Managing the Parents of Your Myopic Patients

I wish that myopia management in young patients was as simple as understanding the disease, designing and fitting orthokeratology (ortho-k) lenses, or prescribing atropine drops. But after about 7 years of growing my myopia patient base from zero to now hundreds of patients, I have realized that it is less about the lenses and drops and more about our interactions with the patients’ parents.

Yes, parents are the keys to a successful myopia management practice. They make all the decisions and have all the control. They are armed with smartphones and ask a lot of good and difficult questions, but underneath they are emotional, stressed, and worried. In this article I review five truths that can improve the way you deal with the parents of the children with myopia whom you manage. I wish someone had shared these truths with me 7 years ago. It would have saved me a lot of time and headaches.

FIVE TRUTHS

Truth No. 1: Parents Have a Hard Time Accepting That Myopia is Real

Parents are often shocked and upset when they learn that their child has myopia. Many have never heard the word “myopia” and think we don’t know what we’re talking about. Sure, they may have some level of trust when they walk into our exam room, but more often than not their initial response to a myopia diagnosis for their child is, “No, this can’t be happening. I don’t understand. I reject what I’m hearing.” I’ve seen parents visibly shake, I’ve had one yell at me and another post a negative review online—all simply because I informed them that their child had progressive myopia.

Myopia is a progressive disease, and parents usually aren’t able to detect changes in their children’s vision because they bring them in for an eye exam only every 1 to 2 years. As we know, a lot can change in 1 year, especially during a pandemic when you’re doing 7 to 8 hours of online schooling or using a personal digital device for gaming or social media.

The truth is that parents need to first accept that their child, through genetics and behavior, is becoming more nearsighted. It’s also important to recognize that acceptance of this change is never achieved in one session in the exam room. As a result, we have revamped our strategies for breaking the news to parents.

Now, after an initial exam, we have a brief conversation about myopia with the parent, using a reassuring tone and demeanor. Next, rather than loading the parent up with paper handouts and brochures, which end up being thrown away or misplaced, we ask them to scan a QR code that takes them to the “Start Here” page for Hoot Myopia Care, a cloud-based content and software platform that my husband, Bob Miglani, created to help optometrists manage myopia in children.

We use a QR code because the first thing most parents do when they leave our examination room is google “myopia in kids.” These are tech-savvy parents, so we created a specific page that addresses their burning questions right away. On Hoot Myopia Care’s “Start Here” page, they see a video of me explaining why their child had a jump in their prescription, which hopefully starts them on the path of slowly learning to accept that myopia is real.

Truth No. 2: Scare Tactics Don’t Work

Individuals with myopia are at increased risk of developing sight-threatening diseases, including glaucoma, cataract, retinal tears, and myopic maculopathy or myopic macular degeneration,^1,2 and those with high myopia (≤ –5.00 D)^3,4 are at even greater risk of developing these conditions.⁵ However, myopia is not a death sentence, and we cannot treat it that way in order to compel parents to sign their children up for treatment. The tone that we use to explain likely future scenarios should be calming, not scary. It’s not always about pointing out how bad things could be for their kids in a few years.

To achieve this, we have learned to be balanced, thoughtful, and caring in our early encounters with parents. We reassure them that, with proper intervention, their children will be all right. We explain that children with myopia are at increased risk for the aforementioned vision-threatening diseases in the future, but we then paint a picture for them of their child free of glasses (thanks to ortho-k). Moving forward with a treatment plan is also a meaningful way to regain control of their child’s healthy life—something many parents desire.

Truth No. 3: No Parent Can Handle a Deluge of Information

As previously mentioned, many parents have never heard of myopia, and the usual response from the clinician is to do what our professors did when we were in optometry school: drown us in learning materials. That makes sense, right? Learn by studying the problem.

Not exactly. Parents don’t want to be overwhelmed with homemade handouts or brochures from drug or lens companies. They want to be intelligently informed, but they want to learn on their own time, at their own pace, and via their device of choice. And, they want video! So, instead of giving them handouts or emailed studies, we again provide them with a QR code in the examination room, which takes them to a “Start Here” page with a video explaining why their child’s prescription “jumped,” then we “drip” other informative short videos to them once a week thereafter for 4 to 5 weeks. This process results in 95% of parents booking an appointment for a consultation.

Truth No. 4: Parents Don’t Want to Feel Alone

Parents feel guilty enough stressing their children out to study hard and play sports, etc. Asking them to make their kid put ortho-k lenses in their eyes at bedtime—something they’ve never heard of before—can immediately raise a wall. They may have heard of myopia or even atropine therapy from their pediatrician, but they haven’t heard of ortho-k or dual-focused soft contact lenses. That can be a big problem.

Parents don’t want their children to be the only ones with this “new” ortho-k lens. If they consult their friends, they will likely all say they’ve never heard of the treatment before either, and some may suspect that you are trying to sell them something that their child doesn’t need. Without any other reference point, the parent never books a consultation appointment or turns down the proposed treatment plan simply because one friend said he or she had never heard of ortho-k.

Parents need social proof, and we’ve found a way to give it to them—not with just one or two testimonials, but with more than 30 photos and many videos of happy, smiling kids and comments from their parents who have had positive experiences with myopia management therapies such as ortho-k. These are all on the Hoot platform, where parents can see that others have survived the myopia management program and are thriving.

Truth No. 5: Parents Want Natural, At-Home Remedies

Whether we like it or not, while children are undergoing myopia management programs their parents will ask whether there are any “natural” remedies or exercises their child can do at home to help slow the progression of their myopia.

I used to tell parents that there was not much out there in the way of natural, at-home remedies, but I learned that they would find something on YouTube and try it anyway, with or without my knowledge. Parents want to be a part of the process. Deep down, they feel guilty for putting too much stress on their child or for passing down their poor vision. It’s about them helping their child.

Now when I’m asked about natural, at-home remedies that parents can do to supplement their child’s myopia management program, I direct them to a series of behavioral coaching video modules that we created for the Hoot Myopia Care site. I sign them up to receive these videos once a month, and they learn to educate and coach their child naturally, at home, on improving study posture, conducting visual strengthening exercises, and more. These videos are easily shareable from the Hoot platform, which parents appreciate.

Optometrists must find ways to educate parents and children about the importance of adopting behavioral changes in combination with their ortho-k lenses, atropine drops, or dual-focused contact lenses. We can take a page from our primary care colleagues’ playbook here. When a patient has high cholesterol, for example, the primary care physician encourages the patient to exercise, eat right, and quit smoking. If the patient can’t get his or her numbers down with the behavior changes alone, then the doctor will prescribe a cholesterol medication; they don’t just immediately prescribe a pill. We would be doing our patients with myopia a favor if we took a similar approach.

A LABOR OF LOVE

Practicing myopia management over the past few years has been one of the most difficult yet also rewarding aspects of growing my optometry practice. Adopting technology and digital tools to help educate parents has made it easier for them, for us, and for our staff.

If you are thinking about expanding your services to include pediatric myopia management, take the tips above into consideration. They may end up saving you time and headaches. I wish you, my fellow myopia practitioners, the best of luck in this noble pursuit!