By Aamena M. Kazmi, Therapeutic Optometrist, Diplomate, ABO
Nov. 9, 2022
Myopia management offers significant benefits to patients by controlling the progression of a condition that increases the risk for retinal detachments, myopic macular degeneration, glaucoma and the early development of cataracts.
It also offers a practice a springboard for patient growth and additional profitability. However, before patients and practices can realize these many benefits, parents must understand what myopia management is, how it works, and why it’s worth the significant out-of-pocket costs. Here’s how we do this in our practice.
Show Parents What Their Myopic Children Are Experiencing–and Will Experience If Left Unchecked
The most powerful thing I do to educate parents about myopia management is also the easiest. I use plus-powered lenses in the exam room to demonstrate their child’s current refractive state, and have them compare it to what their future refractive error could be in 2-3 years if no progression management is initiated.
Parents’ jaw-drop reaction (which ALWAYS happens) clearly demonstrates that this is a highly effective approach. The conversation often shifts from WHY should we do this to WHEN can we get started.
Sometimes when their child already has a high refractive error, parents will ask why initiating treatment now is essential. The parents will ask, “Why do we need to do this now? Based on this demonstration, our child will already be dependent on glasses or contact lenses for the rest of their life unless they get LASIK.” I immediately use this as an opportunity to begin discussing the increased risk of ocular comorbidities with high myopia manifesting in adulthood. I also share that higher refractive errors threaten LASIK candidacy in the future.
If the child is a -2.00 D myope, have their parents look across the room through a +2.00 D lens. Then you can either use a myopia calculator (i.e. Brien Holden) or estimate what the child’s refractive error in 2-3 years could be based on their current trends and/or risk factors and give the parents a plus powered lens of equal magnitude to look through to compare.
Explain Science Behind Why Child Is Becoming Myopic In Relatable Terms
I keep my discussion of the causes of myopia as cheerful and relatable as possible. I want myopia management to be perceived as something new and exciting and not something scary, dull or tedious.
I often begin my discussion by emphasizing that while their child’s eyes are healthy, they have developed myopia/nearsightedness or that their myopia/nearsightedness has progressed, whichever the case may be. What parents need to understand is that their child is becoming more myopic because, just as their child is getting taller, their child’s eyes are growing longer, and, at this time, their child’s eyes are growing at too fast a rate. Once the patient and parents understand this, I touch on how this elongation of the eye puts too much stress on the anatomical structure of the eye, making the child/patient more susceptible to problems in the future. Then, I enthusiastically tell the parents and child while WE (the parents and I) did not have options to safely reduce this rate of change when we were growing up, there are now several methods we can implement for their child today to prevent this same fate.
I usually can see that the parents and patient are both fully engaged in what I am saying after hearing the science behind myopia. Their body language and head nodding indicate to me that they are easily following what I am saying, rather than getting lost in unnecessary medical jargon.
Click HERE to read Review of Myopia Management, and learn more about making myopia management a profitable part of your practice.
I keep my conversation simple and emphasize this is a new era in optometry with better options for our children rather than spending time on discussions of myopic defocus or the mechanisms behind how low-dose atropine, multifocal contact lenses and orthokeratology manipulate the retinal signal for growth. Parents trust that we, as medical professionals, understand all of this on their behalf, and instead, want to focus on how they can better their child’s future.
I tell patients and parents about how when I was growing up I had to turn my older, weaker glasses in for newer, stronger glasses every year without any way to stop the change. Parents often tell me they had a similar experience and are excited to have an opportunity to help their child avoid having the same experience.
Of course, some parents WILL ask how these methods work. If they do, I recommend keeping it as simple as possible. Avoid scientific jargon and theories on the mechanism of action.
Emphasize the Need to Return & Continue Myopia Management Conversation
I always project a positive attitude, even when parents initially pass on starting myopia management. I will never forget the power of patient recall. No matter how many times you have this conversation, or how good you are at it, you will always have families that are just not interested or that fear their child “is not ready.” Look at this as an opportunity to plant the seeds for next time.
Other Articles to Explore
Whenever families choose not to enroll in a management program at present, I have them schedule a 10-minute follow-up appointment in 3-6 months before they leave. I leave the discussion open and tell them I would like them to return sooner than in a year to repeat a few measurements and develop a trend for their child’s rate of change/progression. When they return, one of two things will likely happen: a. the patient has progressed and the parents are more motivated to enroll in a program once this change is discovered or b. you at the very least have another opportunity to impress upon the parents what myopia progression is and why action is recommended.
This repeated discussion with not only new, but also returning, patients will undoubtedly help you become more comfortable with the conversation. The more comfortable you are with the discussion, the more successful you will be.
Things are always better understood the second time around. When parents are no longer hearing about your action plan for the first time, they can comprehend your proposal more fully, ask more meaningful questions and take action more promptly.
If progression has occurred, parents are often initially surprised and/or sad. Next, they usually ask if it is too late to initiate treatment. Use this time to remind them that what has happened cannot be undone, but further progression can be more effectively managed with prompt action.
Aamena M. Kazmi, Therapeutic Optometrist, Diplomate, ABO, practices at Bellaire Family Eye Care (BFE), including its Contact Lens Institute of Houston (CLIH), in Houston, Texas. To contact her: Kazmi@bfeye.com