The Myopia Exchange
Dr Kate Gifford, a global authority on managing childhood myopia (short-sightedness) in clinical practice, discusses the latest myopia research and clinical techniques with experts from around the world.
The Myopia Exchange
Myopia SOS with Prof Ian Flitcroft - Episode 1 - Off the naughty step
Myopia SOS! In the first of this six part series, join your 'agony aunt' Dr. Kate Gifford, an optometrist, researcher, and co-founder of Myopia Profile, and 'agony uncle' Professor Ian Flitcroft, a distinguished paediatric ophthalmologist and co-founder of Ocumetra, as they tackle your burning questions on myopia management. In British vernacular, an Agony Aunt or Uncle is someone who gives advice to people sending in problems or questions, traditionally to magazines or newspapers. You can be part of this first-of-its-kind format – send your myopia management challenges for Kate and Ian to tackle via podcast@myopiaprofile.com.
What takes 17 years? Not just a childhood – this is the typical delay between research findings becoming standard of practice. In episode one, Kate and Ian discuss where we are on this myopia timeline; “parent power” and prescription puppies; determining your “patter” for clinical communication and a case on getting started. What’s this about a naughty step? Ian’s five steps for myopia management make it accessible for all walks of eye care – where are you right now? Finally, don’t miss the story about Kate’s short-lived Las Vegas gambling career (unrelated to myopia)!
Welcome to the Myopia Exchange, Myopia Profile's podcast series where we talk all things myopia from research to practice. If you have joined us for the first time, a massive welcome to the community. My name is Dr. Kate Gifford, and I'm an optometrist, researcher, and peer educator from Australia. I co-founded Myopia Profile in 2016 alongside my PhD optometrist husband, Dr. Paul Gifford, initially as a way to share a simple communication tool that I developed to help me in my practice. Myopia Profile has grown to become the world's largest and most popular multi-platform digital suite for professional education and public awareness in childhood myopia. I've always been fascinated by how we can take the latest research and find the translation to patient care. How can we keep improving and what do we still need to learn? The information provided in this podcast is of a general educational nature, representing the opinion of Dr. Kate Gifford and does not characterize the opinion of any companies represented by our podcast guests. Examination procedures, management options, and clinical pathways for myopia management are described in this podcast on the basis of later scientific evidence. Any clinically relevant information is general in nature and intended to be globally relevant to eye care professionals who must then be individually responsible for appropriate application by practicing within the limits of their own scope and setting of practice. In addition some of these management options may be off-label or unavailable in certain countries and it is the responsibility of the individual eye care practitioner to be aware of regulatory requirements pertinent to their practice. Today I am joined by one of my most favourite myopia nerds in the world, paediatric ophthalmologist, prominent researcher and Ocumetra co-founder, Professor Ian Flitcroft, all the way from Dublin, Ireland, for the first of a series of six podcasts where we will be delving into numerous aspects of myopia management and helping answer your burning questions on research and tricky clinical cases you've seen in your practice. We would like you to send in any of your burning myopia questions that you would like us to answer. Our theme for this series is Myopia SOS, advice from your agony aunt and uncle. Now you'll clearly hear that Ian is British and a British colloquial term for someone who gives advice to people who send problems or questions to a newspaper, magazine or radio show is an agony aunt or an agony uncle. Over the last several years I've enjoyed many conversations with Ian, tapping into his extensive knowledge and benefiting from his guidance and I'm also regularly contacted by colleagues with myopia questions. So it's not meant to be It's actually going to be fun. So here are your agony Aunt Kate and agony Uncle Ian to help with your myopia quandaries. Uncle Ian, how is Dublin at this time of year?
Ian:Well, I think today's, isn't that going to be the grumpiest day of the year? But we had nice clear days. Clear weather today, it wasn't raining, and I'm going on holiday tomorrow, so actually I think I was bucking the trend there of the saddest... Blue Monday, isn't it? That's the phrase, Blue Monday, but now I was actually feeling pretty upbeat because I'm escaping tomorrow.
Kate:Excellent. All good. Hopefully escaping to even more sunshine. So you're heading away from home, and I've just got home from Las Vegas, where I went to the Global Specialty Lens Symposium, or GSLS, and was lucky enough to receive the Rising Star Award, which was fantastic. um okay
Ian:there's cowboys are there shorts
Kate:oh i only saw um one set of cowboys out and around with crazy shorts on it was more sort of the ladies with all the feathers but um but funny story also i gambled two dollars in las vegas this is my third visit to las vegas and i thought i should gamble um you know i should give it a crack and i ended up in a a hotel that was smoke-free because that's the thing i thought oh i should give it a crack but i just can't sit there in that that atmosphere of with all the cigarette smoke so i was in this smoke-free one that i'd gone to to have dinner and i thought all right i should give it a crack and it turned out so i went up to one of the staff and i said i'm such a straighty 180 i've never even gambled before how do i actually do this and he went okay we've got a virgin and then took me off to do this and that and the other thing and he said okay you need cash so you've got to get some cash out and the ATM fees for getting cash out were $12 which is like 20 Australian dollars and I went nah I'm not doing that because that's how much of a gambler I am I had $2 so I put on two bets on an 88 cent machine and I won 18 cents on the first one then I had to cash out my 39 cents and that's the end of my gambling career
Ian:that's $2 keep the day job
Kate:That's like 3 Australian dollars anyway But moving on to topics of myopia, so here's how we're going to approach today's episode. Firstly, we're going to chat about why we need to see all of our colleagues around the world engaged in myopia management. We're going to talk about some cases and questions that we've been asked on this topic, and we might also discuss some new science and things we're excited about in the year to come. So, Ian, can I ask you a couple of questions to start? We've got this clear picture from research that myopia prevalence is growing around the world, and there are very Thank you.
Ian:Yeah, something that's been wrecking my head for years, often, and the big concept here is translation. Translation from basic science to changing clinical practice. And it's been well proven, about 17 years it takes from the start of something obvious to a clear breakthrough. I was just writing something up recently and it's actually 37 years since the breakthrough. There's the proof that an environmental manipulation can make an animal myopic. And then that started the chain. But so, you know, we're actually well behind the curve. I also gave an example of Barry Marshall. He's the guy, Australian guy, won a Nobel Prize, not very famous for it, unfortunately. He discovered Helicobacter, that kind of weird little bacteria that makes stomach ulcers and stomach cancers. But he did it in about sort of 13 years, but he faced such resistance. No one believed his bacteria would do that. So he famously... drank a beaker full of his bacteria oh um and then looked at his stomach with endoscopy sort of two weeks later to prove that yes this stuff really does fill your stomach with uh with ulcers um and then in a few years after that they came out but he had huge vested interests against him but he still did it faster than we are so if there was a uh If there was a glass full of bacteria, I could swallow to prove the point at this point. I think I'm so frustrated. I would absolutely borrow Barry's example and say, look, my eyeballs have grown 10% in two weeks, as long as I have somebody reversing it, which might be hard.
Kate:Yes.
Ian:So when you go back to the very start, I mean, you know, back in 1987 when it first came out, everyone was convinced it's all genetics. You know, the notion that there's nothing you can do, it's all your parents' fault, is still ingrained. The other big thing is this, my sort of personal little pet hate, is if there's pathological or pathological myopia, then obviously there's physiological myopia, which is just the stuff that you need glasses for, which is the vast majority of people. of myopes. I spent years trying to prove the fact that something which stops your eyes from doing what they should be doing, which is seeing clearly, by definition, isn't physiological. It's a disease. And all the complications, the big four, the cataract, glaucoma, detachment, and myelopathy, they're all starting before you get to minus six. And some of the work I was presenting over in Korea, which sort of baffles people, but for grades two or higher myopic maculopathy in Singapore, the majority of people who develop that are in fact low myopes. They're below minus six. And the reason is there are a lot more of them. So yeah, okay, so the rate increases. There's more of them. So we're trying to resist the notion that it's all genetic. That's pretty ingrained amongst clinicians who really haven't been getting much, haven't been tapping into the back chat of this story for decades. Then the idea that it's just pathologic myopia, the rest of it is just myopia. And the other thing is we're not replacing one thing with the other. So Barry Marshall was replacing... very expensive tablets with some very cheap antibiotics. Industry hated him, obviously, for that. But at least there are people used to writing prescriptions and doing something. We're also faced with a paradigm shift here. People have gone from a transactional correction model to a treatment model. So that's another huge barrier. So it's a little bit more challenging than most, but we have to admit... we are way behind that 17-year curve. When you think that the first modern trial for atropine was in what year?
Kate:It was the last century. Well, the first modern trial, I guess, was almost 20 years ago, but I remember seeing the first research in atropine last century.
Ian:Yeah, well, I mean, Bedrosian published in his crossover trial in 1979 in ophthalmology. Then there's just like this deafening... silence it just nobody
Kate:yeah for decades took it on board and you're right
Ian:i mean the it was a you know enthusiasm back in the um in the early uh early 20th century and it is the 19th century um so the one interesting thing about that 17 year why it takes 17 years um and one theory is that well The average person with medical school and everything else is probably going to be in practice for about 35 years. So you literally have to wait 17 years for half the dinosaurs. Wow.
Kate:And look, that's definitely a trend. I think we see that younger colleagues are very interested and engaged in myopia and they're probably mostly myopes themselves. But it's a fairly shocking thing to think about 17 years when you and I have been talking about myopia for so long. And even those of our colleagues who are early adopters who are practicing myopia management for so long, it's getting that knowledge into practice. But also the 17 years we're talking about is having the majority of our of practitioners accepting and practicing in this new way as well, isn't it?
Ian:Yeah, and I think that the parent power, I mean, if you think about the amount of chat about all sorts of health topics, good and bad, I mean, the vaccine is a great example of information and disinformation, you know, being very sort of parent-led. But Obviously, in places like the West Coast of America, the Asian community, I mean, they're very on top of it. Maria Liu, when she opened her clinic in Berkeley, said that it had to be Saturday morning, the only time she could have a space. Nearly all are Chinese-American, and that they kind of walked in the door and told her what they want.
Kate:Yeah, they had already decided. They'd already worked out their treatment plan before they even got there from reviewing the science.
Ian:But that meant they are a minority. So, you know, you get the occasional little sort of radio piece about it, but it doesn't really sort of catch the imagination. So I don't know how we can force that.
Kate:I guess what popped into my head just then is in... the world where parents can access this information and they can read the papers. We have so many papers now that are open access. So if you have the parent who's particularly inclined, they could actually get in and get into this detail. Do you think that all of the information we have at our fingertips nowadays could shorten this well-known 17 years of new technologies or new knowledge being adopted into standard of care? Or does all the information out there just mean more noise and it will still take a long time? I guess that's the good and the bad of having all this information available.
Ian:I think we kind of fall prey to the concept that if you build a brilliant product, the world will beat a part of the door. History tells us that's not the way the world works. And I'm sort of moving now towards the thought that in terms of at a population level, we could probably get... more communication emphasis out of a really sort of serious look at primary prevention, bringing in GPs, bringing in paediatricians in America, because they do a lot of talking to parents early. So the outdoor message, it is cheap and effective, really sort of pushing that. And then getting schools on board, There was a meeting in Paris last year, just about produced a report recommendation. And it's driving this concept, which is that there's a public health policy for kids' health. And the American Association of Paediatricians published this magnificent document, talked about screens and things, didn't mention myopia at all.
Kate:Oh,
Ian:wow. So that's because, you know, we kind of think, you know, we're high people, you know, we do our vision screening, we do school screening, you know, that's our thing, you know, we just look after it. But it's not part of that, you know, overall health package. Governments fund child health programmes. You know, they don't really want to fund, you know, a prevention programme. But if you say, well, look, this is important part of kids' health. And we can both list off 10 reasons why, you know, there's a good reason why this should be part of a public health program. Just as common as obesity, some of the same treatments, you know. Yeah, same restrictions. Get outside, do something. And a sort of a rather madly complicated interaction between the two things. But... rather than try to say to governments uh you know fund primary prevention why don't we just sit in every country um let's be part of your health promotion strategy for kids.
Kate:It makes sense yeah it makes sense it just seems insane to me um that we don't have as as good a penetration of that message of the importance of vision care for kids when so much what is the statistic that's probably not evidence-based at all 80 90 percent of what we take in or how we learn is through what we see. You know, how would we not think our eyes are a most important sense for kids and for their learning?
Ian:So, I mean, if we can... So the basic tagline of this editorial we're trying to get at is that, you know, the messages about outdoor time for prevention of mobile should be integral in every, you know, kids' health program in every country. So... And that would be a much cheaper way than just trying to do it alone. And the conversation, which is, this is good for kids, because it stops them becoming short-sighted. And then the ease to tag on the, did you know, if it does happen, don't forget to ask your optometrist, your doctor, about the new treatments. You can stop it from getting worse. Because if you wear glasses, when you were a kid, it got worse and worse and worse, nothing we could do about it. And then eventually you ended up, as an adult, and you get out of bed and you feel blind because your get-out-of-bed vision is useless. Yeah. And I always think that patients are much more sensitive to the impact of myopia in their eyes than professionals because they're all sort of hung up on best corrective visual acuity. Yes. When you get out of bed, that ain't your best corrective visual acuity. Yeah, yeah.
Kate:And those things don't take long to say. Like you said, you've said one sentence about if your child does become myopic, there are things we can do to slow it down. Talk to your optometrist or doctor about that. That's such a key thing as well. Just having those little sound bites, those snippets that... that can start the conversation without a colleague having to feel like they have to explain the whole history of myopia and myopia management. And, you know, you don't have to. You just have those sentences. I'm sure you have sentences that you say, you know, multiple times a day that work and that cut through.
Ian:You patter. And that's part of the issues that I think ECPs have, which is they have a patter for, you know, everything, you know. dry eyes, they have a very bad patter for trying to explain astigmatism to people, which we all, none of us have really cracked that one. The famous rugby ball convinces nobody. It's bad eyesight, but it's not near or far. It's kind of bad everywhere.
Kate:Instead of some lines, yeah.
Ian:I just say bad everywhere.
Kate:Bad everywhere.
Ian:But if we could get the public health message going in GPs and paediatricians in countries, particularly the US, where that's their big thing. I think one of the advantages is that that group of doctors don't believe they know it all already. You know, there's a pretty fair chance they're short-sighted. There's a pretty good chance they have kids that are short-sighted, so they might be tuned in. But they don't have the resistance points and the baggage that, you know, it's just... it's just correction you know it's all hype it's just trying to sell expensive glasses or just trying to sell you know the industrial complex trying to sell even more glasses um so you know for them it's just new and if we could get sort of buy-in that this is part of children's health promoting um time outdoors i said and then just tagging in the fact that um So that's primary prevention. Secondary prevention is preventing kids who develop myopia from getting worse. That's all part of that conversation. And then before the kids become myopic, parents will be aware that there's something that can be done. It's not inevitable. It's not their fault. It's not a sign their kid's particularly brainy and something to be grateful for. Oh my God, my kid's got glasses at six, they're going to Harvard. No. Just prove that one. So I think we have to sort of sit back and look at the delays we've experienced and try to, you know, work out what we can do. One of my PhDs, when we sort of Kicking off the early trials, I did a lot of focus groups, just looking at all the touch points for optometrists in training, in medical practice and in academic practice. And it was a very long list of reasons why they couldn't do it. So it was all sort of using all your creativity to find an excuse not to do it.
Kate:Instead of using creativity to find the soundbite, the sentence to say, the way to do it. Okay,
Ian:yeah, I can do that. And that's all those sort of confidence points about... you know, what to say to parents and how to monitor it. You know, what if they say no? It's kind of led to our sort of interest in that communication piece. So obviously one of the things I've been involved with.
Kate:And this is a perfect time for a quick word from the sponsors of this podcast, Ocumetra.
Advertisement:You know it's critical, but let's be honest. Explaining it, tracking it, and making it stick with patients, that's a challenge. Enter MySuite, a software solution that removes the barriers, simplifying patient communication, boosting treatment uptake, and saving you chair time. No more sales pitch fields, just data-driven, evidence-based care that builds confidence. No biometer? No problem. MySuite even provides axial length estimates.
Kate:So let's talk about that and communication and let's use it in view of getting started with myopia management. So if we think about a patient case, and this is illustrative of a lot of those starting out cases that can be a real struggle. Let's imagine we've got a young patient. We'll call her Sarah. She's six years old. She's got two parents who are myopic. Maybe one is moderately myopic or maybe one is highly myopic. And her refraction right now is minus 0.50, minus 0.75. We'll presume we've done an accurate refraction. We've controlled accommodation. That's her refraction. So how would you manage Sarah? And what would you say... to a colleague who says we should wait and see. And I guess the theme of this podcast is myopia SOS. So the myopia SOS moment for a patient like this is how do we actually talk about this? How do we get parents on board to believe that this is a problem, that this is a disease and this needs active management?
Ian:I think one message is just, okay, imagine the conversation in a year's time.
Kate:When she's minus two, minus one-fifty.
Ian:Yeah, she could be minus two. And, you know, the parent goes, you know, after this new treatment said, well, could we have done this last year? Yeah, but I didn't think you'd be interested. So the notion that, you know, it's a one way street pretty much. And the fastest progression is right at the start. So the biggest way of protecting it. And even though we talk a lot about the future impairment risks from higher levels, a really, really useful goal for early intervention is keeping kids seeing well. So, you know, if you get the chance of a kid coming in minus 0.5, they're being brought in, you know, usually for a checkup. You know, they're seeing fine. No one's going to be spotting. There's nothing wrong with their distance vision at minus 0.5. But with a, you know, positive family history... if they're six and minus 0.5, I mean, they're right on the edge of the curve. So that group of population are the future high myopes. If you want to change the trajectory, the time to do it is now. And what I would, in that situation, is always just say, give parents the choice. So I've had quite a few of those kids. They're often, I've had a uh one of my colleagues uh ophthalmologist she's about she's about minus eight i think dad's about the same um and we wanted the kid checked um you know functioning fine uh a little bit older i think about seven or eight years old so um and i said look you know we don't she doesn't you know need glasses to function right now but we could put her into these glasses um that I don't want to sort of mess up her childhood and freedom and everything else, but the environment that makes kids short-sighted is school. So wearing glasses just for school and homework and taking them for everything else, and they might be sort of plainer in one eye and minus a half in the other. And I'd be putting kids into that, or at least giving the parents the choice and say, look, here's what we can do. We can do nothing. We might be surprised. It might shoot off and be... be you know really high than six months or a year's time and we're going to kick ourselves thinking we should have done something um we can just do something right now which uh as i said you know just take them off when the kid wants to do something where they're going to get in the way um but but for school um and that gives us probably the best single chance of of of doing something um and i've you know it's a probably around about 10 kids have done this in the last year or two. But, you know, so far I've actually been pretty successful. I think I've changed one pair of glasses in that time. But we also, I mean, and you're throwing in the, by the way, time outdoors, screen time. Actually, my latest one is dogs.
Kate:Oh, dogs. Oh, I like dogs
Ian:And this is a study I was saying on another podcast recently. We have to do the dog study. Is dog ownership a protective factor for myopia?
Kate:Isn't dog ownership protective from a cardiovascular point of view and a mental health point of view? Isn't there... potentially already evidence that dogs lower your blood pressure? I don't know. What's your knowledge of dog research?
Ian:I have a knowledge of dogs, so I don't think dogs are great. I think dog people are a nice bunch of people. Cat people are nice too. I love cat people.
Kate:Yes, let's not discriminate against cat people. But they're harder to walk. People do walk them, but, you know, it's not as common a thing walking the cat, I guess, as walking the dog in terms of the study design for myopia.
Ian:But so I've had, and then when kids come back, the, you know, one of the questions, if they have progressed, like the first intuitive test is, you know, behavior. What else are they doing?
Kate:Do you ask them if they have a dog?
Ian:Actually, I often get around to that. When we're having the outdoor conversation, are the indoors out, the outdoors? Do you know that actually modern kids spend less time outdoors than prisoners do?
Kate:Yeah, it's a shocking statistic.
Ian:That's what I say. And I recommend sort of two things. Buy a dog and make sure that the kid walks the dog, you know, because you'll have a happy kid.
Kate:How much tension is that potentially caused by? Because you don't know walking in if there's been a lot of background discussions about having a dog, you know, all of that. Has that led to any uncomfortable silences, meaningful looks between parent and child about, see, he's saying I need a dog. Mum, I want a dog.
Ian:You know what, if I sort of, you know, get a... The parents will come round. Yeah, prescription dog. Reluctant parents always end up dog loving. But going back to that first conversation, the lack of patter and having everything at your fingertips, I think, is a problem. So that list of reasons that people came up with for not doing it is... And we've tried to tackle all those things into a set of communication tools. This is a spin-out company, OccuMeta, we did through the university, based on all the research that we've done, but there's pressure points. And basically, what it allows you to do is just to, that six-year-old kid, you could just, from a central point of view, you can see how extreme they are and where those kids tend to end up. If I see a kid like that, I'd always, you know, if the parents are glasses, you know, do you know your number? Sometimes they do, sometimes they don't. And then I ask them, what age did they start wearing glasses? And you say, well, you know, your kid's just going down this path. You know, she's four years ahead of you in an environment which actually seems to be far more dangerous for her eyes. She's going to end up way worse than you are if you don't do anything. You tell a mum that your kid's going to be worse than she is, poof, you know. Yes,
Kate:That's very motivating.
Ian:What I call a Jerry Maguire moment, you know, you have me at hello. It's like, okay, let's stop talking. Yeah, yeah. So in our communication pact, I think called My Guide, so that's the first starting point. You know, what could happen if you do nothing? Next one is a simulator saying actually just how blurry things are. So some... Parents have quite an emotional reaction. The two big things is, you know, can you see a face? Can you see leaves on trees? And at minus 0.5, we can show, look, they can see faces and see leaves on trees. Let's fast forward to 20 and see what this kid is likely to be. You know, no faces, no leaves on trees. Just, you know, green blobs and pink blobs. If we let Mother Nature do what she might do. Yes, yes. That's a launch pad off. So a big point is you don't need to say everything. So the super complicated sort of, you must talk about X, Y and Z, just try them the, if we do nothing, what will happen? Will they end up worse than the parents? The visual simulator is a really great sort of touch point for parents just to show, particularly for those young, mild ones. And I think that's something we should, you know also be changing my colleagues say that yeah that you know if you're minus 0.5 you don't tend to say minus 0.5 not for long you will progress um and then further down all the other sort of um risks benefits steps are all there and what you could do um so effectively we've um You can just, in the order that you want, you can just dip into that. There's a little talking point. The little inflation blocks actually have all the patter in it. So you can just learn to have your patter. I think a really important thing is don't be afraid. What if they say no? That doesn't matter. You know, just plant that seed. Yes, you've had the conversation. Yeah. So the conversation next visit, if you haven't said anything and they got worse... is much more comfortable. The conversation, if you have said something and the parent's gone, they're fine, they're fine, and they've got worse, is super short. It's like, okay, we should have done it last time. Okay, okay. You know those glassy things you mentioned last time? I think we should probably do that. I think that's a good idea. That's it. That's the consultation.
Kate:So it doesn't have to take 20 minutes of clinical communication to get the process across. There are tools available to help you. And like you said, having that patter, having those talking points. Do you think that it's useful to talk about the long-term risk of eye disease? Or do you think it's more useful to talk about blurry vision in the future? And how far into the future do you tend to talk, I guess, in having these conversations?
Ian:despite being sort of probably famous for banging on about eye disease risk and everything else for decades, I hardly ever mention it. The short-term goals for parents are, if I get a 0.5 kid, I say, look, the aim here is I want to keep them able to play sports without their glasses forever or for as long as possible. The... vision simulator and just how blurry they'll be and how particularly that's useful for parents who don't wear glasses as well it's like you know a non-myopic parent you've been thinking whoa that's going to be if that's what a face will look like with their glasses yeah because they're thinking that's that visceral patient thought you know that get out of bed glasses um you know and that and if you ask somebody who's not professional you know how bad's your eyesight they will, that phrase, oh God, I'm really blind. That's kind of the words that they come out with. And for an ECP, that's their logma zero, six, six. I mean, they're perfect. They don't feel perfect. So they get that sort of visceral reaction. And you just need one reason for them to get on board um so sometimes uh i've been picking up my neck of the woods just around the corner from google uh you get google parents or they'll go all that and then say well you know so what are the figures they want a graph you know they're a tiny proportion of people it's it's there um uh so what i if i'm encapsulating um the long-term risks uh I just say I want to keep their good eyesight, keep their eyes healthy into old age. Because one of the things about my opinion is that it damages your eyesight when you get older. And in those first few conversations, I don't think we need to emphasise that. That conversation is really for reimbursement sort of organisations, gatekeepers, decision makers who are saying, look, this is the public health, going back to the why maybe we should be part of the public health thing, which is that on a population basis, this is the only modifiable risk factor, the second strongest factor of visual impairment after age. So we should be doing something about that. We can bang that message and talk about visual impairment and life course improvement costs and all those opportunities, I think that's for a very important bunch of gatekeepers who can control the reimbursement. But for parents, I mean, I really, you know, I don't think you'd need to go into that. But the one word that's in hospital setting, I always ban the B word. I've never heard any junior mention the word blind. In hospital clinic, I do a lot of genetic eye disease. So, you know, a lot of those inherited retinal dystrophies, you know, the B word is hovering in the background, but absolutely, completely, utterly banned. And I don't think you need to use the B word in myopia either. No. It's just that, look, this is something, you know, that left to some devices, it gets worse. It can affect how well you see in your old age. And there's something we can do about it. Are you interested?
Kate:Yes. Yeah. And that didn't take long. Yeah.
Ian:Was that five seconds?
Kate:Ten, five seconds. Yeah. Not even ten.
Ian:And if, you know, if they... They say, no, just, you know, just, okay, well, let's bring you back. And then depending how worried you are, it could be shorter. If you're really thinking somebody should have said yes to this conversation, you can bring them back a little bit sooner. If the parents are very sort of uncertain, you can, you know, another reason to bring them back sooner. Having all that information available, In a takeaway package, I think it's important. If you want to actually just tick the boxes to say, you know, I'm complying with all the guidelines. I can comply with all the guidelines by giving something apparent takeaway. And that's another part of our sort of package, which is having sort of a QR code where they can just get the information on the phone and they can see all the same little sort of interactive bits. And step by step, that information is in there. in a sort of a gently non-scary way, without using the B word. And also the information about what else should you be doing in terms of screen times and outdoors and what the options are. So even if you have short conversations, it's fine, just bear glasses and walk out the door. They have that. So look at that and think about it. You don't have to be sitting there and watch and read it. You don't have to tell them all. Yeah. And there's always the missing parent. So it's very rare to see two parents in with a kid for any appointment. In this day and age, there's still more mums than dads, but the dads could bless them. They're usually, they're all sort of slightly terrified. And so it's, you know, before they go out the door for some, you know, if it's a complicated condition, you know, I'll always say to them, so, okay, what's she going to ask you when you get home? and they go oh god you know and then they'll sometimes embarrassingly pull out their list of questions but if you can just say well look actually it's all on this just scan that it's all on there you can actually you can whatsapp that to your partner he or she, or they, and just consume it at their own time. But if that package contains everything in these big, long, recommended protocols, and I do, I'm afraid to say, Kate sometimes referred to your management sort of IMI paper and saying, look, that can be disincentive because it looks like you have to do so much and you're going, oh my God, that's... Life's too short. It's like me and emails.
Kate:<To fix> the clinical communication and and getting parents on board
Ian:Yeah no i think the um because it can seem like uh just you know if you're new to it it looks you know it looks daunting you just slap the imi guidelines on your on your desk and say okay we're going to do this tomorrow it's like oh yeah and that's when all that creativity about reasons why we can't do that in this practice. We'll come to the fore. It's a bit like me and email, which is, you know, if an email is sort of less than six lines long and asks me to do one thing, pretty good chance I'll react to it. If it's a big, long email with a whole load of sort of multi-step things I have to think about, I'll go– I'll tune out halfway through. I'll get back to that. Oh, my God, I spend my life, you know, dropping balls left, right, and center because guess what? I never get back to it. It's always something else shorter and easier to do.
Kate:So simple messages. We're talking about simple messages, simple approaches.
Ian:Simple. bite-sized messages, have the information at your fingertips, share it with the parents so they have it, so you've done your job of sharing all the upside-down risk benefits, what you should be doing, behaviourally, what options are there. They have all that. And if they said no, you've ticked your box for your... The UK guidelines are... Actually, it's quite extensive, but if you can just... you know, have that information conveyed to them, then you've done your job.
Kate:Yes, yeah, absolutely. It's all about, yeah.
Ian:My five-step programme, which I kind of did a few years ago and I've been dusting off recently, which is that you don't have to just jump to perfection. So everyone's on one of these five steps. So the first step is the people who think that glasses are the problem and they're going to correct. So that's the naughty step.
Kate:Yeah. And that's still happening out there, but naughty step.
Ian:So if you're on the naughty step, just move to single vision. Move up one. Full correction. Move up one. And then... As you're sitting there sort of smugly sitting on step two, but don't believe all that thing, but knowing that, well, someone else does and maybe I should, you know, you have to mention it. That step three is just doing one thing and just finding, OK, I can prescribe, I can fake glasses, I can centre a pair of glasses. you know, dims or stills glasses on a kid's face easy enough. Like, yeah, I can manage that. You don't need to actually learn to start. You just, you know, pick your first patients, you know, have a simple conversation about trying to get them going. And that's kind of it. Then you just... learn as you go along. You get more comfortable with the patter. If there's tools around to make it easier, then, you know, use the tools. What's step four? Step three. Step four is where you're starting to, it becomes, you know, every Muppet kid coming through the door You have that conversation. So you've got over your fear. You've learned enough practice to be able to do it quickly. If you've run a practice, you've told everybody, look, this is what we do. This is part of our thing. You still might not have a monitor. You might now have contact lenses and glasses. And then step five is you're into the full biometric monitoring process. This is, and a business model. So you actually, you've thought about, okay, am I going to sort of grow my business through dry eye or go through business through, you know, my peer control? And so that's, so step five really is, is your guidelines. Plus a business model. And that's one of the, you know, oddly important important barriers. If you could just give someone and say, look, this is the right thing to do. And here's some tools to have that conversation to make it sort of easy and slick. But also telling them in a little package how they can organise this.
Kate:Yes, yeah.
Ian:To make sense for your practice. And, you know, the big multiples, I mean, they're definitely getting into that whole thought now. possibly driven by doing the right thing they're probably a little bit more risk averse as well in the sense that not doing the right thing could reputationally come back and bite them a bit more.
Kate:So I think that's a great way to express it because our colleagues might think they have to go straight to step five when in fact there's so much that can be done to establish confidence and establish experience in the field and to get the patter right and to get the communication right. You don't have to have jumped straight to step five and in fact, you can't because you're going to find those ways that, you know, just through experience that work for you. And obviously, as you've talked about, there's lots of tools to help you as well.
Ian:But, you know, the whole world is on one of those steps. So all you have to do, if you're on step five, you're on step five, I don't know what you do, but if you're on, you know, if you're on one to four, you know, you can just take one more step. Yeah. And in those first few patients, you may be sort of cherry-picking and picking the ones you think will say yes easily. If that's what you need to get your confidence to get you going, that's fine. Fantastic. Don't go and climb a really hard-to-climb tree. Just get a really easy one with big, fat branches close to the ground and just... Just go it easily, and then very quickly you'll just get thinking, oh, I kind of like this climbing thing. Get a hang of it.
Kate:And that's useful advice for many things in life, isn't it? Not just myopia. From Agony Uncle Ian, just take one step. Obviously, myopia is what we're talking about, but just taking one step is useful for many, many things.
Ian:Absolutely.
Kate:Fantastic. Well, that brings us to the end of our discussion today. Thank you so much, Ian. And we want to answer your burning questions as agony aunt and agony uncle. So make sure you send any of your burning myopia questions. We've talked about communication and getting started today. Send them to podcast at myopiaprofile.com and we'll tackle those for you. We also keep chatting about all things myopia and most of all, curly cases and how we actually make this work in practice, how this actually works in terms of managing patients as well as being able to ensure that you can take those steps up that five-rung ladder that Ian has talked about.
Ian:And if you listen to this, you're probably an enthusiast. So my message today is to go off and find a dinosaur and have a conversation with them. And try to just, you know, share some of your own enthusiasm and knowledge, you know, with them. Because if everybody who's keen could convert one other person, you know, we're talking about Moby epidemic. Why don't Moby imagine an epidemic? Let's have all the enthusiasts infect all the diehard stick in the muds.
Kate:Positive infection. Love it. Love that concept. Fantastic. Thank you so much. Stay tuned for the next podcast in the series when Uncle Ian and I will be chatting more about myopia cases, research and helping you with your burning myopia questions. I would like to thank Ocumetra for sponsoring this episode of the Myopia Exchange. Ocumetra provide a range of software products to simplify myopia management in clinical practice. To learn more, head to Ocumetra.com. And thank you for tuning into the Myopia Exchange, learning about myopia research, innovations and the translation to clinical practice. I trust you've found some useful pointers for your next patient and you've enjoyed the nerdy goodness. Please stay tuned for more episodes. And in the meantime, make sure to check out the numerous resources, courses, cases and more available to help you on myopiaprofile.com. Together, we can improve children's vision care worldwide. Thank you very much. setting of practice. In addition some of these management options may be off-label or unavailable in certain countries and it is the responsibility of the individual eye care practitioner to be aware of regulatory requirements pertinent to their practice.