As more practitioners commit to proactively treating progressive myopia, finding ways to overcome common objections from parents becomes critical. Because most objections arise from a lack of understanding of myopia management, our responsibility as eyecare professionals is to educate parents and patients about the benefits and the methods used to combat progressive myopia. Here are some of the comments that I hear most often and how I respond.
“I’m highly nearsighted and I turned out fine.”
When I hear this comment from parents after educating a family about myopia management, I know that they have not fully grasped the reality of axial elongation and its association with eye diseases such as retinal detachment. To overcome this objection, I emphasize that increasing myopia is a risk factor—not a guarantee—of future eye disease (Flitcroft, 2012). Just as we know that not every patient who has hypertension will experience a stroke, not every progressive myope will develop comorbidities; but, this should not deter us from making an effort to reduce the risks.
Another variation of this objection is: “Can’t my child just have refractive surgery one day?” While I agree that refractive procedures such as laser-assisted in situ keratomileusis (LASIK) can correct vision by reshaping the cornea, they likely have no effect on the risks for eye disease, which are thought to be secondary to eye elongation.
“Can’t we just see how this year goes (again)?”
In my experience, parents who want to “wait and see how things go” generally do not pursue myopia management. This statement indicates that the parents don’t appreciate the urgency of proactive myopia treatment.
I take this opportunity to remind parents that 1) any myopia corresponds with an increased risk for eye disease, and 2) myopia progression is not linear; the largest increases generally occur at earlier stages (Flitcroft, 2012; Kim and Lim, 2019). In other words, beginning myopia management as early as possible may be most critical. If parents insist on waiting to reevaluate, I clearly outline a plan of action with follow up in six months to evaluate for change.
“This sounds too expensive/time-consuming.”
The unfortunate reality is that some myopia management strategies may be cost-prohibitive for some patients. Fortunately, we have several therapy options, and not all of them require the same amount of time and financial commitment. For example, while many practitioners reach for daily disposable distance-center multifocal contact lenses to treat progressive myopia, reusable contact lenses of this modality are also available.
Regarding the time commitment, I let parents know that after the first year, only two visits (an annual examination and a six-month follow-up exam) are generally needed. It’s also worth noting that patients may save significant time and money in the form of future medical care if we can prevent future eye disease.
“My child isn’t ready for contact lenses.”
If a patient truly is a poor candidate for contact lenses in your judgment, low-dose atropine therapy is an effective alternative. Some parents who want to be more “hands-on” are drawn to this option because they can closely monitor compliance with the recommended treatment protocol.
It’s worth noting, however, that parents sometimes have a misconception that contact lenses pose a higher risk for complications in younger children. Take this opportunity to explain that contact lenses are safe in pediatric populations, and some evidence suggests that younger children may experience fewer complications compared to older children (Bullimore, 2017). If parents are particularly concerned, let them know that daily disposable contact lenses can reduce the risk of complications (Chalmers et al, 2012). CLS
For references, please visit www.clspectrum.com/references and click on document #304.