April 15, 2019
By Daniel Press OD, FCOVD
You have read the concerns regarding myopia, in particular high myopia, you have the desire to help curb the trend and you understand the different options available. Now all you must do is put it into practice.
Miscommunication is often cited as the most common reason for lack of compliance in medical practice, and that concern is no different when attempting to start a child on a program for myopia management. The challenge in providing pediatric vision care is that effective communication must take place between three parties, the doctor, the child-patient and the parents/guardians. For that to occur, you will need the appropriate time to communicate your findings and recommendations and in a busy vision care practice that can be difficult to accomplish in the same visit as an annual eye examination.
I recommend scheduling a separate myopia visit, not solely to gather measurements used for treatment recommendations and monitoring but more importantly to have the time to address the questions and concerns that your patients and their parents/guardians have. This article will not cover concepts for the specialized myopia evaluation, but other resources are available for review. 1
An important point that I continually must remind myself is to make sure that I am addressing the child, with language that they can understand, and not just speaking with the parents/guardians. Having the child on board with the concern and treatment recommendations makes the follow-through much easier for all involved.
While there are still many questions yet to be answered regarding myopia development and progression, there is no shortage of information currently available. As evolutionary biologist, E.O. Wilson has said: “We are drowning in information, while starving for wisdom.” The most successful practices in myopia management can synthesize the onslaught of myopia research and communicate that to patients.
I have found the best way to communicate complicated topics in practice is by the use of analogy. When discussing myopia progression, a useful analogy popularized by Dr. Tom Aller is likening axial length growth to blowing up a balloon. An example of utilizing the analogy; “At some point, the expansion is too great for the structure, and it can result in breakage. Some balloons can withstand more pressure than others before breaking down, and we are trying to understand these differences in the human eye as it relates to myopia and axial length. Our goal is to do whatever we can to safely minimize the progression of your child’s eye growth.” As described in the book Shortcut by John Pollack, analogies can serve to obscure complexities and reveal simplicity. 2
I challenge you to think of more analogies that can effectively communicate the complexities of myopia management and share them!
- Press, DJ, Eiden, SB. “Myopia Management in Action” Review of Optometry 2018: Feb 15;78-83
- Pollack, John. Shortcut: How Analogies Reveal Connections, Spark Innovation, and Sell Our Greatest Ideas. New York: Avery, 2014
