Communicating with parents who reject myopia correction

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.

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.

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.

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.

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.

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.

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.

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.

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.

• Keys to Communication in Myopia Management

• Screen time guidelines for children - resources for eye care practitioners

• Contact lenses for kids - paediatric, parent and practitioner psychology