Myopia Profile


Communicating with parents who reject myopia correction

Posted on February 18th 2021 by Connie Gan

While almost all of the information on is dedicated to myopia control and management, what happens when you can't even convince parents to accept myopia correction for their child? This is especially concerning as even a full strength single vision correction is better than under-correction or un-correction for myopic children.1

Communicating with parents about myopia management starts with firstly explaining myopia correction and typical childhood myopia progression. You can read more about this in Keys To Communication In Myopia Management.

But what do you do when you can't even get past the first hurdle, of understanding and accepting myopia correction? This is not an uncommon problem - common misconceptions amongst the public about wearing glasses are that they make eyes weaker, damage them or that they are only for older people.2

Even amongst eye care practitioners (ECPs), more than 20% globally still believe under-correction is a reasonable myopia management strategy, with almost 40% of surveyed South American ECPs utilizing under-correction sometimes or always as a strategy for attenuating myopia progression. This reduced to around 20% in Asia and Europe, less than 10% in North America and less than 5% in Australasia.3

Here is such a case shared by BSL on the Myopia Profile Facebook group, involving a parent refusing the advice that her child needs to wear glasses despite visually disabling uncorrected myopia.

BSL Anyone encountered this before. What will you do? Hard to convince px's new migrant parents regarding the need for glasses because it is not what they are used to. Px 10 yo F. presented with mom. complaining of blur vision onset 2 years. first eye exam. seeing a kinesiologist whom advised them massages to improve vision. Dry Rx R -3.25 -0.50 x 15 6/5 L -3.25 -0.50 x 169 6/5 Near phoria 8exoP with dry rx, +1.25lag with dry rx. Advised glasses. advised lack of evidence of alternate therapies. advised to return for cycloplegic refraction. Mom declined. Only willing to bring child back for cyclo in school holidays (still weeks away). Declined report to GP.BSL Not accepting anything but kinesiology

This experience can be frustrating - the community had a few ideas on communication tips to apply to cases such as these where our professional opinion is not readily heeded.

Tips on how to communicate with parents

1. Make sure they understand your language

NL How good is their English? Did they fully understand you? Could they bring a trusted family friend with them next time. Do they just need some time to think it over? Are there cultural issues that need some consideration? Have patience and keep chipping away. They are probably scared.

It is important to remember that two people may not understand the same language in the same way, especially if the language being spoken is not the native language of one or both of the parties involved.

Make sure that the parent can understand the language that you speak. Using simple terms, images and analogies may help simplify technical concepts and complex scientific jargon. Pictures have been shown to improve health literacy, and can be especially helpful if used in substitute of lengthy text or verbal discussions - read more in Keys to Communication in Myopia Management.

2. Show the parents what their child's uncorrected vision is like

CC It’s hard to comprehend that they have declined your advise as you are addressing the presenting symptoms. Did you consider demonstrating to parent what 3.25 blur would look like ? ( and then step out of the consulting room - walk with them outside and ask them to see what it would look like to attempt to cross a busy road ) .NB I blur the parent in a trial frame. This is what your child can see. This changes how they learn and how they live… PP The “SHOWING,” the parent how the child is seeing helps, many times, to get parental change, I find, also.

Demonstrating the child's level of uncorrected vision to the parents can be a powerful way to show them their child's lived experience. One can simulate myopia by using plus lenses in a trial frame. Of course this only works perfectly on an emmetropic or fully corrected parent, but even if you can't be sure of the parent's vision levels it provides a useful guide.

3. Understanding the parent's thought process and reasoning

SJ I try to understand what the parent's priorities are and see if I can align with them. I tell them, that as an eye doctor, my first priority is to make sure that the child can see what they need to see. If they at student, I need to make sure they are optimized for learning in school. If they cannot see the board, they cannot learn. Usually this is good enough, but I continue on. The second priority is to slow down the prescription if possible. I go over what makes myopia. Not wearing glasses does not slow down, but in fact increases growth of myopia, contrary to what we suspected "20 years ago" (or however many years ago that the parents were children). If we want to slow down, we will use proven modern methods, not avoid wearing glasses.MR If it’s a question of the parent just wanting to avoid correction show them the Brien Holden myopia calculator - it will demonstrate to the mum the long term effect on “ no correction”. Might change her mindRC The sooner that this field gets its vetted evidence together and into the hands of a broad group of health practitioners, the better. When I practiced in the early 1980s in Northern California's commune district I encountered many hopeful misinformed partner. Just like the anti-vaxxers, we need to understand why they are resisting the recommendation of their more main stream practitioners in order to figure out how to get through to them. They do want the best for their kids, but due to mistrust or ignorance, may make a wrong choice.

Parents generally want the best for the children. So, when you are faced with a parent who does not take your recommendation for what is best for their child, it is important to ask why.

While it is difficult to understand all factors which influence a parent’s decision to reject your recommendations, it is important to listen to them and understand how they want to help their own children. Experts show that non-confrontational and participatory discussion with parents can improve compliance.4

The most common source of misinformation is the internet. To the untrained eye, unverified information can be quite convincing.5 Speaking to these common misconceptions and asking what their understanding is of myopia, and vision correction, can help to appropriately address misinformation with facts.

4. Show them the evidence on under-correction

NB Do they not understand that myopia is progressive? Usually I discuss the Chung study (see reference Chung et al) in layman’s terms and get somewhere. Or are we still in “wearing glasses makes eyes worse?”

For the more science-inclined parent, sharing the evidence may help to back up your recommendations, by demonstrating an external source confirming your information. In this case, one commenter suggested showing the parent Chung et al's 2002 study which demonstrated that undercorrection of myopia hastens rather than slows down myopia progression.6 A recent systematic review on under- and un-correction of myopia is also available as open access,1 meaning eye care practitioners and parents alike can access the full text.

5. Inform them of the consequences of inaction

HB let me draw a long but true bow. -3.00 is uncorrected worst than 6/60. So parents inflicting legal blindness on a 10 yo child. If uncorrectable that would qualify for a blind pension. I won’t say child abuse but seriously the poor child has rights too. Very sad. I wish you all the best dealing with this one.PC Drawing the bow further, what if the child, with her uncorrected vision, was to suffer an injury through her avoidable vision disability (eg. misjudging distance while crossing the road) because of her parents' failure to provide her visual needs. I'd say that's negligence.PB At what stage does child protection kick in? Mum is preventing you as a health care professional from trying to avoid what could lead to sight threatening issues in later life. Maybe an extreme view, but still one I hold.NB It could also be argued that the child is unable to adequately receive education with that level of uncorrected myopia - in which case neglect and mandatory reporting apply. If the child did not attend the subsequent appointment or remained uncorrected and met the definition of legally blind (less than 6/60 uncorrected), seriously consider if reporting is appropriate. Neglect is tricky, and medical neglect is harder, because it’s more often low level high frequency (whereas the reverse is more obviously neglect), but this would qualify (in my opinion) and may help them get education on appropriate medical care.BSL It's hard to argue this because optometry is healthcare + retail. We may get copped for trying to hard sell something even by the department of child protection?NB Perhaps, if it was borderline, or debatable, or the prescription wasn’t freely available. If mum asked for the prescription and bought the glasses online, wouldn’t apply. But this is not that, and for the same reason that we’re all horrified, I’m also concerned that you may be required to call as a mandatory reporter, if they don’t attend follow ups and have no intention of getting glasses. Would calling do anything? Maybe not. I’d at least phone the association and ask their opinion.AP This is considered neglect here in the US. We call the school and report the parents. The kid is blind without glasses.RLS They are depriving the child of educational and social development which in my view constitutes neglect.

Firstly we must try collaborative and non-confrontational discussion approaches with parents to attempt to gain compliance.4

However if the parents still resist your advice, it is important to make the consequences of inaction clear. The commenters explored the gravity of the situation when a parent refuses to provide optical correction to their moderately myopic child who is effectively legally blind without it. Does it constitute neglect? This is a complex question, which will vary depending on the country in which you practice. One commenter suggested contacting the professional association in the original poster's country for advice.

In this case, the parent strongly believes in a solution to their child's myopia which is not evidence based, and puts the child at an enormous functional disadvantage. As myopia is irreversible and typically progressive in children, the importance of appropriate intervention - in this case just simple myopia correction - cannot be understated.

6. Sharing the decision-making with the child

While parental understanding and family situation is important to consider, the primary concern of the eye care professional in this situation is the best interests of the child. The child in this case is aged 10, so likely old enough to understand their condition and the benefits of simple spectacle correction, which carry minimal-to-no risk. It is good practice to talk directly to the child and clarify their understanding of their condition and its solution. In older children where decision-making capacity is more certain, this step would likely come much sooner in addressing a parent resisting myopia correction.

There is no universal agreement as to what age minors are deemed competent to make their own health decisions. Children of the same age may show different levels of maturity. Generally children around adolescence (age 12) are deemed 'decision-making competent', but this can vary in context.7 Read more about the general principles of this in the scientific paper Treatment decisions regarding infants, children and adolescents.

Take home messages:

  1. When there is a perception and communication gap between a parent and  the eye care practitioner on the basics of myopia correction, a variety of social and language factors can be at play. Firstly try to simplify your language, use images and analogies, and ask questions to address the knowledge barriers.
  2. Moving into demonstrating the child's vision impairment without correction, and explaining the functional consequences for learning and mobility, is the next logical step. Beyond this, the seriousness of uncorrected myopia must be explained and action implored to the resistant parent.
  3. Before we even get to myopia control, we must ensure parents are willing to accept myopia correction for their child. While the pursuit of best-practice myopia management typically means prescribing a correction which is not single vision, a fully corrected single vision pair of spectacles is a far better choice than under- or uncorrected myopia.

Read more on 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 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 Kimberley also manages our Myopia Profile and My Kids Vision Instagram and My Kids Vision Facebook platforms.

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