Why ‘wait and see’ fails in myopia management

Families who take a ‘wait and see’ approach to myopia risk delaying effective treatment and missing the chance to protect vision. 

Arguably the most impactful timeframe to commence myopia management is after identifying pre-myopia. Delaying myopia has a powerful implications, by reducing an individual’s final level of myopia1 and significantly reducing their lifelong risk of myopia-related eye disease.2 

Younger myopes are particularly vulnerable to the consequences of delayed action, as the younger a child becomes myopic, the faster they will progress. 

The average 8-year-old child will typically progress by about 1D per year if untreated (i.e. wearing only single vision lenses), compared to half this amount for a 12-year-old.3 If left untreated for one year, an 8-year-old child with -1.00D myopia will be expected to go from reasonable unaided vision, to definite glasses dependence as a 9-year-old with -2.00D myopia.

Although the case for myopia control is clear, parental attitudes are typically nonchalant towards myopia. Studies show approximately 1 in every 2 parents regard myopia as an optical inconvenience (46%) and even fewer (14%) expressed their concern about their child being diagnosed with myopia.4 In short, parents have a limited understanding of myopia and its long-term risks for eye disease and vision loss. 

A compelling way to explain myopia management to parents is by leading with the short-term benefits first.

Immediate rewards tend to be more tangible and achievable compared to delayed rewards, and promote persistence towards long-term goals.5 Once parents appreciate the short-term impact of myopia control, the long-term value can then be introduced. 

An immediate benefit of myopia management is preservation of visual acuity and vision-related quality of life.6 

Children with lower myopia have better uncorrected visual acuity than those with higher myopia. A -1.00D myope may navigate their way in and around school uncorrected, unlike a -5.00D myope. Even when corrected, higher levels of refractive error produce greater visual disability and dependence regardless of mode of correction.2

Myopia management reduces the frequency of prescription updates – leading to less frequent lens replacements and compounding cost savings over time. Children experience more stable vision and reduced symptomatic blur between eye examinations. Concurrently, children are less likely to be undercorrected between visits, which can increase the rate of myopia progression.7

Highlight the protective effects of myopia management for eye health, as current evidence suggests that there is no safe threshold level of myopia in terms of health risk.8

Early intervention reduces the final degree of myopia and associated axial length, and subsequently lowers the lifelong risk of vision-threatening pathology and visual impairment.9 Highlighting conditions such as cataract, retinal detachment, and myopic macular degeneration (especially if present in family members) – can make long-term health benefits of myopia control seem more tangible for parents.

Long-term benefits also include preserving more treatment options for future vision correction. Lower myopia expands suitability for refractive surgery and can be helpful for uncorrected near vision, especially as a presbyopic adult in the future. 

While children might not be able to relate, these downstream benefits may resonate with parents, who may also be myopes themselves.

1. Early myopia control provides immediate benefits such as clearer vision between exams, improved comfort for reading, and better performance in school and sports.
2. Slowing myopia progression in childhood lowers the lifetime risk of vision-threatening conditions including myopic maculopathy and retinal detachment.
3. Leading with short-term, practical benefits is an effective way to engage hesitant parents and encourage timely treatment uptake.