Post Consultation Report

Atropine

Date:

Patient Name:

Parent or Guardian 1

Parent or Guardian 2

I am writing to share my clinical assessment of 's consultation.

1. About

Description

Myopia Profile

	Outstanding	Average	At Risk
Genetics
Current Prescription
Time Spent Outside
Amount of Near Work/"Screen Time"

2. Prescription

Latest Exam:

RE:

LE:

Last Year’s Exam:

RE:

LE:

3. Myopia

4. What can we do?

Click here to see a video of all the four therapies.

5. Recommendations

Based on 's clinical assessment and level of myopia,

we have determined that  is a very good candidate

for Atropine

Eye Drops therefore as ’s eye doctor,

I recommend beginning their myopia care program with Atropine Eye Drops.

Atropine Eye Drops are drops that go into the eye once a day before bedtime. Although Atropine drops are approved by regulatory

authorities such as the FDA they are not yet approved for myopia management indication. However, Atropine has been proven in

numerous clinical studies to be effective at slowing down the progression of myopia. Here are some of those studies:

My reason for this recommendation is because I believe that will be able to

implement this therapy and the program very easily with a minimal amount of training. My staff and I will work with you

and  to ensure that the therapy is being done properly and is

making  comfortable. With any therapy, there are risks of

infection if appropriate care and maintenance are not practiced. We mitigate those risks with lots of communication between our staff and parents.

6. What to expect:

1. We determine the correct dosage for based on clinical findings and age.

2. We call in a prescription for Atropine drops at a special compounding pharmacy since Atropine doses can change, this formulation of Atropine eye drops has to be specially compounded.

3. The compounding pharmacy will ship the Atropine drops to your home.

4. We will share with you an Atropine drops insertion video that helps train you and .

on the appropriate use of Atropine.

5. You as a parent would insert the Atropine eye drops in your child’s eyes at bedtime.

6. You and our office around four times

a year to measure and monitor ’s progress. Remember kids’

prescriptions can fluctuate often and that’s why it is important to come into the office for evaluations about four times a year.

7. Behavioral Coaching:

To help you with this, please see this video here:

Additionally, our office will enroll you and in the automated behavioral coaching video program where you will receive videos about once a month talking about reducing screen time, encouraging outdoor play, and making other modifications to help your child have a successful myopia management program.

Doctor Name:

Doctor Number:

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Parent Email: