Over the course of two decades of practice, it has become apparent to me that there’s more science and psychology at work when it comes to persuading both parents and patients about the benefits of the eye care services we provide. Myopia management is no exception. As most parents do not present educated about how myopia management can benefit their children, they may voice objections due to the time and cost associated with this important service.

In 1984, Robert Cialdini, an American psychologist, wrote the book Influence: The Psychology of Persuasion. In it, he discusses the 6 principles that affect decision-making, particularly as they relate to consumer buy-in: (1) reciprocity, (2) scarcity, (3) authority, (4) commitment and consistency, (5) liking, and (6) consensus (social proof). Understanding and utilizing these principles, when appropriate, has enabled me to best educate parents to consider and often opt for the service that provides their children with the best vision — in this case, myopia management.

Here, I will highlight how we have used this approach in our practice.

1 RECIPROCITY

People are inclined to return a favor or repay it, in kind, when they are given something. The act of receiving or accepting something (however small), such as a free sample, or a trial offer, influences people to do something in return, including purchasing that which was sampled, Dr. Cialdini notes.

• For optometrists to consider. In myopia management “samples” can include diagnostic lenses that allow the patient to temporarily experience the benefits of contact lenses, sans purchasing them outright. Having a complete fitting set of specific lenses designed for myopia management on hand allows me to place a pair of diagnostic lenses in the child’s eye during the initial consultation. I find that this practice usually confirms the ease of the process and convinces parents to have the child take home a few to practice the insertion/removal procedures. This real-world experience of using the lenses often translates to parent buy-in.

2 SCARCITY

That which is less available or in short supply is seen as having greater value, Dr. Cialdini reveals. This applies to objects (gold, for example), a limited quantity or a “limited time” offer. (I have found that briefly available opportunities appear to have greater value due to their risk of being lost without immediate action.) Further, when a product or service is one of a kind, or when the benefits are unique, these characteristics can also convey scarcity, notes Dr. Cialdini.

For optometrists to consider. In myopia management it’s not the “scarcity of product,” but the scarcity of “time window” that I educate parents on. A typical conversation would be, “Ms. Jones, this lens is FDA approved for children ages 8 to 12. Your son, John, is in the right window for us to commence prescribing these lenses to help slow his myopic progression.”

Another point to consider: If you are one of only a few myopia management providers in your town and you have limited appointments, explaining this may create a feeling of scarcity on the part of the parent. The side effect of this is the implication of greater value on the service, which makes the out-of-pocket cost associated with myopia management more digestible for the parent.

3 AUTHORITY

People are inclined to respond to, respect, and be influenced by authority figures. In some instances, this can extend to the representation of authority, such as wearing the white doctor’s coat.

For optometrists to consider. Titles and white coats are often a given in health care settings. For ODs to truly set themselves apart as authorities in myopia, they can have their receptionists mention the optometrist’s knowledge and credibility in the area, upon answering the practice phones: “Hello? This is Priority Vision. Dr. Eyecare has over 20 years’ experience in myopia management, including several published papers in peer-reviewed journals. How can I help you?”

Discussing studies by authoritative institutions and the endorsement of industry experts during that first visit may also evoke authority in the parent’s mind. I have discovered that this is one of the easiest ways to establish confidence about outcomes. (See “Myopia Prevalence: A Snapshot,” below.)

Also, we have multiple tabs to sites that establish confidence in the myopia management process. Some are a multitude of free online tools and websites that discuss myopia and myopia management:

• Myopia Profile (myopiaprofile.com )
• My Kids Vision (mykidsvision.org )
• Brien Holden Vision Institute Myopia Calculator (bhvi.org/myopia-calculator-resources/ )
• Myopia Care (myopiacare.com )
• Institute for Control of Eye Myopia in Children (myopiainstitute.com )

Myopia Prevalence: A Snapshot

A cross-sectional study of pediatric patients enrolled in the Kaiser Permanente Southern California health plan shows that out of 60,789 patients ages 5 to 19, 41.9% had myopia.¹

 

Additionally, myopia was more frequent in patients age 17 to 19 (59.0%), with Asian/Pacific Islanders and Black patients having a higher prevalence of the refactive condition vs. whites.

 

 

Also, a median neighborhood household income ($25,000 to $40,000) was linked with lower rates of myopia vs. median neighborhood household incomes below $25,000.

 

 

Further, having at least 60 minutes of daily exercise was associated with lower prevalence of myopia (OR 0.87, CI 0.85–0.89).

 

 

The entire cohort received an ophthalmologic or optometric refraction, and electronic medical records were assessed for demographic data, refraction results, and exercise data. The frequency and relative risks of myopia (defined as ≤−1.00 D) were characterized, and age, sex, race/ethnicity, median neighborhood income, and exercise minutes daily were examined as risk factors.

 

REFERENCE

1. Theophanous C, Modjtahedi BS, Batech M, Marlin DS, Luong TQ, Fong DS. Myopia prevalence and risk factors in children. Clin Ophthalmol. 2018; 12: 1581–1587. doi: 10.2147/OPTH.S164641.

4 COMMITMENT AND CONSISTENCY

When someone has said or done something prior, they want to stick with that, points out Dr. Cialdini. Their oral or written commitment to sticking with whatever it is, is the action step to show they will remain true to their decision/conviction. Additionally, that action step shows they don’t want to be seen as inconsistent or even untrustworthy, he notes.

For optometrists to consider. To obtain this commitment, ask. Although asking is surprisingly easy, it can often be overlooked. As one example, young patients who are given instructions may or may not understand what they are being told. But winning their compliance with a course of treatment will be more effective if asked:

“Can I count on you to wash your hands prior to handling lenses/remember to place lenses in your eye 15 minutes before bedtime (in the case of orthokeratology)?”

Small asks like these lead to large behavioral changes. Since the commitment part of this process rests on the patient, our practice has created a mini-contract that we have the child read and acknowledge with their initials. The contract includes bullet points like, “I promise to wash my hands before handling lenses,” and “I promise to wear my lenses for 7 hours at night.”

5 LIKING

People are more easily persuaded by the requests of people they like, asserts Dr. Cialdini. Likeability can be a similarity to themselves (age, appearance, interests), having mutual goals, and appearance of truthfulness, among other factors.

For optometrists to consider. The social media platforms’ “like” and “follow” options are, not surprisingly, examples of the principle of liking. In the optometric practice, people tend to like and respond to situations in which they feel a benefit is derived from a provider through a service or a product. Therefore, to achieve “liking,” it makes sense to identify with the target audience and show how the specific product or service delivers benefits to others like themselves.

For example, when speaking with parents of myopic children, I constantly refer to my teenage son having his nose buried in a digital device and how much it bothers me. Most parents nod in agreement and see my recommendation for myopia management as a validating decision. When I indicate that my son has started myopia management, they recognize that I am treating their child as I would my own. This clearly improves the level of trust they place in me, their primary care eye doctor.

6 CONSENSUS (SOCIAL PROOF)

People emulate others regarding the correct thing to do because what others are doing validates “the right thing.” (After all, if others are doing it, it must be “right”), points out Dr. Cial-dini. I have discovered this is especially true when patients hear about or observe the behavior of others like themselves.

For optometrists to consider. Patient testimonials and word-of-mouth referrals are examples of consensus (social proof), as they come from peers or other members of a target audience.

To utilize the power of consensus to persuade parents to try myopia management, ODs can consider having a practice “wall of success.”

Highlighting through various social media platforms, such as Facebook, also contributes to “social proof.” A caveat: Be sure to have the parent and patient’s permission first.

RECOGNIZING THE BENEFITS

By utilizing Dr. Cialdini’s 6 principles to persuade parents to consider myopia management, ODs can help young patients achieve their best vision — something they and their parents will be grateful for. As he wrote, “People don’t care how much you know, until they know how much you care.” OM

DR. BHAT is the CEO of Union Family Eye Associates, a practice in Matthews, N.C., that he founded 13 years ago. He is a graduate of Elite School of Optometry, India, the following of which he completed a Master of Science degree at the University of Auckland, NZ, and an OD program at the New England College of Optometry, Boston.