Myopia: Getting Parent Buy-in to Treatment

It’s no secret that getting parents to commit to myopia interventions and follow-up visits for their children undergoing a myopic shift can be difficult. After all, typically, these parents are of the mindset that a new pair of glasses is the ideal solution. To overcome this difficulty, I have created a successful three-pronged approach:

I EXPLAIN MYOPIA’S SERIOUSNESS

Here’s what I say to parents: “Myopia, also known as nearsightedness, is much more than a need for a pair of glasses. It’s a chronic and progressive disease that increases the risk of developing severe eye conditions. These eye conditions are myopic maculopathy, which causes irreversible central vision loss, glaucoma, which causes irreversible peripheral vision loss, and retinal detachment. The retina is the part of the eye that delivers images. Your child is undergoing a myopic shift that needs to be addressed. While new glasses will enable your child to see well for a time, they will not help to prevent these further complications down the road.”

I like to end the conversation with, “This is not meant to be a scare tactic, but rather a sight-saving discussion.”

• Pro Tip. Should you decide to adapt this parent-facing script, I highly recommend asking them whether they or someone else in the family has a high prescription for nearsightedness. My reasoning: Most parents don’t want their child to be in the same situation. Additionally, the ongoing need for replacement spectacle lenses can be expensive.

I DISCUSS THE TREATMENTS

In explaining the seriousness of myopia, I find that parents are often eager to hear the interventions available to preserve their child’s vision, so my next step is to discuss these treatments with them: “Multiple FDA-approved and effective off-label treatments are available to control your child’s myopia.”

From here, I detail the specific benefits of each intervention:

• Orthokeratology. “These contact lenses are worn while your child sleeps, so they can reshape your child’s corneas and, therefore, treat the myopia. They are safe when worn as prescribed and when proper hygiene—both of which my contact lens tech will discuss with you—are practiced. Your child should expect a period of adaptation to their vision as these lenses go to work.”

• Soft Contact Lenses. “Distance-center multifocal lenses provide a pattern of focus for the wearer that can slow myopia. Dual-focus contact lenses contain specific alternating optical zones that provide myopia control.”

• Myopia-Control Spectacle Lenses. “These lenses employ a design that sends a signal to the eye that helps reduce it from growing longer. Because myopia progression occurs from the eye growing too long, this lens helps slow changes in your child’s prescription.”

• Low-Dose Atropine. Low-dose atropine eye drops work by slowing the signals that cause the eye to continue growing longer and longer. As a result, low-dose atropine can significantly slow myopia progression, especially when treatment is started as early as possible.

• Combination Therapy. “During each visit, I want to check for any changes in prescription, as well as further growth of the eye itself. If I notice either or both of those measurements progressing faster than desired, adding another form of myopia control can be extremely beneficial.” (See “Combination Therapy for Childhood Myopia.”) Again, regardless of the treatment we decide on, the goal is always to decrease myopia progression and prevent ocular health issues.

In addition, I speak with parents about the importance of their child spending at least 2 hours a day outdoors and minimizing their screen time, which we know are lifestyle choices that can mitigate myopia progression.

It can be easy for us to underestimate how far a parent will go to give their child the best options. In reality, when parents understand the benefits of these treatments, I have found that they are typically willing to invest in the treatment that most benefits their child’s health and vision.

I PROVIDE AN EDUCATIONAL FLYER

Even when presented clearly, the aforementioned can be an overwhelming amount of information for parents to take in during one sitting. To help alleviate this feeling, I created an educational flyer that is comprised of everything discussed in the examination room. Specifically, the front of the flyer reiterates what myopia is, related concerns, and the practical ways (eg, spending time outdoors and limiting screen time) parents can help. The back of the flyer provides a brief description of each of the different treatment options for myopia control.

PARENTS VERSUS OPTOMETRISTS

Given our education and skillset, it’s easy for us to understand the importance of myopia control when a child’s previous prescription was -2.50 D and their prescription is now -4.00 D. For parents who don’t share this experience, this is not so easy to understand. Yet, when I’ve taken the time to explain myopia and its treatments, parents are eager to make decisions to benefit their children.