Reading time 5.18
The Problem
Do you ever get frustrated when a patient presents with a preventable problem? Whenever I see a patient like this, I feel compelled to review my attempts at patient education. Did I do enough? Is there something else I could do that would be more effective in the future?
The source of my recent discomfort was a child with bilateral refractive amblyopia. I have practiced for more than forty years and can’t believe this can still happen. With all the advances we have made in other aspects of eye care, I would have thought we could have made some progress in this area too.
How can parents still be surprised that their child needs a professional eye exam before they attend school? Many people still don’t know amblyopia is preventable, especially if caught early. And for that matter, the public doesn’t know that amblyopia does not mean an eye “drifts”. These are facts that the general public can’t seem to grasp. Speaking for myself, I know that I need to do a better job educating the patients in my care.
The patient I mentioned happened to be the nine year old son of a good friend and long-time patient of mine. Her son appeared for his first eye exam at age nine. He is a good student and plays on several different basketball teams. Not only does he play on several teams, but also happens to be one of their best players. He is a perfect example of a child who shows no visible sign of any eye problems.
I can’t say his parents don’t care because his parents are attentive and would make sacrifices to be sure their children didn’t suffer in any way. I won’t go into detail on all the clinical findings. Suffice it to say, his best corrected visual acuity in both eyes was only 20/50-. His refractive error was more than five diopters of hyperopia with some astigmatism in both eyes.
I am optimistic that with therapy and close follow-up, we will be able to reverse some of his amblyopia. Still his findings made me consider what I can do to step up my education of parents in my practice.
Patient /Parent Education
I am disturbed by any child who presents with amblyopia, but this one hit me especially hard. Patient education is a big priority for me. Telling parents that their children need a full eye exam between the ages of 3-5 is standard in my practice.
I point out that pediatrician and school screenings can miss many problems. The development of the visual system is discussed. Information is given on how amblyopia can develop. I also share that the earlier the risk factors are detected, the better then outcome will be. But, even with that, it still allows children to slip through the cracks and develop amblyopia anyway. I don’t know what the answer is, but I think it is something we need to consider.
We are all faced with the dilemma of deciding how to keep the levels of our care as high as possible. How do we provide quality care, but also educate our patients? Patients expect us to provide excellent care for their current problems. Though unspoken, patients also expect us to advise them on how to guarantee that their vision stays good for their future.
A Unified Approach
It is possible to change public opinion. We can do a better job teaching the public about children’s eye care. It’s not impossible. When I get discouraged, I always think about the example of dentistry. They have educated new parents well. No parent would wait until school for their child’s first dental appointment. Nor would they wait until their child complained about their teeth to take them to a dentist. Yet, parents just assume that they will know if their child needs eye care. Or worse, they have the false security that a screening will pick up any visual problems their child might have.
AOA began a public education campaign about the importance of early eye care when InfantSEE® launched. There were a lot of public service announcements then, but they seem to have disappeared. Ophthalmology has not done any better at educating the public. And I’m not sure if all pediatricians are even aware that their screenings can miss potential problems.
A possible good start on changing the narrative on children’s eye care would be to team up with pediatricians and ophthalmologists and present a unified message to the public. Pediatricians are vital to preventing amblyopia since they are always the first, and maybe the only doctor, to see infants and toddlers. Just as they instruct parents to take their children to the dentist, they could also emphasize that children need a full eye exam by an eye care practitioner.
It would be wonderful if all professions involved in the care of children could join forces to educate the public. Even better would be enlisting the help of an industry leader in children’s health to underwrite the cost to get the message out. That is well beyond what I can do, but would be a great dream for the future.
Begin in your Community
In the meantime, there is nothing to stop us from trying to make changes in our own communities. We can work with the schools, pediatricians and ophthalmologists in our communities to come up with a plan that everyone can support. Talk with local pediatricians and share with them your concerns about preventing amblyopia and identifying children who are at risk. Discuss the problems with screenings instead of full exams.
I think the responsibility comes back to each doctor in his/her practice. We educate our patients about cataracts, dry eyes, glaucoma and macular degeneration to name a few. But, be honest with yourself, how often do you discuss the importance of early childhood eye exams and the prevention of amblyopia?
I have thought long and hard about how to approach this with my own patients. Since my time in the exam room is at a premium, I need to think of other alternatives to help.
I have no new revolutionary ideas to present. Pamphlets, flyers or posters around the office could help. Creating a special education campaign could be part of your Back to School efforts. Giving a handout to all parents with children is an obvious possibility. Printed materials are helpful, but the problem is they don’t always get read. Providing additional information on our websites, blogs and social media platforms can be useful, but only if a parent chooses to read it.
For these reasons, I concluded that I must make an effort while parents are in my office when I have their full attention. I will continue to make a renewed effort to provide information on childhood visual problems. That presentation will stress our ability to prevent these problems. Without us providing the answer to why early eye care is so important, our efforts may fail.
This educational effort may be a place where we can all learn to delegate. If we don’t have the time, then maybe we should consider training one of your staff to take over that duty. Our staff could also be an effective addition to the other educational efforts in our office. Most offices use staff effectively for contact lens training, so why not consider expanding that to cover other issues.
No parent wants to neglect their child’s health. If we provide them with the proper information, hopefully they will make the right choice.
Every doctor needs to consider how to handle this best in their practice. We need to address amblyopia prevention if we expect to provide the best care we can to our patients and their families.
What measures do you use in your practice to educate about the importance of early childhood eye care? Do you use your staff to help with education efforts? Tell us how you handle pediatric care in your office and leave ideas that may help others in their practice. Please leave your comments below and join in this important discussion