A visionary optometrist, Dr. Jagrut Lallu has spearheaded the establishment of New Zealand’s first myopia management clinic. Through his pioneering efforts, he emphasizes the importance of fostering a close collegial relationship between optometrists and ophthalmologists to combat myopia collectively. Dr. Lallu shared with COOKIE Magazine his insights for cultivating this collaborative approach to myopia management.
Dr. Jagrut Lallu’s journey began during his final year as an optometry undergraduate, when he predicted that myopia management would become an integral part of every practice.
“The more you give, the more you learn and get. It’s really an easy philosophy,” he said, sharing one of the key elements to successfully pioneering New Zealand’s first myopia management clinic in 2009. Below, he shared his tips for anyone who wishes to emulate this model of myopia management.
A clear vision for the future
From the get-go, Dr. Lallu’s vision was very clear— he wanted to set up an Ortho-K and myopia management clinic. Back then, myopia management was not a priority, and Ortho-K was considered risky.
When he was first setting up his myopia management clinic, he reached out to over a hundred local ophthalmologists and 300 sports clubs, informing them about the new clinic concept. Fortunately, they were all receptive to his ideas. Pediatric ophthalmologist Dr. John Dickson and a group of ophthalmologists at the Hamilton Eye Clinic were particularly supportive from the very beginning, even agreeing to accommodate his patients and conduct axial length measurements at their facilities.
Today, the thriving myopia management clinic has been instrumental in bringing together a community of optometrists and ophthalmologists in the Hamilton area. It sees many referrals from its direct optometric competitors, the local hospital, as well as private consultants and specialists.
“How the model works is that either an optometrist or an ophthalmologist would refer patients to our myopia management clinic for expert opinions,” explained Dr. Lallu. “We would then write back to the referring practitioner following the development of a treatment plan. In cases where the referrer is an optometrist and [the patient] requires spectacle correction, we recommend that they fulfill that need, and then we proceed with co-managing the patient’s myopia. In addition, we also receive referrals from general medical practitioners who seek our review on the next best steps for myopia management.”
Building a strong practice through co-management
How does one even start the ball rolling to set up a myopia management clinic or community?
He said the most important thing is to start doing something. “Do one thing a day, you’ll eventually get there and things will just get better,” shared Dr. Lallu. “Reach out for mentorship and support, and ask for help from people like myself who are happy to share everything,” he added.
”It’s all about creating a mutually beneficial agreement. When we were initially setting up the clinic, we asked if we could have axial lengths measured by a local ophthalmologist, and they initially offered to do it for us free of charge,” Dr. Lallu shared. “However, instead of accepting their generous offer, we proposed a different approach: ‘Let’s pay you a fee.’ This model has been quite successful because it allows the ophthalmologist to earn additional income while building a relationship with the optometrists.”
Seek opinions, build trust
“Whenever there’s a tricky case, you might want to seek another practitioner’s opinion and bounce ideas off each other,” Dr. Lallu said. This exchange of knowledge and ideas enhances patient care and promotes a comprehensive approach to managing complex cases.
Sometimes it could also be as simple as sharing meals together. “Generally, on an annual basis (excluding the COVID period), we would go out to dinner with all of the 15 or 16 ophthalmologists in our area, as well as registrars at the public hospital,” he shared. “What’s nice about that is we get to put faces to names of the people we work with, either through phone or via email. This helps create a sense of collegiality, building relationships that are independent of roles and responsibilities. These social gatherings allow us to build trust and camaraderie.”
“Trust is not difficult to build if you go with an open heart,” he enthused. “Just be honest. If you don’t know how to do something — say, can I pay you to do an axial length for me? Can I take you to lunch? Can we go to dinner? Can you educate me on this? What are your views?”
Being honest and asking for help and support from colleagues greatly contribute to establishing trust and rewarding professional relationships.
A rewarding mutual partnership
Apart from the above factors, Dr. Lallu mentioned that having an organization like the New Zealand Corneal and Contact Lens Society — founded in 1958, the oldest in the world, and has ophthalmologists and optometrists as its members — had also paved the way for fostering “a very strong relationship” between the two professions.
“I realized it’s not necessarily like that in some other countries,” he said. “And that’s okay. However, I think our colleagues very quickly realized that it is important to get along and work together where possible.”
It’s an enjoyable two-way relationship. The mutually beneficial partnership can yield numerous referrals to both private ophthalmologists and the public healthcare system. “When you have a good relationship with optometrists, you will see a substantial number of cataract surgeries and referrals to subspecialty areas, creating a symbiotic environment,” Dr. Lallu noted.
Furthermore, mini-myopia management clinics have been set up throughout the country — only confirming the fact that this model for co-managing myopia works.
Personal rewards and a sense of fulfillment
Dr. Lallu said his greatest satisfaction stems from the outcomes of effective patient care through customized myopia treatment plans. He shared, “One of the most rewarding things is seeing these children grow up, especially those patients who have been under our care at a very young age, and who are now in their 15th year of myopia management. We’ve had a lot of wins,” he shared.
However, he also acknowledged the challenges posed by delayed treatment. “It’s better to treat them when they’re less myopic. Why wait until a patient becomes -5.00 before you refer them, when we can intervene at -1.00? But it’s a continuous process of learning progress. And we’re getting there.”
And he’s just getting started…
Dr. Lallu’s next goal is to help make atropine a publicly funded prescription to help reduce the cost to the public. He also continues to lobby for a minimum standard of care for myopia management.
“There’s been too much evidence for the benefits of managing myopia, and there’s no reason why any practitioner in the country can’t get access to these products that work,” he explained.
“Now’s the time for the government to do this and if they do this first, it will pave the way for other countries to continue this message,” he added. “This can actually change the way we look after myopes.”
Dr. Lallu is also fully supportive of his colleagues in their optometric initiatives, among which is Amanda Edgar, Senior Lecturer of Learning Spaces Innovation from the Faculty of Deakin Learning Futures. She built a virtual clinic platform that allows students from across the globe to participate and learn about various topics in the fields of optometry and ophthalmology.
In addition, they are looking at a few clinical trials related to specific products connected with red light therapy. Besides working with different countries and supporting them in their regulatory approvals, Dr. Lallu is investigating prospective research and retrospective analyses, thanks to a large accumulation of data from long years of myopia management and through products such as MiSight® (CooperVision, California, USA), Forge Ortho-K (EyeSpace, Worcestershire, England), and MiYOSMART (Hoya Vision Care, Tokyo, Japan) lenses and methods of combination atropine treatments and orthokeratology. They are hoping to publish findings that might benefit a wider audience.
They also have an education arm to educate and support practitioners who come in to learn about various subspecialties.
“It’s about seeing what you can do to get involved,” Dr. Lallu emphasized. “By sharing your knowledge and experiences, you can foster personal growth and achieve success in this field. If you don’t know something, just ask someone because 99% of all of the eye care professionals are actually happy to lend a helping hand,” he concluded.
Editor’s Note: This article was published in COOKIE magazine Issue 12.