Communicating with parents who reject myopia correction

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While almost all of the information on MyopiaProfile.com 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.

1st clinical communication

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

2nd clinical communication

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

3rd clinical communication

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

4th clinical communication

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

5th clinical communication

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

6th clinical communication

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.
Kimberley 120x120

About Kimberley

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

Connie headshot 120x120

About Connie

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

References:

  1. Logan NS, Wolffsohn JS. Role of un-correction, under-correction and over-correction of myopia as a strategy for slowing myopic progression. Clin Exp Optom. 2020 Mar;103(2):133-137. (link)
  2. Alrasheed SH, Naidoo KS, Clarke-Farr PC. Attitudes and perceptions of Sudanese high-school students and their parents towards spectacle wear. African Vision and Eye Health. 2018 Feb 26;77(1):1-7. (link)
  3. Wolffsohn JS, Calossi A, Cho P, Gifford K, Jones L, Jones D et al. Global trends in myopia management attitudes and strategies in clinical practice - 2019 Update. Cont Lens Anterior Eye. 2020 Feb;43(1):9-17. (link)
  4. Connors JT, Slotwinski KL, Hodges EA. Provider-parent communication when discussing vaccines: a systematic review. Journal of Pediatric Nursing. 2017 Mar 1;33:10-5. (link)
  5. Chiò A, Montuschi A, Cammarosano S, De Mercanti S, Cavallo E, Ilardi A, Ghiglione P, Mutani R, Calvo A. ALS patients and caregivers communication preferences and information seeking behaviour. European Journal of Neurology. 2008 Jan;15(1):55-60. (link)
  6. Chung K, Mohidin N, O’Leary DJ. Undercorrection of myopia enhances rather than inhibits myopia progression. Vision Research. 2002 Oct 1;42(22):2555-9. (link)
  7. Grootens-Wiegers P, Hein IM, van den Broek JM, de Vries MC. Medical decision-making in children and adolescents: developmental and neuroscientific aspects. BMC Pediatr. 2017 May 8;17(1):120. (link)