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Tell Your Kids to Go Outside: Exposure to Sunlight May Reduce Risk of Myopia.

diagram explaining myopiaBig news today for pediatric eye doctors, parents, and children! The New York Times reports exposure to sunlight may reduce the risk of developing myopia, according to a new study published in JAMA Ophthalmology. Researchers found that people “with the highest UVB exposure, especially in the teenage and young adult years, had about a 30 percent lower risk for myopia than those with the lowest exposure.”

Here is the conclusion from the study abstract:

The conclusion of the Increased UVB exposure was associated with reduced myopia, particularly in adolescence and young adulthood. The association was not altered by adjusting for education. We found no convincing evidence for a direct role of vitamin D in myopia risk. The relationship between high plasma lutein concentrations and a lower risk of myopia requires replication.

USA Today reports the researchers found that exposure to UVB “between the ages of 14 and 29 years was associated with a significant decrease in the chance of developing nearsightedness as an adult.” The article points out that a previous study found that the number of Americans with myopia between the ages of 12 and 54 increased from 25% to 41.6% from the early 1970s to the early 2000s.

child squinting and running with water balloonOne thing that was interesting, is that this was the first study that I have read that showed a correlation between lutein and myopia. From NYT, “The researchers were surprised to find that people with the highest blood levels of lutein, a nutrient found in leafy vegetables, had a 43 percent reduced risk of nearsightedness compared with those with the lowest levels.” Before we make specific recommendations, doctors will need more information about myopia and lutein. But it is always a good idea to eat more leafy green vegetables.

It is encouraging to see more research on myopia and its development. For those children who develop nearsightedness, there are treatment options that can slow or prevent worsening vision. To see if your child is at risk and find out what you can do, visit our myopia page.

-Dr. Nate

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Myopia gene? Well, Partially.

 

For those of us who are concerned about myopia and its development, there is some pretty big news! Just take a look at the screen shot of all the news headlines to the right. It goes on an on.

Under the title, APLP2 Regulates Refractive Error and Myopia Development in Mice and Humans, scientists described a gene identified in children that leads to myopia (nearsightedness). We clearly know that there is a genetic component to developing nearsightedness. It runs in families. We also know that it is not all genetics. The more years of studying a person does, the more likely he or she might become myopic.

Here is an excerpt of the abstract from the study (without all the technical info):

Myopia is the most common vision disorder and the leading cause of visual impairment worldwide. However, gene variants identified to date explain less than 10% of the variance in refractive error, leaving the majority of heritability unexplained (“missing heritability”). Previously, we reported that expression of APLP2 was strongly associated with myopia in a primate model….This work identifies APLP2 as one of the “missing” myopia genes, demonstrating the importance of a low-frequency gene variant in the development of human myopia. It also demonstrates an important role for APLP2 in refractive development in mice and humans, suggesting a high level of evolutionary conservation of the signaling pathways underlying refractive eye development.

This is a big deal because this, as Lead author Dr. Andrei Tkatchenko- Assistant Professor of Ophthalmic Sciences at Columbia University, says, “the first known evidence of gene-environment interaction in myopia.”

So children with the APLP2, “myopia gene,” are more likely to become nearsighted. But here is the kicker from the research: both mice and children who had the “myopia gene” didn’t necessary develop myopia. They only became nearsighted if they also spent time reading or doing close work. Close work would include reading and hand-held video games.

What does this mean for optometrists like me who see people, not mice, in their exam chairs. Business as usual. We will continue to educate patients about options for seeing well despite myopia and options for limiting its progression. And for goodness, sakes, kids need to be outside more!

Stay tuned. There will be more on this front, for sure!

-Dr. Nate

Probable Myopia Gene Owner

Myopia Control FAQ & Scientific Research

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Understanding Myopia

Myopia, or nearsightedness is a very common vision problem. It's estimated that more than one-third of Americans are nearsighted, and it is increasing.  Nearsighted people have difficulty reading road signs and seeing distant objects clearly, but can see well for up-close tasks such as reading or sewing. If your glasses or contact lens prescription begins with minus numbers, like -2.50, you are nearsighted.

See the treatment options for myopia control.

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myopia-facts-infographic-580x2400Myopia Control FAQ

Does my child need to have a general eye exam before starting Myopia Control?

Yes, a comprehensive eye exam from an eye doctor is required. We would be happy to provide that exam. However, if your child has had an eye exam with another eye doctor within the last year, you can request that doctor refer your child to our office for Myopia Control.

Is there any additional charge for the Myopia Control procedures?

Yes, standard optometric charges apply. We offer several different year-long programs. Following the comprehensive eye exam, a Myopia Control Consult is necessary to determine which program is best for your child.

Can I request to see either doctor?

Either Dr. Nate or Dr. Beth can discuss Myopia Control at your child’s comprehensive eye exam. After that, Dr. Nate performs the Myopia Control Consult and the Myopia Control treatment visits.

What techniques are used in the Myopia Control Program?

There are three options:

  • Orthokeratology (corneal reshaping) is the wearing of special contact lenses at night to provide clear vision during the day without lenses.
  • Multifocal soft contact lenses are worn during the day.
  • Atropine, in the form of eye drops, is used at night time.

Every patient is different – one treatment does not work for all patients. That is why a specialized Myopia Control Consult is necessary before selecting the best treatment method.

How do I get an appointment at Bright Eyes?

You can request an appointment here or call us at 813-792-0637. Be sure to specify that you are interested in Myopia Control so the Bright Eyes staff can book the appropriate appointment for your child.

Do I need to bring anything to the appointment?

Just the patient. 🙂 Bringing previous eye exam history or old glasses can also be helpful at the initial appointment.

Will Myopia Control require many office visits?

There are multiple office visits as the treatment is begun. After that, there are quarterly (every three months) follow up visits to ensure that all is going well for your child.

Will Myopia Control hurt?

No! If your child is new to contact lenses or eye drops, sometimes there can be discomfort while he gets used them, but we use the latest technology to ensure quick adaptation.

I am nearsighted and my child is nearsighted, too, and it’s getting worse. Is there anything I can do for them?

Probably! More children than ever are becoming nearsighted (myopic). Fortunately, there different options to help children of any age.

My eye doctor told me that myopia is in my genes, and that there is no way to slow or stop it. Is there scientific evidence that this really works?

For years, many doctors thought that myopia is caused only by genetics, but in the last 10 years or so, there has been very dramatic research that has shown this to be not the case. Take a look at the research section below to see some of these studies.

Are there vitamins that my child should be taking to keep his vision from getting worse?

No. At this time, there are no studies that show benefits of taking vitamins. However, it is a good idea in general to maintain a healthy diet including more vegetables and less sugar. Talk to your pediatrician for specific information on nutrition.

What about eye exercises?

There are some specific cases where vision therapy (sometimes called eye exercises) may reverse mild nearsightedness due to eyestrain. This is often called “pseudo-myopia”. However, true nearsightedness cannot be reversed or eliminated with eye exercises. A comprehensive eye exam with a doctor trained in children’s vision is necessary to tell the difference.

My child is only 8 years old. Is really OK for them to do Myopia Control? Even if it involves contact lenses?

Yes! It used to be thought that children should not use contact lenses until they were teenagers. Several studies have shown that contact lenses are safe for younger children as long as they are taught proper care of the contact lenses. Also, contact lens materials and designs are safer than ever for all patients.

Does Myopia Control have FDA approval?

No. As of right now, the treatment options that exist for myopia control are FDA approved procedures, but are not specially approved for myopia progression. For example, orthokeratology was FDA approved for the temporary treatment of blurry vision due to myopia, but treatment for Myopia Control is considered “off-label”. The same is true for atropine and multifocal contact lenses. However, this is changing. Recently a meeting was held between the American Academy of Ophthalmology (AAO), American Academy of Optometry (AAOpt), American Association for Pediatric Ophthalmology and Strabismus (AAPOS) and more to establish an FDA study for myopia control.

Do only optometrists offer Myopia Control?

No, both ophthalmologists (MDs) and optometrists (ODs) offer myopia control. Bruce Koffler, MD, an ophthalmologist wrote this important document called “The Case for Myopia Control Now.” You can find doctors all over the whole who provide this service via the American Academy of Orthokeratology and Myopia Control.

Myopia Control Scientific Research

Below is just a small sampling of scientific research supporting myopia control. If you’d like to see more, go to http://myopiaprevention.org.

Increasing Prevalence of Myopia

Development of Myopia

Risks of Myopia

Myopia Control Options

“Will My Child Be Nearsighted?”

nearsighted childFollowing the American Optometric Association’s recommendations of performing eye exams for children before age 1, at age 3, and before starting kindergarten, that is one of the most common questions that Dr. Knighton and I get. Parents who are nearsighted, or myopic, especially ones who got their first glasses in elementary school, often want to know if their child is going to be nearsighted too.

Over the years, optometrists have had many theories about whether a child will be nearsighted or not. Some of these theories have been helpful, and some have not. Now, thanks to some outstanding research published in this month’s issue of the journal JAMA Ophthalmology, we are closer to an answer.

With 1 simple eye examination, we can now more confidently evaluate if a child will be nearsighted in the next few years.

We have known for a very long time that most newborn infants are not nearsighted, but farsighted (optometrists call this hyperopic). Over time, the amount of farsightedness naturally gets smaller and then levels off at a very small, normal amount. Because of this, eye doctors who see many children have suspected that children who have neither farsightedness nor nearsightedness, rather than being “perfect,” are actually pre-myopes, or kids who will be nearsighted.

This research is big news! It has been covered by Today and NPR. The study of almost 5,000 children over 20 years, shows just that: a 6-year-old child with less farsightedness is at greater risk for developing myopia sooner. The older the child, the more effective the refractive error is as a predictor of nearsightedness onset by age 13.

Fortunately, if a child does have rapidly increasing myopia, there are no options to help slow down the worsening of the prescription. You can read about those options for your child here. One other thing research has shown – kids who spend time outdoors are less likely to become myopic. So make sure those young kids spend time outside each day!

If you are concerned if your young child might be nearsighted, or become nearsighted, call 813-792-0637 to schedule an appointment at either Bright Eyes Family or Bright Eyes kids.

-Dr. Nate

Nathan Bonilla-Warford, OD, FAAO, FCOVD

 

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