You’ve completed your comprehensive myopia eye exam and carefully determined the prescription. Now for the challenging part - communication between patients, parents and practitioner. It’s important for parents understand the risks of myopia to encourage them into action, but not to leave them with overwhelming anxiety about their child’s vision and eye health. While most people understand that spectacles improve vision and are open to simple myopia correction, you might be the first person to introduce the concept of myopia control. So where do you start with communication in myopia management?
Explaining myopia with infographics
Using pictures in health communications has been shown to improve patient attention, recall and comprehension of information and adherence to treatment.
A review of the role of pictures in improving health communication showed that "pictures closely linked to written or spoken text can, when compared to text alone, markedly increase attention to and recall of health education information. Pictures can also improve comprehension when they show relationships among ideas or when they show spatial relationships."1
The Managing Myopia Guidelines Infographics and Parent Brochures, freely available for download, are designed to guide you through the process of explaining myopia control using simple messaging and pictures. Firstly, you'll need to explain the difference between myopia correction and control, and then pick up your Infographic to discuss the key messages in myopia management.
The difference between myopia correction and myopia control
Explaining the vision correction aspect of myopia is the simplest part. If parents would like a visual representation of their child’s vision, CooperVision have created the Vison Simulator, which steps through examples of blur as the myopia increases. This is potentially the easiest way to explain why it is important to prevent further growth - more blur, more impact on unaided vision, thicker and heavier glasses.
Consider using plus lenses to simulate myopia for emmetropic parents, so they can understand the impact of blur as myopia increases.
Moving from myopia correction to myopia control, the simplest short-term way to explain the 'why' is that a child undergoing myopia control will have a more stable prescription, and so suffer less time with blurry vision in between eye exams.
A child aged 7-8 years wearing single vision glasses will progress around 1D per year.2 If they go a year between eye exams, this means their vision will likely worsen from clear vision with new glasses, to vision impairment (around 6/12 or 20/40) within a year. If this same child is undergoing myopia control, they may take one-and-a-half or two years to undergo this same vision change.
If a parent now understands the immediate functional benefit of myopia control, you can take them through understanding visual environment and the options, and follow up with the long-term reasons as a conclusion. The Managing Myopia Guidelines Infographics and Parent Brochures, freely available for download, are designed to guide you through this process. Here's where to start:
"Now I'm going to explain a little more about childhood myopia to you, so we can determine the best way to manage your child's vision and eye health."
1. The childhood visual environment
As the family's eyecare expert, it isn’t surprising that parents can turn to you for advice on reducing or restricting children’s screen time. This information on visual environment is important for all of your paediatric patients, not just those at-risk or with myopia, as too much screen time has been associated with dry eye disease, acquired esotropia and even reduced physical fitness and childhood obesity. When parents simply monitor their children’s screen time, research has found overall time spent on devices reduces and both sleep and school performance improves. Read more about this in Is screen time to blame for the myopia epidemic?
The Australian Department of Health and the American Academy of Paediatrics recommend less than two hours per day of leisure screen time for school-aged children. For more information and communication tips specifically on screen time, read Screen Time Guidelines for Children - Resources for Eye Care Practitioners.
There are four key messages about the childhood visual environment in the first panel of the Managing Myopia Guidelines Infographic. These provide advice on outdoor time, and nearwork / screen time - the 20/20 rule, the Elbow Rule and the Two Hour Rule for leisure screen time. These are also reiterated in the take-home Parent Brochure, which you can also freely download for printing.
2. Myopia control options
This is potentially the most overwhelming conversation for parents because there are lots of different options, sometimes involving brand new concepts for parents like contact lenses for kids or continuous use of eye drops with atropine.
The second panel of the Managing Myopia Guidelines Infographic helps you describe spectacle, contact lens and atropine options in terms of their short-term efficacy. It's important to note here that the use of percentages to describe treatment efficacy is currently a source of scientific debate and review - here they are used as categories and as a communication tool.
Percentages are a reasonable, evidence-based description of efficacy when we understand that they only apply over the 1-3 years of most myopia control studies. We can't promise a percentage reduction in progression over any longer time period than that.
Using percentage efficacy as categories
The myopia control treatments are grouped into percentage categories based on comparison of available research. The two key categories are '50%' and '33%'. Parents easily understand what 50% means ("it will slow progression by about half") and 33% ("will slow progression by about a third") and these percentages also clearly communicate that there is no myopia control strategy which can halt progression by providing 100% efficacy. The bicycles are designed to show that once a child becomes myopic, we can't stop the bicycle pedalling away but we can slow it down. The more effective myopia control strategies see the bicycling-children having stronger helmets for better protection. The poor little single-vision corrected bicycling child has no helmet at all, as he careens towards high myopia!
These categories are based on current research and hence subject to change as more products and comparative research are made available. This is already the fourth version of the infographics that we've created, to stay up to date! Your download also includes a version which doesn't include atropine, if it isn't available in your region or scope of practice.
Discuss options and seek feedback
Involving parents in the decision making is essential to achieving informed consent, and ensuring that you are recommending a treatment strategy that works for the family. For example, a child living with two separated parents may not be suitable for orthokeratology unless both parents are willing and committed - daily disposable soft contact lenses might be better. A child intimidated or a parent squeamish about eye drops may not be suitable for atropine or contact lens options.
3. Are you recommending contact lenses?
The third panel in the parent-facing communication side of the the Managing Myopia Guidelines Infographic explains the benefits and safety of contact lenses in children. These are designed to counter typical barriers to contact lens wear for children by explaining the confidence and functional benefits, safety in younger children and ability of kids to handle contact lenses. The 'risk of eye infection' (microbial keratitis) is described at the bottom of the panel to allay parental concerns. Read more about how to communicate this in Contact Lens Safety in Kids.
This information is reiterated in the Parent Brochures so that your message is carried into the home environment for further discussion when that's needed.
4. Why myopia management is important
By now you've explained several aspects of myopia to educate the parent and the young patient - given visual environment advice, discussed treatment options and perhaps recommended contact lenses.
Now that the parent understands the immediate functional benefit of myopia control for their children - less time spent with blurred vision between eye exams - you can affirm why this is a good choice by explaining the long-term reasons for myopia control. This can also provide additional justification if your recommended myopia control strategy is more of a barrier to overcome than spectacles - for example, contact lenses or atropine.
We intentionally put this panel last for parental discussion, to ensure you can get the positive messages across first. It's important for parents to understand the scope of the myopia problem but also that simple solutions are within their grasp. 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.3
The Managing Myopia Guidelines Infographic supports your communication on the long-term risks of myopia as well as the benefits - only 1D less of final myopia decreases the lifetime risk of myopic maculopathy by 40%.
Clinical communication tools to help you
- The Managing Myopia Guidelines Infographics described here are downloadable for free from the Myopia Profile Clinical Resources Page. This includes the Clinical practice infographics, which are used by you for communication and reference, and the patient brochure and customizable insert which parents can take home. These are available in eight languages and offer three versions with each language download to account for printing sizes and utilization (or not) of atropine.
- Direct your patients to My Kids Vision. It is designed to support your clinical communication as it is often helpful for parents to hear a reiteration of what you have explained from a second, independent source.
- The My Kids Vision How-to Video Guides are each readily sharable to your website and social media platforms, and include a specific video explaining the Managing Myopia Guidelines Infographic to support your messaging - this is especially helpful if a parent or guardian attending the eye exam wishes to explain the brochure to another parent or guardian who didn't attend and hear your explanation.
- The free-to-download Informed Consent form for myopia management provides you an easily editable MS Word document, which you can customize to your requirements and then print yourself. It covers general information on myopia and then the benefits and safety of treatments, all with scientific references.
Further reading on communication in myopia management
- Houts PS, Doak CC, Doak LG, Loscalzo MJ. The role of pictures in improving health communication: A review of research on attention, comprehension, recall, and adherence. Patient Education and Counseling. 2006;61:173-90. (link)
- Donovan L, Sankaridurg P, Ho A, Naduvilath T, Smith EL 3rd, Holden BA. Myopia progression rates in urban children wearing single-vision spectacles. Optom Vis Sci. 2012;89:27-32. (link)
- Shamaskin AM, Mikels JA, Reed AE. Getting the message across: age differences in the positive and negative framing of health care messages. Psychol Aging. 2010;25:746-51. (link)