Why is myopia management not always embraced by optometrists and parents?

When your child is ill, you want a course of treatment to make them better. It doesn’t matter if they have a broken leg or a runny nose; whatever the problem, as parents, you look for a swift and sure plan to bring them back to full health.

But what if your child has been diagnosed with myopia? It can be hard to accept that myopia is, almost always, a lifelong condition; where corrective glasses or contact lenses may well be a fixture for the rest of your child’s life.

However, just because there is no magic fix, that doesn’t mean that there is nothing you can do. From corrective lenses to lifestyle changes, parents have several options that they can deploy in order to slow down the rate of myopic change. We cover these in more depth in other articles on this site. But in this article, we thought we’d look at treatment from the other side, attempting to identify why some myopia management plans don’t deliver the expected outcomes.

Let’s start with: expectation. When your child has myopia, it is only natural that you will speak with other parents, with teachers, and with eye specialists in order to find out as much as you can about the condition. However, unless you approach these conversations with an open mind, it can be all too easy to develop a fixed expectation of how your child’s myopia will respond to certain treatments. But every child is different, and the combination of factors that may have led to myopia will be individual to them.

So, what you may see as the failure of treatment may, in fact, not be the case. It could well be that without treatment, your child’s myopia might have progressed far beyond that seen with treatment. False expectations can lead to treatment plans being halted or not being appropriately followed, which will most likely lead to a worsening of the condition. One 2019 study [1] also raised the possibility of a rebound occurring if specific treatment plans are stopped suddenly.

False expectations can also lead to scepticism. Remember, myopia is a long-term condition, and remedial treatment needs to be undertaken over the long term. In addition, different individuals will respond better to different treatment regimes. Stopping treatment too soon because expectations have not been met can lead to a feeling of scepticism, a belief that because one option has had little success, nothing will help. Nevertheless, for the sake of the long– term visual health of the individual, doing nothing is not an option, with studies having shown that this can lead to increased levels of eye damage over the long term.

And when talking about scepticism, it is also worth commenting that some optometrists or ophthalmologists are not always as proactive as they might be in raising the subject of myopia management. So much so that a 2019 survey [2]revealed that two-thirds of optometrists who didn’t offer myopia care commented that there was not enough patient demand, whilst 25% said myopia management was too time-consuming. Whilst that study may be specific (or not) to the USA, where it was conducted, parents in the UK and other countries may need to be prepared to open the discussion and actively work towards a viable treatment plan, or find a more suitable myopia specialist.

Parents themselves also need to be proactive in arranging for regular eye examinations. The sooner that myopia is diagnosed, the sooner that treatment can start. However, one study revealed that parents saw eye examinations as a lower priority than visits to the dentist or other health professionals, with nearly 88% of respondents wrongly believing that “comprehensive eye exams for children are not needed until school age.”[3]

We also must be honest and acknowledge that cost can be a factor. When a child’s eye is developing rapidly, there may well be a need for regular changes of prescription. Some of the cost of fitting is covered by us, but the eye-care voucher won’t cover the total cost of specialist myopia control lenses. Where cost is a major consideration, parents should have an open discussion with their eye care specialist to work out the optimum treatment plan available which meets their financial circumstances.

Whatever plan is chosen, the next point of failure comes when treatment plans are not followed properly. Ensuring that glasses or corrective lenses are worn at all times or as agreed in the plan is essential in order to provide the best possible outcome. Any agreed lifestyle changes such as spending more time outdoors or cutting down on screen time are also vital in optimising results. So, treatment plans must be seen as an integral part of everyday life, not as something which can be picked up and put down as circumstances allow.