My colleagues and I think and talk about myopia (nearsightedness) every day. We talk about the drawbacks (and rewards) of being myopic. We talk about the causes and treatment options for myopia, both short and long term.

But I have never seen a day like today, with myopia in all the papers and on every major TV news program. Given how quickly news travels today, the total number of people thinking and re-thinking about their eyes and vision is probably higher today than it has ever been!

Yesterday morning, I received an email about a newly released study, “Increased Prevalence of Myopia in the United States Between 1971-1972 and 1999-2004.” While I take it as common knowledge that nearsightedness is increasing in much of the world, including the United States, even I was stunned to see this headline about the study: “Myopia Prevalence Rose 66% over 30-Year Period” There is no way around it, a 66% increase is a lot!

So I posted the link on Twitter and Facebook, but I didn’t really have the time to dedicate to the study until today. And then the really big news hit. There are stories on myopia on  NPR, Discover,  the LA Times, and video segments on Good Morning America and local affiliates such as these and these.

So since this is such a hot topic today, I’ll share what I tell patients almost every day at the office.  But first let me say this:  while vision science has advanced tremendously, and we have a better understanding than ever, there still is a lot that we do not know about the details of nearsightedness and its development. And, although this may shock you to read, there are some less-than-ethical people who will claim to have all the answers and will say with a straight face that they have THE ONLY WAY to either prevent or eliminate nearsightedness or glasses. The truth is that we don’t know exactly how this works and we can never make promises because what may work for 1000 people may not work for you.

But we can say some things about myopia more generally. There is a genetic component for sure, but just because you and your spouse are nearsighted is not a guarantee that your children will be . In fact, there may be more commonly a genetic susceptibility than an actual myopia “gene.” And clearly there are other factors involved because while the population is changing (due to aging and immigration) our US genes haven’t changed that much in 30 years, but our eyes have!

So, as many of the links above point out, our lifestyle can have an impact on vision. Our eyes are inherently best-suited for looking off into the distance. This is easy and natural. Yet today we spend an increasing amount of time and effort focusing within arms-length and in some cases just a few inches. And while we have always had (and will continue to have, I hope) kids and adults with their noses buried in bound books, the truth is that intensely playing tiny video games or texting does require more visual effort. And I can attest from seeing patients at Bright Eyes that children are engaged in these activities at younger and younger ages.

So – if a patient has increasing nearsightedness, or seems predisposed to be nearsighted what are the options? Here  are the refractive options from least to most aggressive.

• Do nothing. Some people prefer to not take any action because they do not have need to see better at a distance and they prefer the vision up close. This is totally reasonable, as long as it is an educated choice and not just by default or neglect. However, this is not itself a treatment for myopia and in fact may promote myopia in the long run.
• Traditional glasses or contacts. This will help a patient see clearly in the distance which is necessary for things like driving or going to school which are important. But it will not address any underlying problems leading to increasing myopia.
• Bifocal Glasses. This method was more popular in prior decades to slow down myopia progression. The scientific studies have not shown it to be as helpful generally, but may be for a  subset of people with specific visual problems.
• Multifocal soft contact. There is small but growing evidence that multifical contacts, like Proclear EP, can provide clear distance vision and limit the progression of nearsightedness.
• Orthokeratology (Corneal Reshaping). There is several scientific studies that have shown that this can provide safe, clear daytime vision, and slow or stop progression of myopia. You can read more about this here. And I have written more about this here.
• Atropine drops. This method of myopia control involved the use of prescription eye drops to keep the eyes dilated. This has been used for years and is more popular in Asia, but has not caught on in the US, due to side effects.

But regardless of which method is employed above, it is wise to take frequent, brief breaks from near work. Looking up and away every 15 minutes or so is a good idea, because there is some evidence that it is not the total time during near work, but the length of the individual periods of work that make a bigger difference. Getting outside more is a good idea, but it is not clear if it is the distance vision, sunlight, or some other benefit. Of course, this is true not just for your eyes, but for your body and mind, too!

As vision professionals, we clearly have much work to do in understanding more about why and how myopia occurs. But it is exciting to know that there are treatment options that can reduce the likelihood of progression.

If you have concerns about your vision or if your children have not been thoroughly evaluated, call us at 813-792-0637 to schedule an appointment. After reviewing the examination findings, we can discuss concerns and treatment options that may be right for you.

Be well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
Westchase, Tampa, FL
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(Edited to fix a few typos and add some info left out).

[ I haven't written much for the blog in the last couple of weeks. Mostly I've been busy with Javier and Nora. You can see some of Javier's pictures  on Flickr here: http://bit.ly/1MFiuw - Dr. B].

I am very excited to bring you this interview with Nick Despotidis, O.D. (Dr. D). He is one of my mentors in the orthokeratology/corneal reshaping field. He has written, researched, lectured on the subject for many years. I have attended several of his lectures and have always been impressed with his insight and enthusiasm. I was even more impressed when I read his book “My Children are Nearsighted, Too.” Dr. D practices in Hamilton Square, New Jersey.

Dr. B. Writing a book takes a lot of effort. What prompted you to write a book and not just a large pamphlet?

Dr. D. : As health professionals, we often get asked similar questions from patients. However, nothing seems to elicit as much emotion as when parents are discussing their children’s vision. Seeing the concern or sheer disappointment on a parent’s face when I tell them their child needs glasses still moves me, even after twenty years in practice.

Parents often ask: “Why so young? Do they have to wear glasses all the time? Is this inherited? Is it going to get worse? What can be done?” My explanation and subsequent recommendations take time, time we often don’t have while in the examination room, yet parents deserve.

So now I actually give my patients a copy of our book and highlight specific sections I want them to read. Then, after they develop a good background and learn the answers to many of their questions, we discuss how to help their son or daughter. It’s worked amazingly well. I’m very proud after parents tell me how much the book has helped them understand vision and given them an arsenal of recommendations.<

As a parent myself I appreciate the frustration of being told my child requires some type of treatment without fully understanding my options. The book was written to empower parents when it comes to their children’s eyesight.

How long did it take for beginning to end?

Two years!

As an early adopter of corneal reshaping, did you initially suspect that myopia control was going to be as successful as it has recently been shown to be?

No. In 1992 when it was first introduced into our office it was just viewed as a substitute for daytime contact lenses or glasses. That’s it. We reserved recommending corneal reshaping for patients who could not wear contacts during the day or required freedom from contact lenses or eyeglasses during their waking hours. So we had a lot of athletes, teachers and executives wearing the lens, but it was a select few.

However, clinically we observed that teenage athletes wearing the lenses did not need changes to their prescription every year like many of our eyeglass or contact lens wearing patients. In 1998 when my own two sons began wearing eyeglasses, that’s when the light turned out. You see, even though I prescribe eyeglasses daily, when my young children needed eyeglasses, I was upset, even distraught. Seeing the success they’ve had with corneal reshaping inspired me to become an “early adopter” or advocate of this technology.

If corneal reshaping is such a positive and exciting technology, one that may help thousands of young children from having their eyesight worsen, why don’t all doctors provide this service?

That’s a great question, one I get asked daily! Most eye doctors are not familiar with corneal reshaping even though Paragon Vision Sciences, the maker of the CRT design, received FDA approval over 9 years ago! Some doctors may base their opinion on outdated information or personal experience.

As a “seasoned” health provider I understand how long new procedures take to enter mainstream medical offices. But that does not make it fair or right. For example, it took over 30 years for data to arise that a child’s eye coordination skills may affect their ability to read and consequently learn. Even though I understood this in my early training days it took decades to become “accepted.” And even today some practitioners are not on board.  Corneal reshaping faces the same challenge. In addition to understanding the technology, doctors need to enjoy seeing patients more often than their contact lens and eyeglass wearing patients. This is often not the case.

Lastly, there is a higher level of technology and training required to perform corneal reshaping properly. Doctors may not be interested enough to upgrade their offices to provide this service.

I personally overcame these apprehensions when I saw how well corneal reshaping helped my own sons. Now, literally 10 years after they started wearing these lenses, their eyesight has not gotten worse. Nothing more needs to be said.

What is your next project?

I’m writing a personal development book extolling the life lessons I’ve acquired as a husband, parent, doctor and philanthropist.

Thanks, Dr. Despotidis, for taking the time. I wish yoy, your family, and your patients the best.

You can read more about Dr. Despotidis and orthokeratology at: http://www.gentlevisionshaping.com/. If you have questions about whether or not corneal reshaping is right for your or child, feel free to contact Bright Eyes at the contact info below or call 813-792-0637.

Be Well!

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
Westchase, Tampa, FL
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Ahah! I was scooped on this story by one of my favorite bloggers, Ann Z. from LittleFourEyes. I was going to write a post about this exciting news today, but since she already has. Check it out here.

I Will leave you with a quote from yesterday’s press release:

According to Dr. S. Barry Eiden the trial will also investigate why these special lenses may be effective in slowing myopia.

“Current thinking suggests that these CRT lenses flatten the cornea but other evidence suggests that these lenses may influence the growth in eyeball length (termed axial length). A major contributor to progressive nearsightedness is axial length elongation. Corneal reshaping may actually result in decreased axial length growth. The exact mechanism by which this happens is still being investigated” said Dr. Eiden.

“The results of the SMART Study so far are very exciting,” said Dr. Davis. “The outcomes of this study may revolutionize how we manage young nearsighted patients from this point forward”.

You can go to the SMART study facebook page to find more information.You can also watch a news report on the study here.

It should also be noted that the SMART study is building on additional recent studies that have also found that Orthokeratology has been successful in slowly the progression of myopia.

To find orthokeratology doctors in Tampa and elsewhere: go to the Orthokeratology Academy of America. If you are curious, feel free to call or come in for our no-cost consultation to determine if you are candidate.

Be Well.

Dr. Bonilla-Warford
Bright Eyes Family Vision Care
Westchase, Tampa, FL
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