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).

In 2003 I completed my contact lens externship. It was a chance to see how contact lenses helped a variety of patients in different settings. The majority of these patient encounters were relatively routine in that I was determining the contact lens that provided the patient with clear vision. Some people simply needed a modification of their current contact lens prescription, some were having difficulty with their contacts for astigmatism, and others were experiencing multifocal contact lenses for the first time.

But there were also some special patients that were trying something that at the time was new and exciting: Precise Corneal Reshaping (PCR). Although it goes by many names, including othokeratology, PCR is the wearing of a reshaping lens (similar to rigid gas permeable contact lens) during sleeping hours to mold the cornea and elimate the need for daytime glasses and contacts.

When orthokeratology was first created in 1962, it was rather crude and unpredictable. The process was refined over time but it has only been in the last 5 years that we have seen a trememedous increase in both scientific studies and utilization of PCR. In 2002, Corneal Refractive Therapy ™ (CRT) by Paragon was the first modern system to receive FDA approval. In those days there were very few practicioners doing CRT and I was lucky enough to have this expereince early on.

In the last year I have been asked several times if I am still providing this service. Well, after some work and investment in equipment, I am happy to announce that Bright Eyes Family Vision care is now offering PCR for eligible candidates! We are the only eye care office in Westchase and one of the few in Tampa to offer this service.

Who is an eligible candidate? Well, the procedure can correct myopia (nearsightedness) with or without some astigmatism. It is approved for all ages and is reversible, so it can be prescribed for kids and teens as well as adults. Since PCR changes the shape of the cornea, candidates must have healthy eyes and corneas that will respond to the treatment. Through a series of tests, such as computerized corneal topography, I can determine whether or not a patient will be a good candidate. Because not everyone is a candidate, we are offering the PCR Pre-Evaluation at no charge. This also gives patients (and parents) a chance to ask questions before deciding on the procedure.

PCR will be a great vision correction option for active adults – no worries about contacts while swimming, biking, playing sports, etc. It will be great for kids and teens – no worries about breaking glasses or losing contacts, since the reshaping lenses stay at home and are only worn at night.

In time, I will write about some of the latest research about PCR slowing the progression of myopia, but if you have any questions, you can always call the office for a patient information packet. You can also attend one of the seminars that I will be offering on November 8th, and 15th. Call 813-792-0637 for more information.

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