Turn Hesitation into Action: Mastering the Myopia Management Conversation

When a parent brings a near-sighted child in for their eye exam, they typically expect only a glasses prescription. Often, they are unfamiliar with myopia management. Implementing myopia care through patient and parent education is one of the biggest challenges for optometry today, as we try to standardize myopia management for the next generation of patients.

In 1990, the global myopia prevalence was just over 24%; this number has increased to 35% and is expected to continue to rise to around 40% by 2050.¹ Now is our opportunity as practitioners to shift the standard of care from myopia correction, prevention, and slowed progression for current myopes. The greatest barrier to this change is how we communicate with parents.

Thankfully, we now have the tools to make recommendations for all myopic and pre-myopic children. However, the roadblocks we run into don’t stem from the nature of the recommendation, but from the hesitancy of the parents. So, that begs the question: How do we address the “why” when parents push back on our recommendations for myopia control instead of traditional correction?

Framing the myopia management conversation

Our role as primary eyecare providers is to properly educate on the importance of myopia as a disease. This begins with answering the question, what is myopia? Myopia, also known as nearsightedness, is a progressive eye disease where a child's eyeball grows too long, causing distant objects to look blurry while close-up items remain clear.¹

Recognizing it as a disease is important because this abnormal stretching increases the risk of future eye complications, so the focus has moved to specialized treatments that actively slow its progression rather than just prescribing stronger glasses.²

I like to lead the conversation by demonstrating to the parents their child’s current axial length and prescription, and how it compares to averages in their age group. This allows them to have a better understanding of their child's level of myopia. I then explain that slowing progression now reduces the risk for other eye diseases later on.²

Next, as I’m getting to know the child during the examination, I like to consider their lifestyle and habits. For example, I recently examined a 9-year-old female who presented to the office with difficulty seeing on the basketball court. Upon further discussion, I learned that she was homeschooled, so the majority of what she needed to see was right in front of her.

I explained to her mother that this was the reason her vision complaints only manifested once she started basketball. After careful consideration of her visual needs, I recommended she try MiSight 1 day contact lenses so she had freedom from glasses while playing basketball, and also excellent vision at her computer.

With that, it’s also extremely important to educate the parents on other associated lifestyle risk factors for myopic progression, such as limits on screen time and a minimum of 2 hours of outdoor time each day, encouraging them to make lifestyle adjustments where possible.³

Addressing common objections to myopia management

Parents often come with questions, confusion, and sometimes even suspicion surrounding a myopia diagnosis. Having simple and straightforward responses goes a long way to alleviating fear and instilling confidence.

Here is a breakdown of some of the most common questions I get from parents about myopia control:

“Why haven't I heard of this before?”

This may be the most common question we hear every day. While awareness for myopia management has gotten better in the past few years, it has yet to be the standard of care for all optometrists.

"Why wasn’t this recommended last year?"

Recent studies have shown that while close to 80% of practitioners will offer some form of myopia control, only 33% of practitioners are encouraging these services at the earliest intervention.⁴ Given recent availability of more modalities of care, these numbers should start to increase significantly over the next few years.

"How long will my child need this for?"

Myopia control modalities can be started as soon as the child is diagnosed with near-sightedness. I’ve had patients as young as age 4 who’ve needed treatment. Myopia can progress greatly during adolescent years, though we start to see leveling off in the late high school years.

Depending on the specific case, I like to mention to the parents the possibility of treatment through college or professional school years.⁵

For an evidence-based comparison of myopia therapies, check out A Closer Look at Myopia Control Options: Comparing Efficacy, Safety, and Vision Quality!

"Will my child need to wear their glasses or contacts full time? They read up close just fine."

With both anti-myopia glasses (12 hours per day) and dual-focus or specialty contact lenses (10 hours per day),^6,7 treatment is required basically full time to ensure the best outcome for the patient. This is sometimes difficult with glasses for children with lower prescriptions who are so used to reading books or being on their iPads without any correction.

"What if we wait until next year?"

What should we do if a parent prefers to “wait and see” what happens with their child’s myopia progression? I like to emphasize a few main points when this topic comes up.

First, I remind the parents that the sooner we act, the more chances of slowing down progression we have. Even if we are only in treatment for a couple years, it’s better to do it now since there is no lowering of the prescription, only slowing down.

Secondly, I highlight the risks of vision loss associated with higher myopia. For example, the risk for developing myopic macular degeneration increases by 67% for every diopter change, but decreases by 40% for each diopter saved with myopia control.²

Download the parent handout here!

What Parents Need to Know about Myopia

Use this handout to help educate parents on myopia, its risk factors, and comparing practical considerations for different myopia control modalities.

Example parent conversations around myopia control interventions

Anti-myopia glasses

Patient: A 5-year-old girl who squints to see the board in her kindergarten class.
Optometrist: “It looks like Emma has myopia. Thankfully, we recently gained access to the highly successful EssilorLuxottica's Stellest lenses here in the United States. These glasses have a highly specialized design that carries a clear center to see far away while also having outer edges that create an intentional peripheral blur. This blur actually helps to slow down elongation of the eye over time, ensuring slowed progression.
Parent: “The peripheral blur concerns me, won’t it cause her to not see well?
Optometrist: “Actually, I’ve been prescribing these lenses for similar patients for about 6 months now, and I have yet to encounter a child who hasn’t seen perfectly through them! Not only that, but my niece, who was 5 at the time, was able to get them from Canada about a year ago, and her prescription hasn’t changed since, so I know they can work well.”

Dual focus contact lenses

Patient: A 10-year-old soccer player whose prescription increased since last year.
Optometrist: “It looks like Michael’s prescription jumped a lot since we saw him last year. I’d like to discuss putting him in MiSight 1 day contact lenses for myopia control. These are FDA-approved therapeutic contact lenses that are proven to help slow down near-sighted prescriptions in children. Being that he’s an active child, I think these contact lenses are a great fit for his lifestyle.”
Parent: “What’s so special about these contacts? How are they different from regular contacts, can’t he just use those? Also, are you sure a 10-year-old can wear contacts? I didn’t start until I was in 8th grade.”
Optometrist: “The contact lenses have a dual focus zone that creates a blur image to the peripheral retina, creating a signal that discourages the eye from growing too quickly. This is in addition to the central correction zone that allows the wearer to achieve 20/20 vision as usual. They have been proven to slow down the axial length of the eye much more effectively than regular contacts. As for the age, MiSight contacts are indicated for children as young as 8, and I’ve seen many kids surprise us in how well they do. We will teach him everything he needs to know to be successful with them.”

Orthokeratology lenses

Patient: A 12-year-old competitive swimmer whose prescription changed over the past year.
Optometrist: “I noticed that Samantha’s prescription increased again this year. I know she’s been swimming competitively, and I think her vision can be much better with orthokeratology lenses. These are custom fit lens retainers that are only worn at night and can provide clear vision without glasses or contacts during the day. This will be great for the pool!”
Parent: “How does that even work? Should we be concerned about the change in prescription?”
Optometrist: “When the lens is worn overnight, the soft tissue of the cornea is gently reshaped to change Samantha’s vision, so when removed, she can see without any correction. The bonus here is that the pattern created when reshaping the cornea, has also been proven to slow down prescription changes by creating a peripheral ring of power that changes where images are focused on the retina. So we would be controlling her prescription and giving her freedom from glasses and contacts during the day.”

Low-dose atropine eye drops

Patient: A 5-year-old with a low myopic prescription (-0.50D OU)
Optometrist: “I’m diagnosing your child with myopia, or near-sightedness. Fortunately it doesn’t seem to be bothering her vision thus far, but I am concerned that it will get worse. We have an off-label but well-studied pharmaceutical eye drop called low-dose atropine that has been proven to help thicken choroidal tissue, a layer behind the retina in the back of the eye, that in turn can slow down changes. I’d like to prescribe this for your daughter. In the future, when we see more changes, we’ll discuss glasses or contact lens options to use in addition to the eye drop.”
Parent: “Will this drop affect her vision at all? What should I look out for after starting the drops?”
Optometrist: “Occasionally, we see dilated pupils and difficulty focusing up close. If that happens, we can adjust the dosing or schedule. You’ll bring her in for follow up appointments so we can discuss how she is doing and test her focusing levels in the office.”

Building confidence by sharing success cases with myopia control

I like to reference my previous experiences with cases that are similar to what is presented to me that day. Here’s a specific example of a successful MiSight case: a couple years ago I saw a 12-year-old girl who came in to get fitted with contact lenses for volleyball, and it was her first time at our office.

We noticed her prescription was a bit high for her age, at -5.00D, and it had been changing pretty rapidly each year. After careful consideration of her needs we proceeded with MiSight 1 day contact lenses. Fast forward 2 years and her prescription did creep up a bit, but only by about -0.25D OU each year. Prior to MiSight, she was changing closer to -1.00D each year.

Hearing these stories helps the parent feel more confident in my skills and recommendations, and makes it more likely they will be open to further discussion of myopia management.

The all-important cost conversation in myopia management

The cost of products and services in myopia management plays an important role in parents’ decision making. Remember, many of these families walked into your office that day expecting a routine exam and a prescription for distance glasses.

I like to determine pretty early on whether I think the patient would benefit from myopia management, and I try to slowly bring up the topic while still examining the patient, so when the discussion about costs comes up, it’s less of a surprise to the families. Here’s an example dialogue about how I approach costs:

Sample conversation around costs for myopia control

OD: “Being that we are seeing a huge jump in Miles’ prescription today, I’m recommending our therapeutic glasses option called Stellest. These glasses are FDA approved to slow down how quickly his prescription is changing over time. Here’s a breakdown of why I think this is important: (I then proceed to show them where their prescription is relative to their age group, what their axial length is relative to an emmetropic adult, and what we predict the prescription can become)."
Parent: "Thank you for recommending this, I am definitely concerned with the jumps in his prescription. This happened to me when I was a child and I just got LASIK later on. How is this different? Can’t they just do that when they are 25?"
OD: "Well our goal here is to keep the prescription at a reasonably safe level that still allows a procedure like LASIK to be considered instead of glasses or contacts down the line. Unfortunately LASIK doesn’t change the anatomy of the eye, so the increased risk of eye disease doesn’t go away—that’s what we want to prevent now."
Parent: "Understood, thank you. This sounds expensive, will this cost more than regular glasses?"
OD: "Unfortunately yes, though with our myopia management program we do a couple things differently. Firstly, we will have multiple follow-up appointments throughout the year to ensure Miles is seeing properly with his glasses, and will also monitor the prescription at each visit for further changes. If we see large enough changes at 6 months, we will get Miles’ new lenses at no additional charge, as well as re-evaluate our strategy moving forward. So we do our best to include as much value as we can as we take care of Miles' eyes for the foreseeable future."

Tools that support success

One of the most helpful things we’ve integrated into my office over the years has been posters and signs throughout the optical, front desk, pre-test area and exam rooms. I’ve attached some pictures showing our office setup. Your practice’s CooperVision reps should have access to all of the company's MiSight posters and handouts, same goes for Johnson & Johnson, for ACUVUE Abiliti Overnight and EssilorLuxottica for Stellest handouts.

Figures 1 to 3: Exam room and pretest area with myopia posters.

^{Figures 1 to 3: Courtesy of Eric Heaps, OD.}

These resources help parents see what we offer before talking with the doctor. Handing out a pamphlet for a specific product while still examining the child is a great way for the parent to begin learning and formulate questions, prior to having a conversation with me.

Figure 4: Examples of brochures from various companies we hand out to parents.

^{Figure 4: Courtesy of Eric Heaps, OD.}

Myopia program structure and fees

Other tools that are important for a practice to be successful with myopia management are to develop a solid program with a consistent fee structure and associated documentation to hand out to the patient and parents.

Parent education tools

While I do my best to educate parents and families when they come in for their routine exam, oftentimes parents will want to do their own research or discuss with their spouses. To make sure they don’t leave empty handed I like to provide a link or printout of the patient’s risk profile, with educational information alongside it.

To achieve this I use a service called Ocumetra, which lets us type in the patient’s age, race, gender, prescription and axial length and calculates a risk profile analysis that makes it easy to demonstrate and show the parents.

Figures 6 and 7: Images of a high risk patient from the Ocumetra service.

^{Figures 6 and 7: Courtesy of Eric Heaps, OD.}

While Ocumetra is a paid service, our practice finds it extremely useful as an education tool, being backed by real data, and well worth the monthly cost. Similar information and graphs are available via Myappia.com and BHVI.org.

In closing

Myopia management is set to be one of the largest growth spaces in optometry over the next few years, with even more optical and pharmaceutical options in the pipeline.⁸ As general awareness grows, conversations in the exam room may become easier.

For the time being, it's up to us as practitioners to present the best option for each patient and help the parents understand the importance of slowing down myopia for their child.