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Posted on 08-28-2013

To See Or Not To See, That Is The Question

Originally posted on August 16th, 2012

Myopia Reduction: Try It, You’ll Like It

My last couple of posts were about preventive visual care.  One of the most common conditions and also perhaps one of the most preventable is nearsightedness or myopia.  I have written extensively about myopia reduction over the years, including my book, Looking Differently at Nearsightedness and Myopia: The Visual Process and The Myth of 20/20.  My lectures on myopia reduction, control and prevention continue to be well received.  Myopia reduction means different things to different people.  For me myopia reduction is an almost inevitable consequence of providing the type of visual care that I provide routinely in my office.  I rarely if ever consider myopia reduction as a primary reason to work with someone.  One reason for this is that almost everyone who is nearsighted has other, more important visual issues regarding eye movement, eye-teaming and focusing abilities, which need to be addressed first.

I have a unique philosophy of prescribing lenses to prevent, reverse and reduce nearsightedness.  I am able to speak from a variety of first-hand experiences as a patient, a therapist and a doctor of optometry.  I was just your average everyday nearsighted (actually, above average as far as the nearsightedness went) patient for the first thirty years of my life – my first pair of glasses was at age eight, contact lenses around age sixteen.  At age thirty-one I started having some input into the strength of the lenses I would wear…and why.  That was just before my experience as a vision therapy patient began and four years before I graduated optometry school.  It turned out that I had significant visual issues that were ignored for most of my life, even though I was constantly in and out of eye doctors’ offices (mostly ophthalmologists) from the age of eight on.  Each time I was given stronger lenses for distance and ended up wearing them for everything I did, except sleeping and bathing.

The most important, and the simplest, reason for selecting the proper lenses is this: The typical eye exam results in lenses that are designed to provide clear eyesight at a distance of twenty feet and beyond.  This is very easy to achieve in most cases.  A nearsighted person without lenses can see clearly out to a certain distance (always less than twenty feet), depending on the amount of nearsightedness.  Lenses designed for twenty feet and further are actually inappropriately strong for anything closer than twenty feet.

The fact that young people can still see clearly with their distance lenses, even at very close distances such as that used for reading, does not mean that the distance lenses are appropriate for those activities.  In fact, reading through distance lenses is a major contributing factor in the progression of myopia.  This is a big reason that most people, after getting their first prescription for myopia, need stronger lenses within a short period of time.  This increase in lens power year after year is very common and most eye doctors expect this to happen.  This does not make it right and does not make it inevitable.  Using the appropriate lenses for specific activities can go a long way to protect the visual system from undue stress.

It’s What People Are Talking About

It seems that in the past year or so, almost every month, one or another professional publication I receive has an article related to myopia.  Whether it’s special contact lenses that are used to reshape the cornea (Ortho-K) to mask or reverse nearsightedness, or revisiting the idea that regular contact lenses might slow the progression of nearsightedness, the frequency of articles on this topic has increased dramatically.  A recent study found that providing more light indoors can slow the development of myopia.  Most recently, two studies were published showing the relationship between spending too much time indoors and the onset and progression of nearsightedness. One was done by researchers from Bristol University and Cardiff University in the UK who claim their study provided the first direct evidence of benefits of natural light to the eyes. The second, entitiled The Association between Time Spent Outdoors and Myopia in Children and Adolescents: A Systematic Review and Meta-analysis, was done under the auspices of the American Academy of Ophthalmology; it determined that spending more time outdoors can reduce the development or progression of myopia in children and adolescents.  This was apparently surprising news for ophthalmology though behavioral optometry has known this for many decades.

The thing about this study that was surprising to me was the fact that ophthalmologists allowed it to be published under their banner.  Ophthalmology has fought behavioral optometry tooth and nail over the idea that there might be environmental factors involved in the development and progression of myopia.  Myopia reduction requests typically bring derision from most eye doctors.

Behavioral optometry has, since its inception almost eighty years ago, been very clear that environmental factors play a role in visual development, including the development of myopia.  We have also been very clear that there is something we call visual stress.  Visual stress, results mostly from excessive indoor activities.  Close-work involving two-dimensional surfaces (book, computers, etc.) is the most stressful and has long been recognized by behavioral optometry as a major contributor to the onset and progression of myopia, as well as many other visual conditions.  Of course these activities are almost always done indoors.

Ophthalmology has vigorously insisted that all nearsightedness is hereditary – no ifs, ands or buts.  They have consistently denied that the concept of indoor/close-work affecting visual development had any basis in fact.  They have constantly ridiculed the very idea of visual stress and have no interest in myopia reduction unless it involves laser surgery.  I am certainly glad to see that they may finally be catching up with us on these very important issues.  With any luck this will lead them to think differently about visual development and the visual process in many ways.

It should not be surprising to anyone that there is more and more attention being paid to myopia.  Progressive myopia has long been a leading cause of blindness.  Myopia was reported to be of “epidemic” proportions in parts of Asia in 2008.  The number of nearsighted people across the globe is projected to be 1.6-2.5 billion by the year 2020.

It can’t be overemphasized that a great deal of myopia is stress-related.  That stress is mainly a result of excessive close-work and we are doing more and more close-work as time goes on.  Much of the stress resulting from close-work can be avoided by using the proper lenses at the proper time.

Science, technology and medicine are still hard at work dealing with the symptom – nearsightedness.  Only behavioral optometrists are engaged in determining and treating the possible causes.  Proper lenses and vision therapy can go a long way toward preventing, slowing or reducing myopia.  Everyone knows about laser surgery to eliminate nearsightedness.  Did you know that many people become nearsighted again after the surgery?  This is because the issue of visual stress has been completely ignored.  And surgeons won’t accept younger people for refractive surgery because they know that any improvement from the surgery is unlikely to last.

There are also new high-tech lenses that can give some people clearer eyesight than they ever had before.  These things are very nice I suppose, but they do nothing to address the most important issue – how the visual process as a whole functions and develops.  I see people of all ages improve the clarity of their eyesight, often with weaker lenses than they’ve had in many years, as a result of providing them with lenses more attuned to their actual daily routines and in some cases a vision therapy program that addresses the issues at the root of the problem.  I see this kind of improvement on a consistent basis in my practice.

As I have written many times, in many places, a great deal of nearsightedness results from stress created by excessive close work.  The explosion of smart phones, Kindle-like readers, touch pads, etc. will only worsen an already bad situation, making more and more people nearsighted unnecessarily.  And unless more eye care professionals begin to take seriously the impact of these devices on unsuspecting humans, or unless the public figures out that only behavioral optometrists understand all the issues that need to be addressed, the projection of 1.6-2.5 billion nearsighted people eight years from now will have to be increased just like the yearly prescriptions of so many nearsighted people.

Next time: Swing And Miss Less With Vision Therapy

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