Myopia Profile

Clinical

Communicating with parents who insist on undercorrection

Posted on November 21st 2021 by Connie Gan

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In this article:

87% of parents are unaware of the importance of myopia intervention. What can we do when parents insist on undercorrecting their child's myopia?

What are parents' perceptions toward myopia? McCrann et al1 surveyed 329 parents and found that 46% of parents considered that myopia presented a health risk to their children, while an equal proportion (46%) regarded it instead as only an optical inconvenience. Those who considered myopia a health risk were more likely to limit their child's screen time. Some considered myopia as an expense (31%), a cosmetic inconvenience (14%) and even a sign of intelligence (4%). Unfortunately, only 14% of parents expressed concern if their child were to be diagnosed with myopia.1 LC shared a case with the Myopia Profile Facebook community where it was a struggle to get the child's father on board with myopia management.

LC Please advise. Young boy from China I first examined at age 12 a couple of yrs ago so now 14. On initial presentation was -1.75 OU recommended 6 month review thinking Ortho K best if progression but he ignored reminder then saw a colleague at his annual review and was -2.75. Argument ensued with his Dad who wanted undercorrection. He's first off the rank this morning and I expect to find -4.50! Father will want undercorrection. Last two times has taken his script so we have no input with the glasses once he leaves. I would prob want Ortho K for him but what is the worst damage the interfering father can cause with that?LAC … After first examination Father took copy Rx to decide himself whether child needed it.LAC The Dad is actually a nice person but totally unable to hand over control and thinks he is acting for the best… he has run all over town sampling Optometrists and getting similar opinions still hasn't clicked…

What can we do?

Show the parent scientific evidence

KG Firstly, show Dad this! Undercorrection was debunked back in 2002! Unfortunately its still practiced commonly in Asia, as evidenced in Wolffsohn's 2016 paper on global strategies and attitudes to Myopia management.

There are numerous studies that indicate undercorrection enhances myopic progression.2-4 In addition, the research shows a correlation between magnitude of under correction and myopia progression.4 Namely, the greater the amount of undercorrection, the faster the myopia progression. Showing the parent evidence contrary to their assumptions may help open the conversation for a more evidence-based approach to manage their child's myopia.

Inform the parent of possible consequences

KG Talk to Dad about the pathology risks with increasing myopia

As the degree of myopia goes up, the risk of future ocular disease also increases. Explain to the parent that every dioptre of myopia increases the risk of myopic maculopathy by 67%5 Williams & Hammond state that "It is important to make patients aware of these potentially sight-threatening conditions and that their risk appears to be proportionate their degree of myopia."6

Explain the visual impact of undercorrection

LC I spent significant time at first visit explaining the need for full correction... but he went elsewhere to get a lower Rx. The kid is now falling behind at school and perpetually squinting. I explained his vision is a danger to his personal safety crossing roads - Dad won't get stronger lenses

A child who is undercorrected to 6/12 or 20/40 or worse meets the World Health Organization classification for vision impairment. Using these words can be helpful for parents to understand the functional impairments of undercorrection. The distance blur experienced by their child can also be demonstrated with plus powered trial lenses.

Unfortunately, undercorrection is still commonly practiced amongst eye care practitioners (ECPs), with a 2019 survey showing that more than 20% globally still believing that undercorrection is a reasonable myopia management strategy. This was most common in South American ECPs and least common in Australasian ECPs.7

Involve the child in decision making

KG ...And I'd talk to the child about CLs. Get them on board as even if you're not successful today, at least you've planted the seed for the child to talk to his parent, now or in future.

At 14 years old, it is possible to involve the patient in the discussion pertaining to managing his myopia as he should be mature enough understand information on myopia control. Whilst children of the same age may show different levels of maturity, typically children around adolescence (age 12) are deemed 'decision-making competent'.8 The hope is that the child might express his desire to have clear vision, and even to undertake a myopia management strategy, which may help to change the parent's mind on the pursuit of undercorrection.

Understanding the parents' point of view

Attempting to understand the parent's point of view regarding myopia correction and management can help us tailor the clinical message. Research has shown that positive-framing of health messages has been shown to be most beneficial for engagement in preventative treatments and behaviours, and this preference appears to increase with age.9

In practice, this means that explaining the benefits to the child of full vision correction can be positively framed both as improved daily function and quality of life, as well as reducing progression compared to undercorrection. This is the first step in gaining consensus before then moving into discussion about more proactive myopia management.

Parental attitudes and behaviors toward children's vision care habits can influence myopia risk in school-aged children.10 Many parents are still unaware of the complications of myopia (88%) and availability of myopia interventions (87%). On a positive note, two-thirds of parents express interest in myopia management options for their children after viewing educational materials.11

Take home messages:

  • There are numerous approaches to take to explain the need for full myopia correction in their child - explaining both the consequences of needless vision impairment and impact on myopia progression is important. Consider, though, that framing the message in terms of the positive choice and its benefits can be more effective than speaking only of the negative choice and its impact.
  • Providing parents scientific evidence and additional learning resources can support their journey to understanding. Resources for parents and communication approaches are further detailed in Keys To Communication In Myopia Management.

Meet the Authors:

About Connie Gan

Connie is a clinical optometrist from Kedah, Malaysia, who provides comprehensive vision care for children and runs the myopia management service in her clinical practice.

Read Connie's work in many of the case studies published on MyopiaProfile.com. Connie also manages our Myopia Profile and My Kids Vision Instagram and My Kids Vision Facebook platforms.

About Kimberley Ngu

Kimberley is a clinical optometrist from Perth, Australia, with experience in patient education programs, having practiced in both Australia and Singapore.

Read Kimberley's work in many of the case studies published on MyopiaProfile.com. Kimberley also manages our Myopia Profile and My Kids Vision Instagram and My Kids Vision Facebook platforms.


This content is brought to you thanks to unrestricted educational grant from

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