optometry schools - typoscope - low vision clinic

191: I have just examined a ten-year-old boy complaining of occasional problems with reading the board at school and some other distance tasks that are part of his daily routine. My examination reveals -0.50 DS in each eye. His father does not want the boy to have glasses as he thinks that glasses will make his eyes weaker if he wears them. What should I do?

In my clinical experience being the first to discover myopia in a child often leads to problems convincing one or more parents that using glasses is important.

Good research has shown that under-correcting myopia leads to more myopic progression than fully correcting myopia. You should explain that myopia is very likely to progress more if glasses aren’t worn than if they are. Tell the parent that glasses will help improve the clarity of the board at school and that this will help with the boy’s education as well as provide clarity in his everyday life. Tell the parent that myopia will progress with the glasses so there are no surprises at the next examination when you find that his prescription has increased.

Inform the parent that the boy will notice how clear things are with his glasses compared to without so he will often want to wear his glasses. At the moment his distance world is blurred and he has no choice but to live in a blurred world. When he gets his glasses he will have the choice of a sharp world with these glasses or a blurred world without his glasses. He is very likely to choose the sharp world over the blurred world.

Ask the parent to look at the visual acuity chart and hold up a plus +0.50 DS trial lens in front of each to mimic low myopia and demonstrate the negative effect on the clarity of the letters. Take the parent outside the practice and do the same so he can understand the effect on everyday vision.

If you have the knowledge and skills discuss the option of dual-focus contact lenses for myopia control. This may be too much for the parent to agree to at this point but it may be something that can be further explored at the next examination. Let the parent know that the older the child the less effect dual-focus contact lenses will have.

Briefly record your advice in the clinical records along with the parent’s responses.

By being calm, professional, confident, and informative, you will have done the best you can.


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