This article is essential reading for those who are starting myopia management in practice and want to learn how to communicate to parents and children about its benefits. It is also aimed at practitioners who want to increase the uptake of parents/caretakers who choose to help their children by embarking on a myopia management program. For simplicity, for the rest of this article, I will use the term “parent” to refer to anyone who is the responsible adult involved in the decision-making process of managing a child’s visual needs and myopia management.

As a practitioner, by better understanding the process by which people make decisions to undertake a treatment regimen, you will be able to guide and shape your communication with parents and children to achieve positive outcomes. There is a continuum of level of awareness of myopia management, and there is a broad range of associated emotions that accompany the awareness continuum, from helpless and scared to pragmatic and practical. And it is our job as eyecare practitioners (ECPs) to help navigate the various intersections of awareness and emotion in our patient community to help drive the right outcomes for our patients and to increase the uptake of those who choose us to manage their myopia.

WHY NOW IS THE TIME TO START GROWING YOUR MYOPIA PRACTICE

We all know about the looming tsunami of myopia that will slowly, but surely, deluge over half of the population over the next few decades, with more than 50% of the world’s population predicted to become myopic by 2050.¹ Myopia can cause permanent changes to sight and risks to the eyes of a significant proportion of the population. Thankfully, we have an increasing number of options for treatment and management at our disposal to lessen the impending swell of myopia progression.

As a practitioner, mastering myopia management is more than understanding the flurry of new treatment options. It’s also about communicating the importance of myopia management to parents and children and building trust and authority with everyone involved. Achieving this will help to build a successful and profitable practice while helping to manage the surge of new cases of progressing myopes and helping patients in a way that will positively impact them for the rest of their lives.

My practice in London has been providing myopia management services for the past five years. This has grown into one of our most sought-after services and has contributed to significant growth of the business. One of the most important factors of our success is parent/patient communication. We’ve tried and tested many different techniques to convey myopia management to parents to build trust and to help increase the acceptance of this now-essential service.

Introducing and discussing myopia management is imperative at every interaction with parents of myopic children. In addition, you also need to think about how to best convey information and communicate the details of myopia management to the children and how best to empathize with and engage them in the process. After all, they, not the parents, are your patients, so it is essential that they have a greater understanding about myopia and the benefits that they gain from its management.

With practice, discussing myopia management will be a natural part of the conversation and consultation, especially at the conclusion of the visual acuity test. Understanding how parents and children manage and cope with myopia will help you to inform, educate, and guide the discussion and should be considered a crucial step in the process of myopia management.

There are three key factors that I use in practice that build trust and boost uptake: 1) Have the entire practice team engage with myopia management; 2) Understand the information about myopia that parents need to make the decision; and 3) Know what factors influence how parents (and children) decide to initiate a treatment regimen, including myopia management.

ENGAGING THE TEAM AND PRACTICE WITH MYOPIA MANAGEMENT

All members of the practice team should understand myopia, the looming pandemic, and the increased risk of blindness that can result from myopia. They should all recognize the available treatment options and how they can make an impact on children. The support staff (receptionists, dispensing opticians, technicians, etc.) may often be fielding the first call from parents about your practice’s services, so it is important that they are able to help anxious parents who are looking for reassurance and answers. The conversation can also often be less intimidating when initiated by a team member or support staff rather than an ECP. This helps to either plant the seed and/or reinforce the message about the importance of managing myopia. It also provides further assurance that this is something that is important to the practice as a whole, not just to the ECP(s).

The Importance of Storytelling Having testimonials and case studies of children who have been successful in managing the progression of their myopia is essential to be able to help staff and patients better engage with myopia management. Storytelling is one of the oldest, and most powerful, communication mechanisms. Stories allow both the listener and the teller to engage in a shared connection, which can lead to an empathetic response. And sharing relevant stories with prospective parents and patients will help them better understand myopia management and how it can benefit them. So, share the story about the sports-loving teen whose glasses made it difficult for her to play basketball but that she is now able to because of her contact lenses, or about the grateful parent whose child needed a new prescription for glasses every six months but who has not had one change in over a year.

Authentic examples that you have observed in practice are great to share as real-world cases to those seeking to embark on the myopia management journey. They provide assurance and answers to some of the questions that prospective parents or children have. They can also be a powerful way to explain the impact of myopia management on children and their day-to-day lives. Over time, the support staff will have direct experience of successes, which will help when talking about myopia management with parents and children.

The Right Information at the Right Time When planning the information and communication that you need to provide to parents, think about the medium. Will they visit your website first? Will they call or email you for more information?

If the conversation about myopia management starts at the conclusion of the examination, make sure that you will have enough time or that there is a team member in the practice who can continue the discussion. To supplement the verbal dialogue, have suitable printed or electronic information available for each stage of the journey. This is important both for parents who are not well informed about myopia as well as for parents or children who need instruction on application and removal of contact lenses.

UNDERSTANDING THE INFORMATION THAT PARENTS REQUIRE

As a practitioner, it is important to fully understand and internalize information about myopia and how it can affect children as they grow into adulthood. Obtaining a strong understanding of this is essential to effective communication. It will allow you to build the story of a child’s life and how it relates to his or her myopia. What has happened to these children before in terms of their vision? What is happening now? Based on experience and understanding, what is likely to happen in the future?

There are essentially seven key points of information that practitioners need to remember and to convey to parents. I may not discuss all of the options in one visit. With practice, you can identify the ones that are most important to the parents to help them make the decision. The mnemonic that I use to remember the information to share with parents is: “I Can Treat Every Terrific Myope Confidently.”

I – Identity: What is myopia?

Can – Cause: What are the causes?

Treat – Treatment: What are the treatment options?

Every – Effect: What are the effects of myopia?

Terrific – Timeline: What will happen?

Myope – Management: What are the management options for myopia?

Confidently – Consequence: What are the consequences of myopia?

For each question, try to prepare an answer to which parents can relate. I often use the word “nearsighted” rather than “myopia” initially. Some parents may not know the meaning of myopia or may find it very “medical” (and worrying), but they will most likely know the meaning of nearsightedness. If the parents are not myopic, I would explain how myopia affects their children’s sight and how it impacts them in their day-to-day life (for example, when looking at the chalkboard in school). For parents who have not experienced myopia themselves, I sometimes need to demonstrate what the children are experiencing by putting equivalent plus lenses in a trial frame and asking the parents to “look through the eyes of their child.”

As with anything in life, with practice, the conversation becomes easier and more natural over time. Think about how you would answer each one of the questions in the mnemonic, and practice your responses with your team and patients or even with friends and family.

The same information applies when educating your team about the conversations that they will have with parents about myopia. Rehearsing this information and understanding more about myopia will help increase their involvement and engagement in myopia management. It can also give parents an element of control in the process and in helping their children.

I briefly discussed finding out more about the parents’ awareness of myopia. What is their own experience of myopia? It is essential to obtain an understanding of the perception and unconscious biases about myopia that parents may have. Do they have myopia themselves? Have they experienced progression at every examination? Do they have the struggles of having to wear glasses all day?

This is great place to start the next stage of the conversation. Some important points of the essentials of myopia to communicate are as follows.

Identity What is myopia? What does it do? Explaining that the far or distance vision will be blurry while reading or near sight will be clear can be helpful for some parents who do not have myopia themselves.

Cause What causes myopia? Is it genetic? Do the parents have myopia? Is the child an avid reader? Explaining the potential optical factors (such as a hyperopic defocus) in a patient-friendly way can help to demonstrate how methods of myopia management work.

Treatment How is myopia treated? Here, I try to give a distinction between treatment and management. Treatment involves traditional glasses or contact lenses without having a correction for management. Explaining to parents that their children could easily wear a pair of regular glasses that would allow them to see in the classroom—but that wouldn’t manage the rate of change—is an important part of the conversation.

Effect What is the effect of myopia? This is where the conversation turns to the specific impact of myopia on the child. How does it affect a child in the classroom? Playing sports? Are there any sports that the child enjoys playing? In most cases, contact lenses will improve a child’s self-esteem and confidence in playing sports.

Timeline What will occur over time? How do we expect the myopia to progress over time? We know that most children will progress faster between the age of 8 and 12 years old.² The earlier the onset, the greater the risk of progression. Some will progress at a later age, up to the age of 21 years or even later for young adults who undertake studies in academic subjects that require heavy reading or screen time or who perform significant close-up work.³ How would a management option impact this timeline and progression? Giving parents an estimated growth/change chart can provide an important visual demonstration of this.

Management What are the corrective management options? These would include (most are off-label) orthokeratology, a dual-focus daily wear soft lens, and a spectacle lens with myopic defocus (not yet available in the United States). Once parents have a good understanding of myopia, discussing the management options is relevant. Explaining how management options can impact the timeline/progression, their effect, and what the treatment options are will help to give parents an educated and informed choice.

Consequences What are the future consequences of myopia? We all know the risks that myopia presents to adults, especially the risks of very high myopia. Retinal detachment, glaucoma, and myopic maculopathy are more prevalent in high myopia than in low myopia.^4-7 Discussing these risks at the right stage of the conversation will add extra weight to the debate. It is often a balance between mentioning the risks without scaring parents/children to the point at which they become so overwhelmed that they fail to make a decision at all.

INFLUENCING FACTORS

The way that parents deal with their children’s myopia can be a complex process. However, it can be broken down into a smaller range of behaviors that can be managed more easily (Figure 1). Howard Leventhal proposed a model in the 1980s of how patients cope with illness and their adherence to treatment options.^8,9 This provides a useful starting point to better understand our patients and it fosters greater empathy, which in turn can help to increase trust and confidence in you as their ECP.

When confronted by the information that their children have myopia (or that their myopia has progressed), parents will understandably have an emotional response or reaction. They are likely to show fear, concern, and/or worry. Parents may also have guilt because they may have passed down a genetic predisposition for myopia. Parents will use their established coping mechanisms to manage their emotions; these may arise from past experience, either from their own history or from family and friends. As a respected professional, you will need to offer education combined with empathy to help manage their beliefs and perceptions about myopia and its management options.

PATIENT COPING STRATEGIES

There are many factors that influence how we respond when faced with an illness and need to decide the best course of management. Here are some of the most important factors that our patients will be considering.

Socio-Cultural and Environmental Context How would our friends, family, or community manage this condition? Do we know anyone else who has had to manage a similar condition?

Evaluate Past/Present Coping Have we faced other illnesses in the past? How did we deal with them at that time?

Personal Abilities How confident are we in our own ability to manage and cope with an illness? Do we have relevant problem-solving skills? Some of our patients will be more confident in making the decision to initiate management, while others will need more time and information.

HOW PATIENTS CHOOSE MYOPIA MANAGEMENT

Once presented with all of the relevant information, our parents and patients have to weigh the necessity and needs of each option and compare them with potential concerns or risks to make the final decision.

Almost all parents will agree that their children will need some immediate correction for their myopia. Having clear vision is an essential need for school and quality of life. We need to explain the necessity for both correcting myopia and for slowing its progression.

It’s natural for parents and children to have valid concerns about a treatment option. Parents may be concerned about their children’s development and their ability to manage an option such as contact lenses. Some parents may have fears about their ability to pay for myopia management. Others may have fears about the practitioners’ intention in prescribing expensive options. Understanding parents’ and children’s beliefs about necessity and concerns will help to guide your conversation (Table 1).¹⁰

PUTTING IT ALL TOGETHER

The keys to effective communication of myopia management are to involve the entire team, have the correct information in place, and understand the motivations and decision-making of the parents and children. The process may take some time, but you will see the confidence in yourself and in your team grow with experience. You will also see the rewards from helping to positively change and impact the lives of children.

If you don’t have sufficient time to discuss the options with the parents or children, is there a champion of myopia management within the practice who can inform them? An enthusiastic team member can spend time with the family and manage the program. Delivering advice and information in a sensitive, empathetic way is essential for introducing myopia management. It is also the way to build trust and rapport with the parents to steer them in the right direction to help their children and to stem the tidal wave of myopic change. CLS

REFERENCES

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2. Jones-Jordan L, Sinnott LT, Chu RH, et al. Myopia Progression as a Function of Sex, Age, and Ethnicity. Invest Ophthalmol Vis Sci. 2021 Aug;62:36.
3. Loman J, Quinn GE, Kamoun L, et al. Darkness and near work: myopia and its progression in third-year law students. Ophthalmology. 2002 May;109:1032-1038.
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5. Saw SM, Gazzard G, Shih-Yen EC, Chua WH. Myopia and associated pathological complications. Ophthalmic Physiol Opt. 2005 Sep;25:381-391.
6. Verkicharla PK, Ohno-Matsui K, Saw SM. Current and predicted demographics of high myopia and an update of its associated pathological changes. Ophthalmic Physiol Opt. 2015 Sep;35:465-475.
7. Risk factors for idiopathic rhegmatogenous retinal detachment. The Eye Disease Case-Control Study Group. Am J Epidemiol. 1993 Apr 1;137:749-757.
8. Leventhal H, Meyer D, Nerenz D. The common-sense representation of illness danger. In Bachman S, ed. Medical Psychology, Volume II. Pergamon Press. 1980:7-30.
9. Leventhal H, Nerenz DR, Steele DJ. Illness Representations and Coping with Health Threats. In Taylor SE, Singer JE, Baum A, eds. Handbook of Psychology and Health, Volume IV: Social Psychological Aspects of Health, Erlbaum, Hillsdale, NJ. 1984:219-252.
10. Horne R, Weinman J. Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res. 1999 Dec;47:555-567.