Communicating with parents who insist on undercorrection

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.

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.

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

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

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.

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

• 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.