Randall Fuerst O.D., F.A.A.O.
Being nearsighted—otherwise known as myopia, is a growing concern in the eye health industry. It's effects are lifelong, and it's rates of occurrence are increasing drastically. Further, suggested links to digital device use have us looking to the future as more and more kids find focusing up close on a phone or laptop a significant part of daily life.
Earlier this month, the American Academy of Ophthalmology issued a statement regarding a global initiative to address the myopia epidemic. EYEcenter joins the eye health community in heightened concern that the coronavirus pandemic may worsen the epidemic of children at risk of nearsightedness. EYEcenter’s Dr. Randall Fuerst weighs in on the subject below, including suggestions to help your children avoid increased risk.
Last year, the CDC issued a report that stated the average US adult is using digital devices approximately eleven hours per day. I ask my adult patients how many hours they are using a computer, smartphone, or tablet—and these numbers are certainly borne out. Research is starting to show a strong causative impact between screen time and eye and vision changes for the worse. Newer research is now showing strong links to sight-threatening diseases—macular degeneration, cataracts, glaucoma, and retinal detachments—all of which can lead to blindness.
A recent 2020 report out of South Korea, where military service is compulsory, stated that 95.1% of 19-year-old males in South Korea measured as nearsighted (myopic). On November 11, 2020, the Academy of Ophthalmology in a joint statement with the American Academy of Optometry noted that in the US the number of nearsighted Americans has doubled in the past 50 years—to about 41.6% of our population. In Asia, the numbers are now at between 80-90% nearsighted.
So Why is This a Problem?
The trends suggest that by 2050, half the world’s population will be nearsighted. The bigger problem is not more people needing glasses or contact lenses. It is that those who genetically are destined to be myopic are starting earlier—and ending up significantly more myopic—a condition called high myopia, or pathologic myopia.
“Myopia needs our focus now”, states Richard Abbott, MD, leader of the Academy of Ophthalmology’s Myopia Task Force. “Kids who develop myopia early in life and progress to high myopia face an uncertain future. They have 50% greater risk of glaucoma, they are 17% more likely to need cataract surgery, and have 6 times greater risk of retinal detachment and retinal tears.”
In a study out of Finland that followed myopic progression for 22 years, researchers found that ‘over 80% of those getting their first myopic spectacles at age 9 become highly myopic.’
“Right now, the world’s myopia rates are expected to be closer to Asia’s by 2050. It’s possible—but not inevitable,” said Donald Tan, MD, a director of the Myopia Task Force. “ Public health officials need to recognize that high myopia is a disease and promote interventions to reduce its overall incidence and slow progression. Action now can change the future.”
The challenge with myopia is that in the early years, you don’t need to wear your glasses all the time due to your vision only being minimally challenged. In fact, it is called nearsighted for a very descriptive reason—you can see well at near—possibly better than with glasses. But, as the months slip into years, and the vision loss progresses, we miss an important window for intervention. Like the age-old adage states, the earlier, the better. There have been hundreds of millions of dollars spent researching how we can slow and possibly even stop the progression of myopia. “There are a number of treatments available, which slow myopia progression. They include drops, special contact lenses, and glasses. Many of these treatments have been around for decades, and some have undergone rigorous clinical trials. The future for newer and better methods is bright with some newer methods already approved in Europe,” states Jeffrey Cooper, OD, MS, FAAO, professor emeritus, SUNY College of Optometry, and one of the foremost myopia treatment experts.
The key, however, is early intervention – a time when most kids and parents look at nearsightedness as a minor irritation.
There are several common-sense recommendations that we make to parents.
|What Has Shown to Be Effective
- Limit screen time.
- Read and work in good lighting. Lower light levels are adapted to visually by increasing your pupil size. Larger pupils, like camera lenses with larger aperture settings, decrease depth of focus. This, in turn, increases the load on the patient’s focusing system, called accommodation.
- Maintain a good working distance from the eyes to the digital device. This should be at least 12”, and preferably, 14-16” away.
- 20/20 Rule – it is easy to spend hours working on near tasks. For hours then, the accommodative system is engaged and active. This ‘rule’ suggests that whenever possible, every twenty minutes, take a 20-second break, look at least 20 feet away to relax your eyes focusing muscles, and blink 10-20 times (extended computer use has been shown to decrease blinking).
- Go outdoors! There are a number of good studies that show that by being outside in the sunlight, there is a decrease in the progression of myopia.
- MiSight Soft Contact lenses—These FDA approved soft contact lenses have been demonstrated to slow the rate of myopic progression by nearly 50%.
- Orthokeratology gas permeable contacts. These FDA approved contact lenses are worn during sleep, flattening the corneal and slowing the increase in axial length- the factors that change in myopia.
- Low dose atropine—an eye drop that has been shown to be surprisingly effective with slowing nearsighted progression. Atropine is one of the world’s oldest drugs known to man. Eye doctors don’t argue as to whether or not atropine works or not, rather, the argument is on what strength is most effective.
Who would have thought, twenty years ago or so, that we would be so incredibly involved with our digital devices? In the past month, I have had several patients reporting that they are on their devices 16-18 hours a day! Twelve to 14 hours daily is not uncommon. When I asked about sleep and eating and how that factors in, patients just shake their heads.
Optometrists and ophthalmologists are being encouraged to push for greater intervention earlier in children’s lives. The concern is that, by waiting and missing the window when a child has low levels of myopia, you allow the more devasting vision loss causing diseases to, in essence, take root. Noel Brennan, MScOptom, PhD, FAAO, and Clinical Research Fellow at Johnson and Johnson Vision Care wrote recently, Our ability to isolate those myopic children who will not become highly myopic later in life is poor. And suppose you did identify a child who has progressed by, say, a diopter or a diopter and a half a year—that’s progression you now cannot take back. And every diopter reduction in progression lessens the risk of myopic macular degeneration (MMD) by about 40%. The risks associated with, say, increasing outdoor time and use of daily disposable myopia control contact lenses are minimal compared to those risks associated with myopia-related complications later in life.
Be sure and ask your EYEcenter doctor about your child’s risks regarding nearsightedness (myopia) and screen time. Our dedication to keeping you and your family seeing and enjoying the world around us to the fullest is our absolute drive and motivation!