The Eye Practice

Myopia (Short-sightedness or Near-sightedness) historically has been felt to be primarily a genetic issue.  Even though this is true - myopic parents are more likely to have myopic children, over the last few years, more and more evidence seems to suggest that myopia is a result of not enough outdoor activity and excessive reading.

Eastern Asian countries seem to have an epidemic of children becoming myopic, many of them significantly worse than their parents.  Up to 20% of Eastern Asian children are now classified as severely myopic!  

Time magazine recently published a story on how keeping children indoors is ruining their eyesight. 

Myopia is not classified as an eye disease. It is normally referred to as a vision disorder that can be easily corrected with glasses, contact lenses or laser eye surgery. 

Luckily in most cases this is true but...

When myopia progresses to a higher level (which seems to occur with children that are indoors excessively), all sorts of eye diseases become significantly more prevalent.

People that have high myopia are more prone to:

• Retinal detachment
• Glaucoma
• Lacquer cracks in the macula
• Earlier onset of cataracts

This is such a problem in Asian countries now that it is likely to be classified as a health disaster if something is not done to try and arrest this problem.

So what can be done?

At present it is difficult to pinpoint exactly what is the real cause.  Being outdoors seems to be protective.  Is this because:

• Outdoor activity means you read less?
• Outdoor activity means you are exposed to more Vitamin D?
• Outdoor activity means you look in the distance much more?
• Possibly it is multifactorial involving all of the above and other things we are ignorant to?

With the above in mind it seems wise to get our children outdoors.  Get them to play.  Why have we become so obsessed with academic progress?  Do children really need to learn how to read from 2 years of age?  What is the advantage to them in adulthood?

If a child becomes myopic and requires glasses to see properly, consideration needs to be given to a procedure called Orthokeratology.  This has been shown to significantly slow down the progression of myopia.  More on Orthokeratology can be found HERE. You can see a number of videos about this fascinating procedure.  Even an Eye Surgeon in the USA has preferred to have orthokeratology rather than wearing glasses or having laser eye surgery.

At The Eye Practice we have been using this procedure to slow down and in many cases apparently stop any further progression in myopia for over 15 years now.  Children then seem to be able to continue with their academic lifestyle and still be somewhat protected from getting worse.  Imagine if we could incorporate significant outdoor activity with Orthokeratology - the Myopia epidemic could be over!

If you are worried about your child's vision - this is especially true for myopia during puberty, make an appointment now and see whether they would be suitable for orthokeratology.  They will need to be at least 8 years of age and keen to have a go.

CLICK HERE to book an appointment ONLINE or phone 9290 1899.

Eye Strain is part and parcel of our computer driven society today.

There is compiling evidence that eye strain and myopia are related – in that prolonged, repetitive eye strain can not only cause myopia, but make it worse.

Understanding Myopia

Myopia is often referred to as “nearsightedness or short-sightedness.”  It means that your eye has too much optical power for its length. That means you can see perfectly well when things are up close, but when you look at things that are far away, they are blurry.

Understanding the Eye Strain Connection

There are many layers of anecdotal evidence that show a connection with eye strain and the progression of myopia. Look at people who work with computers for extended periods of time, or who are crafts people who sew a lot, or voracious readers who always have a book or e-book in hand. More often than not, you see they are wearing some kind of corrective lenses – and, when asked, they'll tell you they are nearsighted.

The connection is seeming to become clear to many of us – the eye strain caused from up close work links directly to the progression of nearsightedness. But this is no longer staying in the realm of anecdotal evidence – more and more experts are beginning to understand that eye strain can not only make myopia worse, but it can be a contributing factor.

The Running Metaphor

A long ways back, a doctor of optometry compared eyestrain and the progression of myopia to walking.

Using your eyes is like using your legs – when you use either one of these parts, it is like exercising. Looking at something far away is like a walk in a garden. It's easy and doesn't stress out your body.

Looking at something closer, like a television, is more like walking quickly. You can do it with very few side effects and hardships on your body. But looking at things up close, like computer screens, is like taking a jog or a run – you can only do it for so long before it wears out your body. Even a marathon runner has to stop and rest sometime.

Your eyes are the same way. Straining them through up-close work wears them out, and makes it harder to focus on distant objects. Keep pushing your eyes to exercise with too much work up close, and myopia will start to blossom.

One of the symptoms we look for when making a diagnosis of myopia is whether or not you've been experiencing eyestrain. We also ask if you've been working with computers and doing other up close activities. Eye discomfort, squinting, and blurred vision when looking into the distance are all signs of myopia. It is therefore not difficult to see a connection between eye strain and the development and progression of myopia, is it?

If you're having any of the symptoms of myopia, and you often have eye strain or headaches, give us a call on 9290 1899, and we'll be happy to help you find the problem and a solution.

Possible solutions include:

• Glasses
• Contact Lenses
• Orthokeratology
• Eye Exercises

Only a careful eye examination can reveal what the best and most efficient treatment options will be.

Myopia, which is also known as Short Sightedness or Near Sightedness seems to be more common now.  Opinion varies why the incidence has increased. 

Some experts believe that in Australia it is simply because we have become more multicultural and more races that are prone to becoming myopic (short-sighted) are now part of our population.  Whereas these races were not part of the Australian population years ago.

Another opinion seems to think that the extra reading, computer work, iPads and smartphones that we obsessively use has caused many peoples eyes to either become myopic or get more myopic than they would have become purely from a genetic inheritence.

So what does it mean to have Myopia, Short Sightedness or Near Sightedness?

The answer to this question really depends on what level of Myopia you might have. Let's break it down:

VERY MILD MYOPIA

This can be defined from -0.25D to -1.50D.  The best way to understand these numbers is that the lowest measurement of myopia is -0.25D, therefore the mild level is from 1 step of myopia to 6 steps. 

This level of myopia is many cases can be a big advantage in today's society and work practice. 

Assuming your eye muscles are coordinating properly (discussed in a future post) being slightly myopic means that your distance vision is not terrible and reading and computer work without glasses can be relatively stress free!

MILD MYOPIA

Mild Myopia can be defined roughly between -1.75D to -4.00D.  Once you reach this level of myopia you normally are 100% dependent on glasses and or contact lenses, but you are not restricted in what glasses you can choose. Your spectacle lenses will be relative thin and light.  Eye disease is normally not significantly more prevalent than normal eye sight and laser eye surgery is normally a fairly simple procedure in most cases.

MODERATE MYOPIA

It is from here on that things start to change. Moderate myopia can be classified from -4.25D to -8.00D.  In most cases without glasses or contact lenses you will be legally blind.  The good news of course is that in most cases by wearing the correct glasses prescription or contact lens prescription your vision will be perfect. This level of myopia is also important because -8.00D tends to the highest level that can be corrected with laser eye surgery.

Certain eye diseases tend to become more prevalent when myopia becomes higher than -4.25D. In this group of myopia patients the following are more common:

• Retinal detachment
• Glaucoma

Glaucoma has been discussed in some detail in previous posts.  We will continue to update you with more information in the future.  CLICK HERE for more information about glaucoma.

There is also a great video describing glaucoma on The Eye Practice's Glaucoma page - CLICK HERE.

Retinal detachment is sometimes a medical emergency.  It occurs with more frequency with myopia because the eye tends to be more "stretched" in myopia, so the back of the eye called the retina can tear and then detach.  More information and a great video explanation can be found by CLICKING HERE.

The picture on the left is indicative of glaucoma.  The picture on the right is what will be seen when the retina is detached.

HIGH MYOPIA 

Once myopia is greater than -8.00D it can be classified as high.  The risk of retinal detachment is higher, as is glaucoma.  At this level the retina needs to be carefully observed on every visit, even with no symptoms.  Digital photography is not enough.  Eye drops need to be used that open up the pupil of the eye, so that the peripheral retina can be viewed in detail using an instrument called a binocular indirect ophthalmoscope in conjunction with a condensing lens.  Using this specialised piece of equipment our optometrists at the Eye Practice are able to give you a complete and comprehensive retinal check.

Finding subtle irregularities in the retina using this type of specialised equipment can discover the beginnings of retinal detachment before it becomes a big problem.

Making glasses or contact lenses for these types of prescriptions is where The Eye Practice excels.  Choice in frames and spectacle lenses becomes critical in making them functional but also cosmetically appealing.  Typically people that are greater than -8.00D of myopia prefer contact lenses as the vision is better and more natural.  Maximising contact lens success is another of The Eye Practice's specialities.  We understand the importance of contact lenses in this vision category.  We therefore will pay a significant amount of attention in guiding our patients to current and future success.

Myopia (Near Sightedness or Short Sightedness) seems to be increasing in prevalence all over the developed world.

Some people (including us at The Eye Practice) think that Myopia is increasing in prevalence because of increased reading, computer use and lack of outdoor activity. Of course genetics plays a role but that does not explain the increasing number of people that are attending for eye examinations complaining that they are struggling to see: subtitles on the TV, street signs, presentations at conferences and recognising faces across the street.

Treatment Options for Myopia

Depending on age bracket various options of Myopia treatment are available.  Some are better than others in our opinion but everyone needs to make up their own opinion depending on pros and cons of each treatment, when considering ones own lifestyle:

Ages 0 - 8 yrs

1. Glasses - in most cases the best option.
2. Contact lenses - require specialised care and reserved for very complex prescriptions.

Ages 8 - 25 yrs

1. Glasses - every person in this age bracket that is myopic should have glasses, even if they are only used as a back up.
2. Daily Disposable contact lenses - if soft lenses are chosen then these are the best as they are hygienic and have been shown to cause few issues.
3. Orthokeratology (CLICK HERE for more information) - this the preferred modality for most myopia correction in this age bracket, as it has been shown to slow down progression .

Ages 25 - 50 yrs

1. Glasses
2. Daily Disposable contact lenses
3. Orthokeratology
4. Laser Eye Surgery - the best ages for this is between 25 and 35 but even up to 50 yrs old is a reasonable option.

Ages greater than 50 yrs

1. Glasses
2. Daily Disposables contact lenses
3. Multifocal contact lenses 
4. Refractive Lensectomy - this is an option that deserves mentioning as it is Dr Jim Kokkinakis's opinion that Laser Eye Surgery after the age of 50 yrs is not a great option for Myopia correction.

As we mentioned before Laser Eye Surgery is definitely best for the age group 25 - 35 yrs.  As we age beyond this  especially in our 40's we find that by doing Laser Eye Surgery we are basically trading in distance glasses for reading glasses.  That is a reasonable option as long as a clear explanation has been presented by the consulting practitioner and the patient decides that it suits their lifestyle.

It has been our experience that most people would prefer to not have to wear any glasses after Laser Eye Surgery.  After the age of 40 even though compromises such as MonoVision can be offered it is less that perfect and reading glasses are still required for serious reading.

We will discuss MonoVision and Multifocal Contact Lenses in a future post.

So what is Refractive Lensectomy?

This procedure can be offered to correct myopia after 50 yrs of age because in this age bracket and onwards a condition called Cataracts becomes more prevalent.  In fact Cataracts are inevitable if one lives long enough.  Refractive Lensectomy is a replacement of the physiological lens of the eye before it becomes cloudy (cataract) for the sole purpose of correcting vision in the distance.

Done in this way means that cataract development will not occur, as the new lens that is implanted in the eye is made of a plastic that cannot become cloudy in the future.  This fixes the distance vision now and bypasses Laser Eye Surgery altogether, saving not only money but also not exposing the eyes to a second procedure in the future, which of course carries twice the risk.

If you are keen to correct your Myopia, irrespective of what age bracket you are in, make an appointment to see Dr Jim Kokkinakis, who will unbiasedly go through all the vision correction options and help you decide which is best suited to your lifestyle.  Call us on 92901899 or Book an Appointment online HERE>

Contact Lenses have been around in some form since the late 1800's.  In those days they were made of glass and were very large. They are called scleral lenses. A similar type of lens is still prescribed for a small subset of patients but these days they are made of rigid gas permeable polymers.

At The Eye Practice we commonly prescribe these very complicated scleral lenses for patients that cannot wear glasses or have any surgery to see.  We discuss scleral lenses in greater detail in a future post.

There has been massive contact lens innovation over the years, to the point that we now have lenses that we can dispose of every day to lenses that we can sleep in, which re-mould the eye into a shape that can give clear vision all day.  The amazing thing with these types of lenses is that they are actually removed as soon as you wake up and the eye can maintain its new shape all day.

This amazing technology is called Orthokeratology.  It's history dates back as far as the 1960's, but studies in the 1980's showed that it was not particularly effective and it was discontinued as an eye treatment.

In the mid-1990's new materials and new machinery was developed, which in turn resurrected Orthokeratology.  Dr Jim Kokkinakis has been prescribing this great vision treatment since around 1995.  In fact in 1998 he was interviewed by Channel 9 (Good Medicine) about the procedure.  Over the years there has been much research and progress in Orthokertology, to the point it has been shown in a number of studies to slow down the progression of Myopia or Short-sightnedness.  More detail about Orthokeratology can be found on The Eye Practice's website: CLICK HERE.

Orthokeratology is capable of correcting myopia, hyperopia and astigmatism.  Where it seems to have its greatest therapeutic use is in an age bracket between 8 and 18 years.  In the developed world we seem to be have an epidemic of myopia.  Even though there definitely is a genetic predisposition, there also seems to be a significantly increased prevalence due to reading, computer work, computer games and smart phones.

During puberty children seem to be most vulnerable to develop myopia (short-sightedness).  Orthokeratology, if implemented when myopia first exhibits itself in this age bracket, seems to slow down its progression dramatically.

In future posts we will talk about both peer reviewed studies and anecdotal observations by Dr Jim Kokkinakis. 

Myopia, near-sightedness or short-sightedness are all the same thing.  There seems to be anecdotal evidence that not only do your genes play a role, but also the environment you are exposed to.

To date there are many twin studies to show that genetics plays some role in the development of myopia.  To prove though that the environment has some role has proven more elusive.

A study published in the American Academy of Optometry's journal in 2009, showed that in a similar genetic pool from China, urban children had significantly more myopia than a group from rural areas.

"The fact that people exhibit different patterns or rates of myopia in urban and rural settings appears to suggest an impact of environmental effects, given that the genetic backgrounds are very similar among people living in the urban and rural areas of the same country.

However, the urban-rural difference may be a surrogate for other myopigenic environmental risk factors because the education, socioeconomic, and nutrition status of the people should also tend to be different in urban and rural environments.

The study in Xiamen found that children in the city spend more time on near-work activities and less time on outdoor activities outside school than children in the countryside: the average time was 2.2 h of near-work per day in the city vs. 1.6 h/d in the countryside, 5.6 h of outdoor activity per week in the city vs. 15 h/week in the countryside."

Without going into more studies Dr Jim Kokkinakis of The Eye Practice is convinced that environmental influences do contribute to the development of myopia or short-sightedness.  Over the years he has examined the eyes of many trade people.  This group of workers tends not to read excessively and is doing manual labour - few of them are myopic.  Office workers on the other hand that are in offices all day staring at computer screens tend to be myopic. 

Is this a good study - of course not but sometimes your gut feel can be correct.

The ideal study to prove this concept once and for all is a large identical twin study of siblings that have been separated at birth and brought up in different environments.  If myopia was purely genetic, we would expect the separated twins to have the same level of myopia. 

On the other hand if the environment played a role we would expect to find a significant difference of myopia incidence between the identical twin siblings that were separated.  Until this study is done and published we think there is more than enough evidence to suggest that lack of outdoor activity combined with excessive reading and computer work plays a role in the development of myopia.

Myopia or Short-sightedness is probably the most common cause of blurry vision in a moderate to high socioeconomic society.  Many other things are associated with having myopia and it seems that excessive near work and decreased outdoor activity are highly likely to be related.

Myopia or Short-sightedness means that without the assistance of glasses the distance vision is blurry to varying degrees.  More information can be found about the technical issues of myopia on The Eye Practice's website where we have a dedicated MYOPIA Page

The image above depicts the level of blurry vision that will occur with increasing levels of myopia (short-sightedness).  Even though myopia is relatively easy to correct with glasses, contact lenses or laser surgery it is important to understand that even with a moderate amount of myopia, distance vision can be very blurry without the optical aid helping you.

In future posts we will discuss most of what there is to know about myopia (short-sightedness). So stay tuned, as it is a fascinating topic.