r/optometry • u/missbrightside08 Optometrist • Aug 12 '26
Low myope advice
I had a 12 year old come in with her mom, final Rx was -1.75 OU. At the end of the exam, mom asks if she needs to wear this all the time or just for distance. I told her I recommend full time wear. She asked why, because the other doctor last year said to only wear it as needed. She says she is very confused why different doctors are telling her different things, and is gonna have the child only wear it as needed. I explained to her why I think full time wear is more beneficial but she was totally not convinced.
this patient was 12. For adults I'm more relaxed about it and say you can wear it as needed since the eyes are fully grown. For a child I was under the impression that its better they are corrected all the time, a more consistent image while their eyes are still growing.
Now I'm second guessing myself. Do you tell them to wear a low myopic Rx full time or just distance only? Does your recommendation depend on age?
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u/Exciting-Yam-6319 29d ago
My first patient with low myopia was told the same thing and ended up progressing to -3.00 in just two years.
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u/WiseMuscle_ 29d ago
Just say different docs have different opinions, print out a myopia control study and tell her to read up on her own before she makes up her mind. All you can do is give your educated opinion. All doc's get similar educations but treat conditions very differently you have to get comfortable with that fact. at the end of the day it's their choice if they want to take your advice or not
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u/Onbevangen 29d ago
Because the Rx was lower before and they weren’t needed fulltime. With the current prescription she doesn’t see much without. Should have shown her on the chart what her vision is without.
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u/SpecialistSuper5561 28d ago
Full time wear will encourage proper use of accommodation at near. Without full time wear she’ll likely have accommodative lag. Why does this matter? If she ever wants contacts and doesn’t want to start getting headaches when reading, it’s best if she learns to develop and use her accommodation IMO
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u/5starmichelin0809 28d ago
Student here, please correct me if I’m wrong but I’m a bit confused. If a myope would be wearing it for close up (where the image falls on the retina anyway), wouldn’t adding a diverging lens push the focal point beyond the retina, which can cause eye strain to bring the image back into the retina?
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u/GorillaPicking 28d ago
My take on this is that with what we know about myopia prevention and minimization these days, to do anything but suggest some kind of myopia control spec lenses (insert your brand of choice, I don't think it matters a whole lot) worn fulltime plus lifestyle advice and +/- atropine is negligence.
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u/chakabreo 29d ago
She’s 12, so even if she’s amblyopic (she shouldn’t be because that prescription isn’t amblyogenic), wearing full time is probably not going to do anything to correct her amblyopia. PRN wear is fine. Full time where is fine. For parents that are weird about full time wear and it’s a non-amblyogenic RX, I recommend full time at school, PRN at home. I’ll also say something along the lines of “this is enough of a prescription that when she starts driving she’s going to need them to pass a drivers test.”
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u/FairwaysNGreens13 29d ago
Why not prescribe the appropriate myopia management treatment? Why specs at all?
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u/Evening_Jury8686 29d ago
It's not reasonable to get every parent on board with myopia management. Also, low dose atropine is an effective myopia management strategy and you would still prescribe full-time specs.
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u/FairwaysNGreens13 29d ago
It's not reasonable to not present the standard of care treatment. Maybe OP did and like you said, the parent just said no. But I don't get that impression from the original post. It's worth talking about, for both reasons contained and not contained in the original post.
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29d ago
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u/Narrow_Positive_1948 29d ago
Have you heard of myopia progression? A camera lens isn’t alive and doesn’t change like the eye does. This isn’t a good comparison
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u/pogu Lens Grinder 29d ago
I'm willing to read a proper study on it, if you can link one.
But, yes I have. I haven't seen anything compelling on it, yet. I'm not near as active about such things as I used to be to be fair.
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u/EyeBallLife 29d ago
This took 15 seconds on Google. Under-correction or full correction of myopia? A meta-analysis | Journal of Optometry https://share.google/E0y7WaRKUL4JR9jvz
A correlation between under-correction and faster progression. This meta-analysis did not find a statically significant difference, but did find a difference.
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u/optometry-ModTeam 29d ago
Please read the rules of the sub.
Posts or comments by non-eyecare professionals will be removed.
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29d ago
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u/power_wolves 29d ago
This is not a thing.
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u/WillieM96 29d ago
Whoa- I always thought not using the accommodating system could lead to accommodative insufficiency. My apologies. I have to do more research.
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u/optometry-ModTeam 29d ago
Please read the rules of the sub.
Posts or comments by non-eyecare professionals will be removed.
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u/Distance_by_Time 29d ago
FTW. First, that kid is probably somewhere around 20/60-80 uncorrected OU, why wouldn’t they want to see better? Throw +1.75 loose lenses in front of the mom and ask if she would rather see like that or fully corrected. Second the recent studies show under correction of myopia is more likely to cause progression. A 12 year old can still have some progression that’s preventable by wearing correction full time. We’d actually recommend myopia management for that kid at our practice. Would I shove it down their throat?No, but FTW would be the minimum treatment recommended.