February 1, 2022
By Dwight Akerman, OD, MBA, FAAO, FBCLA, FIACLE
Compliance with medical recommendations has been recognized to represent a complex challenge since its first mention by Hippocrates about 2,400 years ago (Haynes et al., 1979). The treatment of chronic illnesses commonly includes the long-term use of pharmacotherapy. Although these medications effectively combat disease, their full benefits are often not realized because approximately 50% of patients do not take their medications as prescribed (Viswanathan et al., 2012).
What does compliance have to do with myopia management? When a myopic child demonstrates a poor or less than optimal outcome with treatment, e.g., orthokeratology, topical low-dose atropine, dual-focus/multifocal soft contact lenses, next-generation spectacle lenses, etc., the child’s eye care professional must determine if they are a non-responder, non-compliant, or both.
Before making changes to the therapy device or pharmaceutical regimen, I recommend first assessing the child’s level of adherence to the prescribed treatment. Patient compliance can be complete, partial, erratic, nil, or over-compliant.
Poor patient-provider communication and education have been identified as the primary source of treatment non-compliance. Exceptional and continual patient/parental education regarding the purpose of myopia treatment and outcome expectations is imperative to motivate children to follow the eye care professional’s recommendations appropriately. Frequent touch points allow the eye care professional to re-educate the child and parents on the importance of adhering to the prescribed treatment regimen.
Specific recommendations to improve a child’s adherence to the prescribed myopia control treatment regimen include:
- Frequency: Monitor a myopic child’s progress frequently. For example, a child prescribed dual-focus daily disposable soft contact lenses should be evaluated at one week, one month, six months, and every six months after that (IMI Clinical Management Guidelines, 2019). Other therapeutic regimens may have more frequent evaluation schedules.
- Assessment: At each follow-up visit, compliance should be assessed, and the child should be re-educated about the importance of adhering to the prescribed wearing schedule. They must understand why complying with the prescribed wearing schedule/eye drop regimen is critical.
- Education: Online educational videos should be provided to the child and parents for access 24/7.
- Treatment:
- Soft contact lenses: Ensure that the myopic child agrees to wear their daily wear myopia control soft contact lenses for a minimum of 12 hours per day, at least six days per week (preferably seven days per week), for the duration of treatment.
- OrthoK: Ensure that the myopic child agrees to wear their overnight OrthoK lenses a minimum of six days per week (preferably seven days per week) for the duration of treatment.
- Drop Frequency: Ensure that the myopic child agrees to instill one drop of topical low-dose atropine in each eye a minimum of six days per week (preferably seven days per week) for the duration of treatment.
- Spectacles: Ensure that the myopic child agrees to wear their next-generation spectacle lenses/eyeglasses (not yet available in the U.S.) a minimum of 12 hours per day, seven days per week (may change if combined with myopia control soft contact lenses or topical low-dose atropine).
- Alignment: Ask the child and parent to sign a “Success Agreement,” which, at a minimum, broadly outlines treatment goals, wearing time/drop frequency, planned evaluation schedule, and what to do in the event of an adverse event. Reinforce this alignment document at each evaluation visit.
For more information on this critical topic, please read The Importance of Patient Compliance by Professor Padmaja Sankaridurg.
Best professional regards,
Dwight H. Akerman, OD, MBA, FAAO, FBCLA, FIACLE
Chief Medical Editor
dwight.akerman@gmail.com
