Welcome to question of the day #169

Welcome to question of the day #169

I want to start discussing myopia management with the parents of young children with myopia. Where do I start?

I turn again to a very informative video presentation by Professor Flitcroft through one of the UK professional bodies the Association of Optometrists. Sadly, it’s behind a firewall so there’s no point in me highlighting the link here.

Professor Flitcroft’s advice has been very useful to me and I share it below:

Balance

You aim should be to inform and motivate but not scaring the parents. Avoid using eye jargon and technical language. Most parents don’t have diplomas or degrees in eye care. Some may say they understand what you are saying even if they don’t. Don’t use the word ‘blindness’ in your conversation. Parents will shut down cognitively and not hear what you have to say once they have heard this word.

Slowing down the progression of the myopia

There will still be myopic progression with myopia management but in most children, it will be less than if myopia management hadn’t been started.

Relate to the parents’ own progression if myopic

Relate that to the parents’ own experience of when they were a child having stronger and stronger glasses ever year. Back then, we could do nothing to slow the progression, but now we can. We can get a better outcome than the parent had. And, if the child is already as myopic as the parent then no parent wants their child to be worse off than they are.

The main aim

Aiming to have about half the myopia with myopia management as without.

Protect unaided vision

If myopia management is started early (6-years old) there is a short-term benefit of protecting unaided vision which means that some activities such as sports could be performed without spectacles or contact lenses.

Increase options for later laser surgery

Laser surgery, later on, remains an option and the lower the myopia at the time of the surgery the more straightforward the surgery. It is safer and the more the outcome is more predictable. This is a short-term goal that some parents relate to, especially if they have had refractive laser surgery

Maintain long term eye health

The aim is to keep the myopia at a level that is more likely to protect the eye from visual impairment beyond the age of 50.

Healthy eyes in the long term

Reducing the final amount of myopia will help prevent visual impairment after the age of 50.

Have this conversation with the parents of children who are pre-myopic or who are low myopes in the age range of 6 to 11 years old. Some parents will accept myopia management others won’t. The important thing is to give parents an informed choice and to make a note in the child’s clinical records that you have done so.