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To start, complete the patient’s exam before starting the conversation in earnest. However, during the exam, begin to prepare the patient and the parent for the upcoming conversation. Once it has been confirmed that the patient has myopia, have a handout that the parents can read while the exam is being finished. There are several great myopia resources available. We also include information and videos on our office website.

Define the Terms

We know what myopia is, but parents and patients may know very little about the eye. The first step is to define myopia. Use pictures, such as this diagram of a long myopic eye compared to a short emmetropic one. Explain myopia like this:

“We’re born with tiny baby eyes that grow larger and longer until eventually they reach their adult size. Something happens in myopic, or nearsighted eyes, and the signal saying ‘you're done, stop growing’ isn’t received.¹ If the stop signal isn’t received, the eye takes off and starts growing too fast. Typically, these nearsighted eyes will continue growing until the rest of you is finished growing. Usually, we see prescriptions stabilize in patients’ late teens or early twenties.²”

With non-myopic parents, it can be helpful to demonstrate the child’s prescription to the parents by using loose lenses (the opposite power of the prescription) held in front of the eyes of the (fully corrected) parent. Have the parent view a distance target. This allows a parent to see how their children see the world without correction. To make this lesson even more striking, swap the lenses for those of a myopic prescription several diopters stronger than the patient’s. This demonstrates where a patient’s prescription may end up without intervention. It can also be helpful to use this calculator from the Brien Holden Vision Institute to demonstrate the patient’s potential future prescription.

Lastly, mention that all myopia increases the risk for eye problems in the future and that higher prescriptions make surgeries like laser-assisted in situ keratomileusis (LASIK) more challenging.³ It is advisable to avoid spending too much time discussing the complications and keep the conversation focused on myopia.

Discuss Intervention Options and Costs

Next, quickly go through each of the myopia management options available in the practice. During the initial conversation, this part of the discussion should be short as it takes too much time during a full exam to explain the pros and cons of each. Getting too deep into the options leaves the parent confused and unable to move forward.

If patients and their parents are interested in talking more about these options later, have staff direct them to the practice’s website, discuss options via a phone call, or have them back for a consult visit to talk more deeply about myopia management. It is also recommended to have someone else handle the money conversation, so the practitioner is separated from that conversation.

It is important to have consent forms for the parent to sign for any intervention used. This consent form should include costs, visit schedules, risks and benefits, an off-label disclaimer (if warranted), return policy, expectations, and a disclaimer that slowing the myopia progression is not guaranteed.

Start Managing Myopia!

Ideally, every patient will agree to treatment at the comprehensive eye exam, however, sometimes one parent may want to talk it over with his or her partner, and the practitioner will need to have the same conversation more than once. I’ve had multiple patients leave without starting myopia management, only to come back the next year and start the program once they see their child's prescription increase. The best time to start myopia control was last year. The next best time is now.

References

1. Mutti DO, Hayes JR, Mitchell GL, et al. Refractive error, axial length, and relative peripheral refractive error before and after the onset of myopia. Invest Ophthalmol Vis Sci. 2007 Jun;48:2510-2519.
2. COMET Group. Myopia stabilization and associated factors among participants in the Correction of Myopia Evaluation Trial (COMET). Invest Ophthalmol Vis Sci. 2013 Dec 3;54:7871-7884.
3. Bullimore MA, Brennan NA. Myopia Control: Why Each Diopter Matters. Optom Vis Sci. 2019 Jun;96:463-465.