July 1, 2025
By Kevin Chan, OD, MS, FAAO, IACMM
One of the biggest challenges in the realm of myopia management is not simply about determining which child is a good candidate, or which intervention yields the best treatment outcomes. Despite the wealth of knowledge present or available in clinical research, practitioners often feel they are either not ready, or sometimes feel paralyzed, to channel the subject of myopia management with children and their families effectively. The cognitive obstacles or dissonance can hinder the success of providing time-sensitive interventions for children in need. Here are a few key recommendations to guide practitioners to make the conversations more natural and productive in the exam room.
Begin Education with ‘Suspicion’
Before initiating a conversation regarding myopia and treatment interventions with children and parents, it’s imperative for practitioners to avoid beginning with the mindset of “education first.” What does that mean? The problem is not about the availability of information. The availability of information online isn’t necessarily all considered useful or accurate. It can be tempting for parents, or even clinicians, to follow what are considered mainstream as “facts.” Indeed, this trend has often elicited the opposite impact, in which we are primed to believe and educate others what confirms or supports our own beliefs. This can result in what is known as “confirmation bias.”1
To overcome this cognitive trap, practitioners should be prepared with a critical mindset to help parents understand and debunk key misconceptions or stigmas about myopia, and what myopia management is NOT. This mindset of communication helps expand the perspectives of all parties and ignite curiosity by parents to ask relevant questions for their child.
Create a Supportive Environment
Children are more likely to open up about their concerns if they feel supported. I typically set aside designated time and space to talk with the child and their parents separately. Some children may actually not be too comfortable or candid sharing their genuine thoughts or feelings when parents are present. Try to create an environment where the child feels supported and unhindered by parental pressure or opinion. The key is to encourage them to share—in their own words, not words from parents—how they feel about their vision struggles. It can help minimize the stigma or embarrassment, and reassure them that myopia CAN be manageable for them.
Use Age-Appropriate Language
When discussing myopia with children, use language that is appropriate and specific for their age. Toddlers often need descriptions or explanations as simple as “your eyeballs are getting longer like an inflated balloon,” while adolescents and teenagers can handle, process and internalize detailed and complex information, like “misaligned focus” or “elongating axial length.” The same principle applies to parents who do not have myopia or vision problems, or those suffering from myopia at a young age and are eager to prevent it for their kids at all costs. Indeed, there is no single rehearsed script that could prepare you for all circumstances. It is important to tailor your conversation to each parent’s level of understanding to ensure that they grasp the importance of myopia management, as this can benefit their child’s lifelong eye health.
Invest the Mindset and Action into Daily Routines
When the subject of myopia and treatment plans are no longer “foreign,” but turned into a daily mindset and routine, it can become more normalized. It can be just as common as talking about blood pressure or cholesterol when you see your primary care provider. It is key to start the myopia conversation with children and parents as early as possible—at the first eye exam, or when they have extensive family history of myopia. Instill an ideation of assessing the “myopia health status” in every eye exam as part of the routine protocol. Encourage the importance of outdoor time and proper reading distance and habits. In essence, humans are generally accustomed to routines. Try to seize and embrace every opportunity to normalize the myopia conversation.
Maintain Good Balance in Content
Honesty and transparency are paramount when discussing myopia with children and parents. Uneven emphasis on either aspect can trigger confirmation and anchoring biases.2 While normalizing the facts and communicating the action plans are key, practitioners also need to maintain balance in their communication. Explain the irreversible consequences of untreated myopia, while also reinforcing the positive aspects of myopia management for better lifelong vision.
Establish Trust and Rapport
Finally, be patient and understanding. The process of starting an initial conversation about myopia, to prescribing (not recommending) a specific treatment plan, to tailoring each specific treatment plan for every child can take time—for practitioners, children and parents. It is indeed a journey, not a sprint. It is crucial to establish trust and rapport with the family as soon as they become your patients. A study showed that physicians, on average, interrupt patients after 11 seconds.3 The process involves a “triad” of support—actively listening to their concerns; explaining your clinical reasoning as a practitioner; and acknowledging and validating their feelings (and sometimes guilt). The sooner rapport and trust are established, the easier the cognitive acceptance of myopia management is for children and parents.
Initiating conversations about myopia management with children and parents can be intimidating at first, yet it does not have to be nerve-wrecking. To effectively manage myopia in a timely manner, we need to normalize the subject and treatment strategies with open communication and a supportive environment.
References
1 Kaanders P, Sepulveda P, Folke T, Ortoleva P, De Martino B. Humans actively sample evidence to support prior beliefs. Elife. 2022 Apr 11;11:e71768. doi: 10.7554/eLife.71768. Erratum in: Elife. 2022 Jun 28;11:e81228. doi: 10.7554/eLife.81228.
3 https://hbr.org/2017/10/making-time-to-really-listen-to-your-patients
