May 6, 2019
By Sarah Galt, OD, FAAO
Review of Optometric Business May 2019
Pediatric patients don’t always wear the glasses the doctor prescribes, and it’s not just because they are children. Reasons for noncompliance can be complex and involve parents.
Following, I will show you how to improve compliance in this difficult population. Improved compliance benefits the patient’s developmental processes and quality of life, and improves practice success by creating satisfied patients and families who are more likely to return for care.
Non-Compliance is a Multifaceted Challenge
Reasons for non-compliance with glasses wearing typically involve parents, peers, spectacle fit, prescription or some combination of all of these.
Specific causes include lack of understanding by the parent and the patient on what the glasses are being prescribed to accomplish, i.e. will improve distance vision, will keep patient’s eyes from having to work too hard while in school, will alleviate the patient’s need to squint to see the board.
Poor fit can also be an issue. If the spectacles do not fit the patient and fall off, or are painful, they will be unable to wear them.
Peer pressure can also play a role in children not wearing their glasses. School-aged children go through phases in which spectacles are desirable or less desirable. These phases are tough to predict, and often have a lot to do with the spectacle-wear status of the “cool” kids in a class/grade–something entirely out of the doctor’s and parents’ control, but which adults should keep in mind as they are educating the child about the importance of wearing their glasses.
It is important to anticipate these reasons for noncompliance during your exam, and address them when spectacles are first prescribed to increase the likelihood of good spectacle-wear habits from the beginning. You must communicate to the parent why glasses were prescribed, how to wear them, and any potential complications you anticipate will arise with difficulty to adaptation, need for specific frame technologies, or other problems.
Get Parent’s Undivided Attention
The doctor should be enthusiastic when announcing the need for spectacle wear to the parent and patient. An emphasis should be made on the potential for improvement of visual and academic function.
This message must be conveyed to an attentive, un-distracted parent. It is important to include the patient in the conversation, but ultimately, the parent can heavily influence compliance and they must understand your instructions.
When you announce that glasses are the best vision correction option, it is important that the parent understands why glasses are prescribed, how they will help their child see better and what to anticipate when first trying the glasses. Reassure the parents that you only prescribe glasses when: (1) they are absolutely necessary and (2) they will improve the child’s quality of life.
Once you have finalized the prescription, these tips can help you increase compliance and maximize vision potential:
LET PARENT SEE WHAT CHILD SEES. Make a trial frame of the “opposite prescription” for the parent. This allows them to see for themselves that the child’s vision may be functional, but far from perfect.
TRY GAME AT DISPENSING. Suggest a game of Eye-Spy with patient and parent once new glasses are dispensed. Have the parent point out objects in the distance that, prior to correction, the child could not see (will vary with Rx type).
EMPHASIZE GLASSES ARE A MUST. Explain the importance of wearing glasses: there can be no negotiating. Glasses should be worn as directed by the doctor. Parents should understand that glasses wear can be as important as using a car seat in maintaining vision and eye health, and helping to prevent injuries from the child tripping over obstacles they didn’t see.
IMPART RESPONSIBILITY TO THE CHILD. Useful phrases for the doctor to say to pediatric patients during the exam include: “When they’re not on your face, put them in your case” and “There are only two times when you don’t have to wear your glasses. Can you guess? If you’re not in the shower and not in bed, where should your glasses be? On your head.”
FIND PATIENT’S MOTIVATION. If the glasses help improve binocular vision and stereopsis, this might be just what the athlete and athlete’s parents want to hear. The fear of not passing a driver’s license vision test, or not being a candidate for military service, can be a significant motivator for older patients. Find out your state’s vision requirements for driving and try to get your amblyopes to improve beyond that visual acuity at a young age. Otherwise, it may be difficult to develop good vision by the time they are old enough to drive.
WORK WITH SCHOOL. With the parents’ consent, we sometimes write a note to teachers, sometimes on the school excuse letter-form, saying that the patient does, or does not, need spectacle correction. Sometimes I include preferential seating requests, and that the child be allowed to use a “line reader,” or graph paper, for writing and math.
Reinforce at Dispensing
At dispense, a repetition of why the glasses were prescribed, how they impact the vision, and any adaptation period should be re-emphasized. Opticians should be trained to be positive and upbeat about the initial wear, as well as be able to adjust the spectacles for best success.
Reinforcing that spectacles should be put on first thing in the morning and not removed until bed or bath time can increase the chances that a child makes it to school corrected.
Give Patient Positive Feedback at Dispensing
It is always a nice affirmation when the doctor can come out and compliment the patient on their spectacles, but a well-trained and enthusiastic optician can successfully dispense the spectacles when the doctor is not present. Following the adage “only do what only you can do” imparts responsibility on the optician and staff, and allows the doctor to focus on the clinical aspects of care, seeing the patient back for their follow-up on visual acuity as needed.
Model Glasses-Wearing Behavior Yourself
I always try to wear fun glasses during clinic. My staff is also encouraged to wear spectacles, as well as bright and cheerful colors, befitting a pediatric patient population. When appropriate, I may cite celebrities or sports icons specific to the child’s age range and interests. This can encourage wear by creating an atmosphere of inclusion. (It is important to tailor this so that we aren’t excluding non-spectacle wearers, which may include other siblings in the room).
Optimize Social Media to Encourage Wear
If your office uses social media, featuring spectacle-wear success stories (with parent permission via a HIPAA marketing authorization form) can be a great way to inspire wear!
There are many fun social media accounts dedicated to patching, amblyopia and aphakia – these can be cited to parents and used to show patients that there are other kids like them.