How do I...
Talking to patients about myopia
Independent optometrist, Luke Allen, on discussing myopia management with children and adults
As an optometrist, I think that when you begin to discuss myopia control (MC) with patients is of pivotal importance. Personally, I do not wait for a patient to present with the signs of myopia, instead explaining the new, exciting research to many patient groups such as the ‘pre-myopic’ child and myopic parents.
It doesn’t have to be a big explanation, but just a quick ‘by the way’ because if a parent is aware MC exists, they know that there is something available to help, so when the child presents as myopic, it doesn’t come as a surprise or a concern to them – it’s important for parents to know that there is something we can do.
Sometimes it is a struggle to convince people that MC is a real thing and that it’s not just the optometrist trying to sell them something. Therefore, educating people in advance makes it much easier to convince them to go ahead with treatment recommendations when required.
The art of explaining
When it comes to discussing MC with a child or an adult, optometrists must be confident and have an understanding of the condition and the management options, so I would encourage practitioners to do the research. Being able to quote some studies will instil confidence in your patients.
Personally, I start by explaining myopia with my Johnson & Johnson Vision Institute model eye in front of me so that I can demonstrate to the patient what is happening in the eye when myopia develops and why. Explaining the condition in simple language helps them understand it’s the eye growing, not the eye ‘going wrong.’ It’s really important to make that distinction with the patient and parent to help them understand that this is a physical change occurring, hence an increased risk of eye disease.
In my experience using terms such as short-sightedness rather than myopia, and blur along the edges rather than peripheral defocus, has been effective. I try to explain that making the eye more short-sighted on the edges ‘tricks’ it into thinking its more short-sighted, and stops it growing.
However, I would warn that you do have to pick your audience; you don’t want to be telling really young children or really anxious parents about possible eye disease. On these occasions, I talk about keeping the prescription low.
"You must find a balance between talking to both them and the parent, which means body language is really important"
The fitting process
When a myopic patient presents and I think they would benefit from a myopia control treatment, I try to make sure that I use the phase, ‘this is my recommendation.’ I always say ‘you don’t have to do this, but this is what I recommend as the best thing for your eyes in the long term.’
In my experience, I have found that many parents do not want options, but for you to tell them what is most suitable.
For children, I like to show them a contact lens, explain how it feels wearing one, and discuss the benefits of contact lens wear in general, highlighting how contact lenses can make it easier for sports, for example. I do this because the child won’t wear contact lenses to simply stop getting more myopic, the child will wear them because they like not wearing glasses; the prospect of their eyes not getting worse isn’t always the biggest appeal.
Cost will always be a factor with some patients. When I am recommending a treatment, I have found likening it to something mundane such as purchasing a cappuccino every other day, is useful.
What to avoid
Some practitioners can be nervous around children and have a tendency to ignore the child once they have finished the test and just interact with the parent. You must avoid excluding the child at this important point because ultimately you are not going to fit contact lenses to a child successfully if they do not like you, or if they are not on board. Speak to them, ask their opinion and check if they have questions.
You must find a balance between talking to both them and the parent, which means body language is really important.
For the older child or teenager, I actually speak to them directly, but leave my body language open to invite the parent into the conversation to ask questions. I also don’t push too hard on the eye disease front as some people can find it a scare tactic.
Three steps to success
- Bring up myopia with children and adults as routine, before they present as myopic
- Do not tell them what’s suitable, make a recommendation
- Do not ignore the child, including them is key to a successful outcome.