The Science of Compliance - The Importance of a Flexible Approach to Managing Myopia in Children

It has been shown to have an effect but not to the same degree as on-label products. I personally would not prescribe varifocal or multifocal spectacle lenses to a child today. For my colleagues in countries that do not have the same treatment options at their disposal as I do, I would of course go with whatever option is best for the child within the options available to me – and read up on what is to come.

Ortho-k does have an element of discomfort which then requires the parent to continuously reinforce that “It will get better”; but we all know that children who experience something to be uncomfortable will probably not want to wear it. However, for a while ortho-k was my only option. Nowadays, I tend to find children more compliant with soft contact lenses, particularly with daily disposable lenses. When it comes to spectacles, it is very difficult to monitor compliance because they can easily take them off. Spectacles probably have the least observable compliance. This is where ortho-k is really good, the parents see the lenses put in in the evening and taken out again in the morning.

In general, my experience is that compliance is better with MiSIght 1-day contact lenses than ortho-k lenses. Whilst parents may have the best intentions, they tend not to do all that you tell them to do; a classic example is deproteinizing the lenses, we ask them to deproteinize the lenses twice a month and when you speak to them, they are probably not doing it quite as often. Whereas with MiSight contact lenses, it is quite easy for a child to apply and remove the lenses and the parent can see it is being done.

We have started to send an email one month after the consultation and then three months after to stress the importance of full-time wear to parents. With contact lenses, whether it be ortho-k or soft contact lenses, we also have a face-to-face interaction after six months as parents are obliged to bring their child in for an update of their lenses and pick up a new supply of lenses; as they are asked to bring in any unused lenses, the number of lenses they bring back to us is a great indication of compliance. We don’t have this same opportunity with spectacles.

I think that is a really interesting part of myopia management; at the moment, the only thing I can prescribe is outdoor time and reduced near vision digital device use. It would be great if I could prescribe something like atropine to a low hyperope and keep them hyperopic until their early teenage years.

The only combination approach I tend to offer is if a child would like a day off from their soft contact lenses, for example, contact lenses during the week and spectacles during the weekend. I will then suggest myopia management spectacles in line with their contact lenses; ortho-k is slightly different as you are either all in or out, so to speak. It is not often that we do combination treatments as they typically off-label and icome at an additional cost.

I would communicate more often. Keep your patients and their parents close and continue to constantly reiterate treatment advice and the importance of compliance in different ways using new research and so on. The pandemic really taught us that we cannot leave these children drifting nor can we afford to not be in contact with their parents.