Most readers will be more than aware that there is a solid body of evidence showing how a number of interventions, such as the use of specially designed contact lenses, spectacle lenses, cycloplegic agents and corneal remodelling, are able to slow down the progression of myopia. Importantly, this slowing down means so much more than just the opportunity to let paediatric patients (and their parents) know that there will be less need for stronger spectacles as they grow. The association of myopia with a whole raft of potentially sight threatening conditions, such as maculopathy and glaucoma, means that there are quantifiable long-term benefits for every dioptre of myopia averted.
Being aware of the theory is one thing, taking the first step to put it into practice, however, is another. Obvious pitfalls include the potential for overstating the benefits of myopia management. An eye care professional (ECP) may carefully explain how therapy may reduce the gradual progression of myopia over many years; worried myopic parents may instead hear how spectacles might not be needed by their child who will ‘be cured’ and so will not have to suffer the inconveniences they have had to. The ECP may carefully explain how, by limiting the myopia progression, the risk of developing many of the common age-related causes of sight loss, for which myopia is a risk factor but to which most of us succumb to with age, will be reduced; worried parents will hear how their child will not develop maculopathy, detachment, glaucoma or cataract.
And then there is the age-old challenge of when and how to introduce the topic in day-to-day practice. Should the ECP always introduce the topic of myopia management to all, or just to those where a clear threat of significant future progression is predicted, or simply wait for interested parents and patients to ask for themselves?
With these challenges in mind, what support is out there from experts with experience in communicating the benefits of myopia management?
My Kids Vision
The online resource called My Kids Vision is an information tool developed by Australia-based wife and husband optometrists Drs Kate and Paul Gifford. The Giffords, responsible for developing the excellent Myopia Profile website, an online tool to assist optometrists in managing myopic patients, recognised ‘the need for an information source to help parents understand myopia and the steps that they can take to help their children.’ And so they came up with My Kids Vision.
The website includes a wealth of easy-to-understand, non-sensational and always evidence-based information about myopia, methods of management and the long-term implications of either acting or doing nothing. One particularly useful feature is the myopia risk calculator. This offers the parent six questions about the risk of myopia for their child:
- How old is the child?
- Is your child already myopic?
- At what age did your child first get glasses for myopia?
- Are you (the parent/s) myopic?
- Aside from school hours, how much of your child’s day is spent on close work?
- How much of your child’s day is spent outdoors on average, including breaks at school?
With this information, the parent is then given a risk prediction and a wealth of helpful advice about what the implications are and what might be done that may benefit the child.
Another feature of My Kids Vision, which should prove useful when having those initial conversations with parents and children, is the blog. It is a number of short features written in a way that would very much appeal to the lay parent. The section on myths relating to myopia are especially useful, where several commonly-held views about myopia and treatment are either dispelled or explained. These include:
- Myopia can be cured: myth.
- Eye exercises cure myopia: myth.
- Pressing on your eyes shortens the eyeball: myth.
- Taking vitamins can cure myopia: myth.
- Contact lenses are dangerous for children: myth.
- Smart phones are making me short sighted: maybe.
As we all start developing strategies for talking with parents and children about myopia, an up-to-date resource like My Kids Vision, which is easy-to-read and yet accurate and non-patronising, should prove invaluable.
Communication With Kids
Professor Nicola Logan has long been recognised as a leading authority in myopia management, both in investigating its impact and in developing strategies to put theories into practice.
Being able to identify suitable candidates for myopia management is more than simply the metrics previously mentioned. The patient (and parent) needs to be fully on board if they are going to comply and, importantly, are not going to have too unrealistic an expectation of any intervention. As part of a presentation to the British Contact Lens Association last year, Professor Logan showed via a recorded consultation the importance of certain questions that might not usually be asked during a history and symptoms. Here are some key examples:
- Do you ever read, write or use a table without your glasses on? If yes, contact lenses may prove a more effective myopia management option.
- Do you put your glasses on first thing and keep them on until bedtime? Spectacle options might be considered.
- What do you like about wearing your glasses? This is a useful way of starting the process of considering corrections.
- Does anything annoy you about being short-sighted?
- Do you know why your mum had laser treatment? Was your mom short-sighted like you? This explores awareness of myopic progression in the family and helps align parental and patient childhood experiences.
- Do your siblings wear glasses too? This helps to identify the potential for helpful myopia management for another family member. Also, this may benefit both children as they can support each other.
- Do your eyes ever feel itchy or gritty? Possible ocular surface contraindications for comfortable contact lens wear may be identified early.
- When you go swimming, is it difficult to see? How many times a week do you go swimming? This highlights not only whether prescription goggles might be useful, but also whether orthokeratology might be considered. This is a helpful option for dedicated swimmers.
- Are there any other activities you want to tell me about? Other activities than swimming that might influence management options should also be explored.
- What do you like about your glasses? Tell me about times when wearing your glasses annoyed you. Encouraging this sort of discussion helps the patient and parent to think carefully about their correction and will have a positive impact on future compliance.
- Do you spend much time outdoors/on a tablet? These questions acknowledge the positive impact of daylight exposure.
- Have you thought about what you want to be when you grow up? This helps build rapport and also introduces a discussion about potential future visual standards and requirements that might be worth considering.
- Do you think wearing contact lenses would help with activities? Would you like to try them?