A tailored journey

This acknowledgement that each child is an individual – with their own unique preferences and interests – not only helps to form an initial connection between practitioner and patient, but underpins the provision of effective eye care.

When it comes to myopia management, a patient’s lifestyle and individual requirements should be considered in order to chart a tailored myopia management journey.

OT approached experienced optometrists for their tips on increasing engagement and enhancing compliance through personalised care.

Timing the myopia management conversation

Boots Opticians practice manager and optometrist, Carine McAllister, highlighted that timing the myopia management conversation is critical to ensure that both the child and parents understand the condition and the potential steps for managing it.

“When booking the appointment, it is important to note if the child wears spectacles and if there is a myopic prescription. This information helps in preparing for the appointment and ensures that the necessary preparation steps are taken in advance,” she shared.

McAllister highlighted that as part of clinic preparation, a child’s history is reviewed – with the potential for a pre-prepared myopia management pack to be added to the child’s record card if myopia is present.

She added that an optical consultant may provide myopia management materials to parents during the pre-screening stage.

“This allows the parent to read through the information while waiting for the next stage of the appointment with the optician,” McAllister shared.

Optometrists will discuss the different options for managing myopia during the appointment, with information materials provided and a follow up appointment booked.

“This appointment will allow for additional tests to be carried out and provide an opportunity for a more in-depth conversation with both the parent and child regarding the management plan,” McAllister highlighted.

Leightons Opticians St Albans practice director and optometrist, Indie Grewal, shared the importance of beginning conversations about myopia before a child becomes myopic.

“Many conversations we have with parents and children begin with lifestyle advice to potentially avoid or delay the onset of myopia,” he said.

“We have discovered that parents are keen to know what risk their child has of myopia. It also initiates a discussion on treatment if, or when, their child becomes myopic,” Grewal observed.

Specsavers Bellshill optometry director, Douglas Waugh, also highlighted the importance of proactive conversations.

“Starting conversations about myopia management early, even before a prescription is necessary, is crucial. This helps parents and guardians become aware of the risks and potential progression of short-sightedness in their children,” he said.

Waugh added that family history helps to inform the approach he takes in practice.

“I always consider the strong family history of short-sightedness as a significant indicator for potential myopia progression. This definitely affects recall and patient monitoring strategies,” he said.

Rawlings Opticians and Hearing Care optometrist, Jasnique Tiwana, told OT that she will talk with children who are at risk of myopia about increasing outdoor time and limiting prolonged screen use.

“For children who are emmetropic but with myopic family members or decreasing low level hyperopia, I explain how myopia develops and discuss lifestyle factors that can help reduce their risk,” she said.

“For children who are already myopic, I discuss management options regardless of how mild their prescription is,” Tiwana highlighted.

Once a management approach is selected, Tiwana will provide clear guidance on follow-up appointments, expected outcomes and monitoring over time.

“By making myopia management a routine part of every consultation, I aim to ensure that both parents and children feel informed and empowered to take action before myopia progresses further,” she shared.

We are transparent about the fact that myopia management is not a cure but a strategy to slow progression

The right product for the right patient

Grewal highlighted that optometrists are the “gatekeepers of any successful recommendation.”

“Many of the patients we see in clinic will not be fully aware of all the different products available for vision correction or for maintaining good ocular health. When it comes to myopia management, we are obliged to discuss all options,” he said.

He highlighted that many parents and carers may not be aware that children can wear soft contact lenses from a young age.

“In our clinic the option of myopia management with contact lenses and spectacles is discussed before a child becomes myopic or is pre-myopic. Introducing the option of contact lenses at the earliest stage of pre-myopia means it’s not a completely new concept once a child becomes myopic.”

Grewal shared that soft contact lenses can offer advantages in complying with recommended wear times.

“Low myopes, who are able to see relatively well without their correction, may remove their spectacles for sports and activities and then not wear them again for a period of time,” he said.

“We know that under correction of myopia promotes myopic progression – a child not wearing their spectacles is effectively under-corrected,” Grewal observed.

Optometrist director at Specsavers Haverfordwest, Andy Britton, highlighted the “essential” role of an optometrist’s recommendation when assessing the most suitable myopia management option.

He shared that soft contact lenses can work well from a young age. Britton highlighted that alongside the compliance benefits of soft contact lenses, there is a lower cost if a lens is lost, damaged or destroyed.

McAllister considers a range of factors when deciding which myopia management product might be most suitable for a patient, including lifestyle, patient preferences, parental involvement, and eye health.

She highlighted that different myopia management products require varying amounts of time and commitment, so it is important to choose a solution that fits with a child’s daily routine. McAllister added that parental involvement can play a significant role in the success of myopia management.

If a child is not yet able to manage the intervention independently, then it is important that parents understand the management plan and the importance of compliance, McAllister highlighted.

Optometrist and practice director at Lynne Fernandes Optometrists, Lynne Fernandes, shared with OT that a personalised approach maximises the chances of success and long-term compliance.

She will consider a broad range of factors, including age, hobbies and refractive error, when deciding what recommendation to make.

“For example, a highly active child might benefit from orthokeratology (ortho-k) or MiSight® 1 day, while a younger child with a lower prescription might be better suited to Miyosmart or Stellest spectacles,” she said.

Optometrist and director of Hammond Opticians, Deven Lakhani, shared with OT that he will always take on board patient preferences when recommending which myopia management intervention may be most suitable.

For example, in the past he has fitted a keen swimmer and gymnast with ortho-k lenses, and recommended myopia control spectacles for a patient who experienced extreme discomfort at the thought of putting something in his eye.

“I will generally be led by their activities and preferences,” Lakhani shared.

Experience has shown that success in managing myopia is enhanced when the child is actively involved

Managing expectations

Waugh highlighted the importance of clearly communicating the benefits and limitations of myopia management.

“Ensuring patients, parents and guardians, understand that these measures won't completely reverse short-sightedness but can minimise its progression is key,” he said.

Tiwana emphasised that setting realistic expectations from the outset can help to prevent frustration and ensure patients stay committed to their management plan.

She shared that sometimes parents may feel discouraged if they have invested in myopia management and their child’s prescription changes.

“I explain that, while myopia management doesn’t stop myopia entirely, it significantly reduces its progression. For instance, instead of their child’s prescription doubling over time, it may only increase by half as much,” she said.

For Fernandes, educational materials can be helpful in explaining how the efficacy of myopia management can vary.

“We are transparent about the fact that myopia management is not a cure but a strategy to slow progression,” she said.

“Regular follow-ups and open communication help maintain trust and ensure families remain engaged with the management plan,” Fernandes shared.

Grewal shared that the informed consent process can be useful in managing the expectations of parents.

He also finds that plotting axial length on centile charts can help parents to understand the efficacy of myopia management.

“Parents are advised that a child who becomes myopic at a young age is still likely to progress, even in a myopia management treatment,” he said.

McAllister shared that in addition to ensuring patients and parents understand that the goal is to slow rather than stop progression, it is important that they appreciate that myopia management is a long-term commitment.

“Regular follow-up appointments are crucial for assessing the effectiveness of the treatment and making adjustments as needed,” she said.

McAllister also emphasised that it is important to address the financial and practical aspects of myopia management from the beginning.

“This ensures that patients and their families are fully aware of any costs involved and the commitments required to follow through with the treatment plan,” she said.

Encouraging open communication can help to ensure that any issues that may arise are resolved promptly and the treatment plan remains effective, McAllister shared.

“Fostering a collaborative approach to addressing any challenges that may arise is key to successful management,” she said.

Lakhani shared that he sometimes uses the analogy of a car approaching an intersection when describing the intended effect of myopia management.

“You don’t slam on the brakes and come to a complete stop,” he said.

“You slowly press the brake and you ease to a stop – that’s what we are trying to do,” Lakhani emphasised.

Supporting compliance

When it comes to compliance, Grewal highlighted the value of regularly reviewing patients.

He shared that careful questioning can sometimes elicit changes to wearing schedules.

“We have previously discovered that some children change habits when on holiday from school and so we e-mail a week ahead of any holidays to remind parents to ensure their children continue wearing their chosen myopia management treatment through school holidays,” Grewal said.

McAllister shared that while the frequency of follow up appointments will vary depending on the treatment plan, patients are generally encouraged to attend at least every six months.

“Experience has shown that success in managing myopia is enhanced when the child is actively involved in the discussion about compliance during these appointments,” she said.

McAllister outlined how different suppliers have resources to enhance patient engagement – from a ‘passport’ that the optometrist and child complete jointly at follow up appointments, to a weekly timetable where the child can plot where they wear contact lenses.

She shared that a common challenge that arises in children wearing myopia control spectacles is restrictions on wearing glasses when playing sport.

“In such cases, we try to support the patient and their parents in minimising the time the spectacles are not worn. If this becomes a significant obstacle to adherence, we will review alternative options, such as switching from spectacles to contact lenses,” McAllister highlighted.

Waugh shared that his practice provides patients with leaflets, videos, and web links to offer patients, parents and guardians accurate information about myopia management.

As well as ensuring patients are well-informed, Waugh pointed to the value of follow up appointments in ensuring that patients are meeting recommended wear times.

“Regular communication and follow-up are essential to ensure patients comply with their myopia management plans, especially when using contact lenses. We aim to touch base more frequently than usual,” Waugh said.