Seven Ways: How to get the principles of myopia management across

Ian Cameron outlines some steps to better communicate with patients on the topic of myopia management

There’s a lot for patients to wrap their heads around with myopia management – risks, theory, interventions, probabilities, contact lenses and more. We cannot always expect people to take that all in during a single appointment and be ready to commit to 10-plus years of contact lenses then and there. Drip feed the concepts as often and as early as possible. Mention myopia management to myopes of any age to increase general awareness, mention it to any kids you test regardless of age and prescription. Mention it to grandparents. Building awareness of the fact there’s ‘something that can be done’ makes future conversations much easier and establishes you as the expert people will seek out when they are ready.

The volume of information cannot be adequately explained through conversation only. Parents and kids will need to mull things over and investigate their questions in their own time, so you need to make sure you have a variety of forms of information to direct patients to. Perhaps a science-based leaflet for the technically minded, some more general lay terminology on the website, and something specifically designed for kids with videos, charts, and infographics. You do not need to reinvent the wheel – much of this is already available from manufacturers and myopia interest groups. Having this written information also helps promote consistency across your practice, ensuring all staff can assist patients with the same, clear myopia management message.

In the rush to explain percentage risks of retinal detachment and axial length growth theory, we can forget there are lots of great ‘side benefits’ to kids wearing contact lenses. Studies show that myopic children aged eight to 11 rate their physical appearance, athletic competence and social acceptance as significantly improved by contact lens wear. Myopia management is maybe the main reason you are having the conversation but there is so much else besides to be gained in the here and now when kids wear contact lenses, so you should talk passionately about these other benefits and remember it is these that are likely to be more important to the child themselves.

It is important that both kids and their parents understand this intervention should be viewed as a treatment. We know you need a significant number of hours wearing the myopia management lenses or glasses for the treatment to have its desired effect. After a while of wearing, kids can forget why they started the lenses and just think of them as normal contact lenses. If they only wear the lenses for their immediate benefits of improved distance vision when doing sport or socialising, the benefits will be curtailed. Regularly remind kids and parents why they wear these lenses and the purpose of myopia management to make sure they maintain good wearing time compliance and regular follow ups.

There is much information to cover with myopia management that it can be overwhelming to remember everything you want to say, especially when you do not have the conversations that often. When it comes to helping patients make an informed decision about a suggested treatment, a useful mnemonic to remember is Bran.
B = benefits of the proposed treatment
R = risks of undertaking this treatment
A = alternatives options to the proposed treatment
N = no treatment option (ie what happens if you do nothing). Having a few clear, concise bullet points on each of these and making sure you always cover those four areas will mean you do not go far wrong.

Find a way you are comfortable with to discuss the trickier topics of myopia management. Talking about the benefits of a lower prescription is easy but finding a way to explain the eye health risks in later life that don’t over or underplay it is trickier. We can be tempted to just mention the things we find easy to talk about if we are not deliberate about tackling these other topics. There are many risk likelihood tables (prescription versus odds ratio of developing eye disease) readily available that allow you to discuss the risks of specific eye disease and visual impairment. Have a few key stats in your back pocket, or laminated on your desk, ready to use as needed. If you remember nothing else, a powerful message is that for every 1D reduction in myopia, the risk of myopic maculopathy is reduced by 40%.

In the end, people will make their own decisions about myopia management. Do not beat yourself up if they do not go forward with it despite your best efforts. Myopia management is a big financial commitment along with everything else so people may see the value in it but just not be able to make the numbers work. Remember there are other things that are beneficial for myopia progression too, such as keeping a patient’s spectacle prescription up to date, increasing time spent outdoors, and taking regular breaks from close work. These are things anyone can do at no cost, so do not let the patient leave feeling like they have missed their only opportunity to do the right thing. End on some positive advice that they can take away and implement rather than them feeling like they have let you down.