with a topographer and a ScanMate A scan to measure axial length. She opted for a portable device because she has two practice locations.
“If you want to do myopia management effectively, the axial length component is important. I can measure and show success with the treatment, and I can help educate parents,” she says. If she measures axial length on an 8-year-old, for example, and can explain that the child has another 12 years of growth, she can create a number line that shows the expected pattern of myopia progression.
When parents do opt for a treatment, she can also use her instrumentation to show it’s effectiveness. “I share a lot with patients and parents. I can say, ‘Here is what the topography looks like today. After a night of orthokeratology wear, come back tomorrow and we can see the changes.’ They love being aware of the impact.”
SCHEDULING PATIENT FLOW
Establishing a specialty practice within a practice located in Walmart is possible – and profitable, she says. Walmart has been a good fit for Dr. Moheeputh in her pursuit of her scope of practice. “Walmart lets us be doctors,” she says. [They don’t] interfere with how I practice and do my schedule.”
She appreciates that she can set flexible hours that allow the team to fit in exams and consultations for her myopia management patients. “I try to identify areas on the schedule that are traditionally slow and schedule my myopia patients for then. So that might be Monday afternoons, for example. But since that isn’t convenient for everyone, I also set aside very early and at the end of the day on Saturdays for these patients.”
Dr. Moheeputh says that she hears from other practitioners that they’re not ready to start offering myopia management services because they do not feel like they know everything about it. That’s a bridge too far, she says. “You can’t learn everything about myopia before you start. The learning evolves and we adapt,” she says. For example, when she began, the guidance was to use 0.01 percent atropine and now it’s 0.025 percent. “I’m always learning from patients and the science. It’s a constantly evolving space.”