Myopia Management in Focus:
A 2024 Survey Report on UK Parental Awareness and Attitudes
Authors:
Jason Higginbotham - Managing Editor Myopia Focus
Richard Kadri-Langford
Dr. Neema Ghorbani Mojarrad
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Most parents were aware of myopia as short-sightedness, but fewer were familiar with the term ‘myopia.’ Awareness of myopia management was very low, with optometrists being the main source of information. Concern about myopia diagnosis increased with additional information and awareness of potential risks.
Willingness to seek myopia management was high but influenced by cost and treatment duration, although these weren’t the most significant factors. Overall, the survey underscores the importance of continued efforts to raise awareness, provide education, and address barriers to myopia management, ensuring the well-being of children’s ocular health.
Contents
Chapter 1
Introduction
In recent years, myopia has emerged as a significant public health concern, not only in the UK but globally. Characterised by a refractive error that impairs distance vision, myopia’s prevalence has been on an upward trajectory, especially among younger populations. This trend underscores the necessity of understanding and effectively managing myopia from an early age. Apart from the inconvenience of blurred vision,however, the major concern is the long-term risk of sight-threatening ocular conditions which become more prevalent in people with myopia and especially high myopia.
Recognising this, Myopia Focus, alongside other organisations, has been working diligently to raise awareness of myopia among parents and the public. As a part of this effort, in 2023, Myopia Focus conducted a survey to gauge parental awareness and attitudes towards myopia management, considering the crucial role parents play in decision-making about their children’s eye healthcare. Following the insightful findings of the 2023 survey, Myopia Focus conducted a follow-up survey in 2024 to further investigate these trends and build upon the previous year’s findings. This was done with the aim of exploring how parental awareness and attitudes have evolved over the year. Understanding these dynamics is vital for developing effective strategies to combat the rising incidence of myopia and ensuring the well-being of future generations.
By examining parents’ perspectives, this report provides valuable insights into public perceptions of myopia, awareness of management options, and potential barriers to accessing treatment. These insights are crucial for healthcare professionals, policymakers, and other stakeholders. They offer a foundation for shaping responsive and effective myopia management approaches, tailored to meet the needs of families and the broader community.
Chapter 2
Methodology
The 2024 Myopia Focus survey was designed to capture an understanding of parental awareness and attitudes towards myopia management. This section outlines the methodology used to conduct the survey, ensuring the reliability and validity of the data collected.
Survey Design and Questions
The survey consisted of a series of structured questions, focusing on various aspects of myopia awareness and management. The questions were formulated to elicit clear and concise responses, ranging from multiple-choice to Likert-scale formats. This approach allowed for both quantitative analysis of straightforward choices and qualitative insights from more open-ended responses.
Population and Sample Size
The survey targeted a demographically diverse group of parents across the UK. Efforts were made to ensure a representative sample, encompassing a wide range of socio-economic backgrounds, geographic locations, and parental age groups. The final sample size comprised 200 respondents, providing a robust data set for analysis and allowing for year-on-year comparison.
Data Collection Method
Data was collected through an online survey platform, which allowed for a wide-reaching and efficient means of gathering responses. Participants were recruited through Prolific, an online platform which helps distribute the questionnaire to participants. These participants are provided with a small incentive for their time to maximise engagement.
Ethical Considerations
All survey procedures were conducted in accordance with ethical standards. Participants were informed about the purpose of the survey and gave clear consent at the start to take part.
Data Analysis
The data was analysed to draw meaningful conclusions. Quantitative data from closed-ended questions were analysed for trends and patterns, while responses from open-ended questions were thematically analysed to extract deeper insights into parental perceptions and concerns.
Chapter 3
Survey Demographics
In total, 201 parents attempted the survey. Of these 200 indicated there had a child or were responsible for a child under the age of 16, with the other one person indicating no, and who then no longer contributed to the results. Here the results for the full sample of parents will be presented, with more attention given to more relevant aspects of the survey.
Demographic Features of the respondents/parents who completed the survey:
Eighty-one (41%) of respondents indicated that their child had been previously diagnosed with myopia, which is slightly greater than the expected proportion of children in the UK, estimated at up to approximately a third of children1,2. This may mean that some of the views reported in the survey are more representative of parents from more urban locations, or those from higher-socioeconomic backgrounds (with the latter being likely here due to the self-reported family income being higher than some estimated averages across the UK).
Chapter 4
Awareness of Myopia and Myopia Management
97% of parents indicated they were familiar with the terms ‘near-sightedness’ or short-sightedness’, indicating some awareness of ocular refractive status. However, just over a third of respondents (35%) indicated they had not heard the term ‘myopia’ before starting this survey. For parents who had myopic children, 100% indicated they had heard of ‘near-’ or ‘short-sightedness’, but a similar proportion (28%) still indicated they were not familiar with the term ‘myopia’. This is interesting as it indicates that more parents than expected have heard or/are generally familiar with the term myopia, although this does not include everyone, and that it doesn’t appear to vary as such with the refractive status of the parent. Nevertheless, the understanding of what it may mean, and awareness of refractive statuses in lay terms is relatively common.
Despite this awareness, the majority of parents surveyed (92%) indicated that they had not heard about myopia in any news or press articles, and this didn’t change much for parents with myopic children (90%). Those who had read myopia- related news were not sure where it was from, although the majority suggested it was likely the BBC.
A search of the most recent BBC items about myopia finds a few that they may have been referring to:
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Lockdown screen time sees rise in short-sightedness among children - View
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Why short- sightedness is on the rise - View
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Doctor claims screens are damaging children’s eyes - View
This generally indicates that the awareness of myopia, as short- sightedness, in the general public is high, but that recent recollection or information about myopia is not a usual consideration.
97%
indicated they WERE FAMILIAR with the terms ‘near-sightedness’ or short-sightedness’
35%
indicated that they HAD NOT heard about’ the term ‘myopia’ before
92%
had not heard about myopia in any news or press articles
Before starting this survey, had you heard of the term 'myopia'?
Have you heard 'myopia' mentioned in any news or press articles?
The majority of parents surveyed (92%) indicated that they had not heard about myopia in any news or press articles
72% of myopia awareness driven by optometrists
Results for awareness of myopia management were of interest
Of the parents sampled, 18% indicated they had awareness of the intervention through either their own experience (which given the age of our sample demographic and the fact that myopia management has only been licenced in the UK relatively recently is likely meant to refer to their experience with their child, or a child within their family), or through a child’s experience. Only 3 indicated they knew about myopia management through their friends, with 81% indicating they weren’t aware of it. For parents with myopic children. 14 (11%) indicated they were aware of myopia management through their own or a child’s experience, with 70% indicating they hadn’t heard of myopia management before.
For all parents that were aware of myopia management, it indicates the large majority were informed by their optometrist (72%), with the rest indicating it was through other means. This is encouraging in the sense that the optometry profession is trying to make inroads into this lack of public awareness, but there is also evidence that the profession is not doing enough to educate patients on myopia and myopia management. This distribution of answers was also replicated in the sub-sample of parents with myopic children.
Overall these results suggest that the awareness of myopia management is still less than hoped. It suggests that more than 50% of parents, including 70% of parents with potentially eligible children for myopia management were not aware of its availability. This is a significant finding, as it suggests that one of the greatest barriers to uptake may be public awareness, which has been reported in qualitative research.3
This is despite the fact that over 50% of the sample suggest they take their children to sight tests regularly with an optometrist (see below), which provides evidence that myopia management could potentially not be actively discussed with all relevant children and their parents, or that it may not be something delivered in a ‘take home message’, which again echos results from eye care practitioners.3
Chapter 5
Near Work and Time Outdoors
New questions in the 2024 survey looked at parents attitudes to screen time, and getting their children outdoors. These were discussed due to the studies that have indicated/suggested that there are significant links between these lifestyle factors and behaviours and the risk of myopia.4
For total screen time, parents indicated the average amount of time spent for their children was about 2-4 hours (40%), however just under 25% of respondents indicated it was either 0-2 or 4-6 hours a day. Interestingly, 2 parents reported they weren’t sure how long their child spends on a screen, and one parent indicated that their child was on a screen for more than 8 hours.
Most parents indicated that they do try to limit and monitor screen time (91%), with 60% saying they attempt a reasonable amount, and 11% indicating they were rather strict about screen time allowance.
54% of Parents reported that their child spent 1-2 hours per day outdoors
Parents mostly reported that their child spent 1-2 hours per day outdoors (54%) with the second greatest number being 24%. Parents with myopic children appear to indicate a similar pattern distribution of time spent outdoors for their children. A similar distribution in the entire group and subsample of parents with myopic children was seen for their response to whether 2 hours outdoors was feasible. 49% of all parents indicated that it was a realistic target with some effort.
Still, intriguingly, 40% indicate that they believe 2 hours outdoors a day is either not at all realistic, or unrealistic to attempt every day. This may be a factor to consider additional exploration – nearly half of parents believe that 2 hours outdoors a day isn’t achievable on a regular basis. This could be due to the weather, time constraints, living situations or other unexplored factors, but nevertheless may warrant investigation due to the fact that time outdoors has been shown to have a significant effect on time outdoors, and there appears to be a barrier to facilitating this for parents.
Note however, that this data cannot be stratified on the age of the child, or any other factors, and therefore these summary statistics on time outdoors and close work cannot be explored in further detail. The questions also may have carried assumptions that parents could not know the answers of in order to feedback more clearly e.g. whether the 2 hours of time outdoors was all outside of school or included breaks and lunchtime.
Time outdoors is significant to consider for these, parents. A meta-analysis and systematic review from City University, London, showed that time spent outdoors was protective against the onset of myopia, but once myopia progression had commenced, outdoor time did not make significant changes to the rate of myopia progression.
Chapter 6
Parental Attitudes to Eyecare and Myopia
Parents in the survey were also asked how often they take their children for a sight test. In the UK, annual sight tests are permitted for free via the NHS, with more regular tests available if there are reasons to do so e.g. the patient is likely to expect more regular changes to their prescription.
58% of the sample reported that they take their children annually or every 6 months, and this was higher in the sub-sample of parents with myopic children (86%). However, 21% indicated they bring their children less often, with 18% of the sample saying they rarely or never brought their children in for a sight test. This corresponds with some of the reports that indicate that up to 40% of parents do not bring their children for annual sight tests. For the parents with myopic children, 1 parent indicated they rarely or never take their child for an annual eye examination.
Most parents (74%) indicated they take their children to a high street brand eye care provider (mostly indicating a nationwide chain, as the other options indicate Independent Eyecare Professional), which is in line with the current market share of optical service providers in primary care. 56% advised that they would only use NHS services to pay for eye care provision for their child, which likely includes both sight test provision and optical correction. 8% indicated they used private costs only, with under 20% indicating either or a mixture of the two (likely as additional costs for additional services or provision of optical appliances like contact lenses or greater cost spectacles).
Nearly half of parents believe that 2 hours outdoors a day isn't achievable on a regular basis
For parents who had children with myopia, they were asked additional questions to provide context of their experience and opinions. When asked whether they were concerned or not when they were told their child was myopic, 58% indicated that they were not concerned about this, with the other majority 41% indicating they were concerned at the time for their future eye health and vision. This corresponds with the additional Likert scale question which gave an average rating from 1-5 (with 5 being the most concerned) of 2.72 (a median of 2), with only 28% putting a score of 4 or 5. This result indicates that parents are potentially unconcerned with myopia and a diagnosis of myopia, however it’s important to contextualise; the most common answers given are not always representative of everyone’s experience; the results here indicate that a significant proportion (up to 41%) of the sample were concerned to some extent about their child’s diagnosis of myopia.
Results from practitioners has indicated that they can sometimes report to feel desensitised to the presence of myopia or myopia onset in children,3 and worried parents may not get the reassurance that they need. Nevertheless, most parents do not appear to be concerned at the point of diagnosis, nor at the point where they are told they need to wear optical correction, this appears to be somewhat related to the fact that they are unaware of some of the risks associated with myopia.
After looking at a table from the Myopia Focus website (adapted from Flitcroft 20125 ) on associated increased risk of ocular diseases, 68% of respondents indicated they were more concerned, with 30% indicating there was no change in their concern. It may be that these individuals were those that reported they were concerned already (and thus there was no change in their concern), but individual change analysis was not possible on the data. As an important factor, it appears that when presented with data of increased pathology risk, most parents do acknowledge this, and share greater concern for the presence of myopia. This implies that discussions about myopia and its associated risks are important, however practitioners may feel uneasy about causing this level of concern or delivering such bad news,3 sometimes unnecessarily, as the majority of myopes do not develop visual detriment despite their relative increase in risk.
After viewing this data 68% of parents were "more concerned" about myopia
Modified from Global Myopia Symposium 2020 and other publications.
Parents with a non-myopic child were also asked how concerned they would feel about their child being diagnosed with myopia. The score on a 1-5 likert scale was 2.72, generally indicating only mild to moderate concern, with only 7 indicating a 5 score of very concerned. After this, as per the parents with myopic children, they were shown data about the additional risks for associated sight pathologies. They also then reported a similar 75% of parents being more concerned than before, with a quarter indicating this did not change their level of concern.
Parental attitudes towards myopia can dramatically shift when they fully grasp the potential long-term implications for their children’s eye health
Eye Care Professionals (ECPs) face a delicate task: they must inform parents about the severity of myopia without causing undue alarm. This balance is crucial because an overly alarming message might deter parents from engaging positively with eye care services. Resources such as Myopia Focus can play a pivotal role here. As an independent platform, Myopia Focus provides balanced, well-researched information that allows parents to understand the risks and benefits without feeling pressured. This independent resource helps parents make informed decisions based on comprehensive data rather than fear-driven reactions.
Results from various surveys indicate that practitioners sometimes feel desensitised to the onset of myopia in children, potentially leading to a lack of reassuring communication to worried parents. This desensitisation can result in parents remaining unconcerned at the point of diagnosis. However, when parents are shown data about the increased risks of associated sight pathologies, concern significantly rises. For instance, after reviewing information from the Myopia Focus website, 68% of parents reported increased concern about myopia. This underscores the importance of clear, informative messaging that educates without causing panic.
These latest findings indicate that the responsibility of educating still falls on eyecare professionals. Despite updated guidance from professional bodies on assessing myopia risk and discussing appropriate interventions, most parents are still uninformed. Are eyecare professionals not adhering to the latest guidance or is it our communication falling short of getting the message across?
Corrina McElduff BscHons MCOptom FBCLA
Director of Professional Affairs, Ocumetra
Chapter 7
Interest in Myopia Management
Further questions to parents with myopic children were delivered to ascertain if they were given advice or recommendations about managing myopia, however 58% of parents indicated they were not told anything specific, with up to 10% admitting they weren’t sure if any advice was delivered.
This, alongside prior responses about the awareness of myopia management indicate overall that, although optometrists and primary eye care practitioners are the largest source of information for myopia and myopia management awareness in parents, they still do not achieve great awareness among the public, including parents of children who could benefit from these treatments.
The updated College of Optometrists guidance released in 2022 indicates that although you do not have to provide myopia management treatments, it is recommended that practitioners should be able to explain and discuss all management options for myopia with all relevant/eligible children. (www.college- optometrists.org), including single vision correction and myopia management treatments.
However, from the reports here, despite most parents here attending annual eye examinations, this does not appear to be happening, including for those with myopic children.
For the 11 participants that indicated they currently had experience with myopia management, 82% were using myopia management spectacles.
For the 11 participants that indicated they currently had experience with myopia management, 82% were using myopia management spectacles.
One child was fitted with orthokeratology, and the other had a child using off-licence atropine. Interestingly none of the sample were using licensed contact lenses or combination therapies. Red light therapy, being a new emerging therapy that’s licenced, also wasn’t mentioned, likely because as yet it is still not widely available.
This subset of participants were then asked how much they pay for myopia management per month. Due to the small size of this subset and given that most participants indicated they use myopia glasses, which are usually purchased with a one-off cost the result is difficult to analyse. More research into the impact of cost on adoption would be of interest.
Interestingly, it seems that most parents indicated that it’s too early to say if their children had seen any positive results (73%). No one indicated they hadn’t, but for all others (27%), they indicated that they had seen positive results. This potentially suggests that they may have thought this a worthwhile investment, as they believe the results they’ve had are positive and beneficial.
The results additionally show that parents were not aware of the growing prevalence of myopia, with 92% indicating they were not aware until watching the accompanying video. This was less so for high myopia, as 28% indicated they were either aware, or somewhat aware of the greater risk of eye disease in later life for high myopia, however this may be an artefact due to question design, as there was an additional option for those unsure of whether their knowledge would qualify for full understanding of this previously. 82% indicated clearly that they were not aware that myopia management treatments were available to reduce the risk of myopia progression, parallel to the prior query about whether they had heard the term myopia management above.
Discussing the risks with parents does appear to have an impact on the parents interest in myopia management, as 65% of parents indicated they would be more likely to consider myopia management after this, along with 28% much more likely to.
WCO: Putting Myopia Management Standard of Care into Action
Optometrists, public health governmental entities and the World Health Organization are recognizing the urgent need to address the global myopia epidemic. Historically the most common recommendation to address myopia in a child or teenager is to simply correct the refractive error without treating the underlying growth. Scientific evidence is identifying new ways to control myopia progression.
Earlier this year, the World Council of Optometry (WCO) announced its global partnership with CooperVision to raise awareness of myopia and the need to use the evidence to improve treatment and outcomes. The collaboration encourages optometrists to embrace active management with evidence-based approaches as the standard of care.
The WCO furthered its commitment by unanimously adopting a resolution advising optometrists to regularly and consistently offer scientifically proven myopia interventions within their practices. While the WCO recognizes that it takes time and resources to achieve the change we are striving for, there are three main components that all optometrists should embrace as first steps toward curbing this public health issue—the three “M’s”:
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Mitigation — optometrists educating and counseling parents and children, during early and regular eye exams, on lifestyle and other factors to prevent or delay the onset of myopia.
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Measurement — optometrists evaluating the status of a patient during regular comprehensive vision and eye health exams, such as measuring refractive error and axial length whenever possible.
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Management — optometrists addressing patients’ needs of today by correcting myopia, while also providing evidence-based interventions (e.g., contact lenses, spectacles, pharmaceuticals) that slow the progression of myopia, for improved quality of life and better eye health today and into the future.
Chapter 8
Factors of Interest for Considering Myopia Management
When investigating what factors would be important for parents considering myopia management, the top two factors appear to be the advice of the optometrist, along with the presence of any long-term risks. Relevant facts and figures and ease of treatment were closely related to as important too, with the next two factors being the comparison of their child’s prescription compared to the average of their age, and the cost and affordability.
Interestingly, the opinion/consideration of the child was the lowest-ranked option. It’s important to note that parents, through this survey, report that all of these factors are at least somewhat important, though there are potential differences relatively, all factors listed were given a score of 3 or above, indicating they were all of some relevance to the factors they would consider for myopia management.
79% of parents indicated they believe that myopia management treatment should be available through the NHS, with only 5% indicating that it shouldn’t be, and the rest unsure. This may be due to the fact that the majority polled would typically use only NHS services as per a previous question. However, it may be that the general public would assume that NHS provision would be expected for this. It also corresponds with how much parents believe they would think is a reasonable amount to pay per month, with the majority (39%) putting the lowest cost category of 0-10 pounds per month, and a cumulative 80%+ of parents indicating they wouldn’t expect to pay about £30 per month.
Additionally, the survey asked about the potential application of biometry. The survey asked that, if a non-invasive test for measuring biometry was available in schools, would parents be interested in choosing this test for their child. 95% of parents indicated they would be interested, whereas 1 person would not, and the other 9 (5%) were unsure. Interstingly an additional question asked about the cost of this and in particular how much parents would be willing to pay for this test. Just under a third (30%) indicated they would not be willing to pay and selected £0. But up to 45% indicated they may be willing to pay a small amount, of up to £20. A small number indicated they may be willing to pay more, with 6% of participants selecting the £45-50 option.
Chapter 9
Conclusion
Overall, in summary, it appears that the general public are aware of shortsightedness as a condition, but are not aware of the implications of it, nor are they fully aware of myopia management availability and what this may include. The results also suggest that parents would show greater concern and interest in myopia management if they were aware of the information and increased risk profile it comes with for sight loss. Parents would sometimes consider paying for myopia management, particularly if it appears that it’s safe, within their budget, and demonstrates minimal long-term risk.
Further investigation into their answers and insights and understanding of myopia management would be beneficial to learn more. However, more needs to be done to raise awareness at a national level. The duty of care to patients is increasingly being recognised as paramount. From anecdotal feedback, we know that some Eye Care Professionals (ECPs) find it difficult to discuss myopia management due to various factors. These include the inability to deliver the service, concerns about offending parents who perceive the cost to be an issue, or the lack of time and resources to provide myopia management, which is often viewed as time- consuming and not cost-effective from a business perspective.
The lack of parental awareness and the challenges faced by ECPs often compound each other, hindering the uptake of myopia management. ECPs play a critical role in raising awareness and are trusted by both patients and parents. Therefore, it is essential to support ECPs in overcoming these barriers to better communicate the benefits and availability of myopia management.
As for parents, further investigation into ECPs’ answers, insights, and understanding of myopia management would be beneficial to learn more and to develop strategies that address these challenges effectively.
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Appendix
The Virtuous Circle - Evaluating and Enhancing Myopia Awareness for clinicians - 2024 Survey Results
In this video, Jason Higginbotham, Managing Editor of Myopia Focus, presents the findings of this survey: "Myopia Management in Focus: A 2024 Survey Report on UK Parental Awareness and Attitudes." In the video Jason builds on the insights from our 2023 survey, highlighting significant trends and changes in parental awareness and attitudes towards myopia management over the past year.
References
-
McCullough SJ, O’Donoghue L, Saunders KJ. Six Year Refractive Change among White Children and Young Adults: Evidence for Significant Increase in Myopia among White UK Children. PloS one. 2016;11(1):e0146332.
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Wong K, Dahlmann-Noor A. Myopia and its progression in children in London, UK: a retrospective evaluation. J Optom. 2020;13(3):146- 154.
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Coverdale S, Rountree L, Webber K, et al. Eyecare practitioner perspectives and attitudes towards myopia and myopia management in the UK. BMJ Open Ophthalmology. 2024;9(1):e001527.
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Morgan IG, Wu P-C, Ostrin LA, et al. IMI Risk Factors for Myopia. Investigative Ophthalmology & Visual Science. 2021;62(5):3-3.
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Flitcroft DI. The complex interactions of retinal, optical and environmental factors in myopia aetiology. Progress in Retinal and Eye Research. 2012;31(6):622-660.
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Dhakal, et al. Ophthalmic and Physiological Optics. 42(3), pp 545 – 558 (2022))
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