Experimental use of eye drug could help slow myopia

 
 

CTVNews.ca Staff
Published Monday, December 21, 2015 10:10PM EST

As rates of near-sightedness, or myopia, soar around the world, some Canadian doctors have begun using eye drops they say can help slow the condition in children before it becomes severe.

In North America, an estimated 42 per cent of the population is myopic, and needs to use glasses or contacts to see at a distance. In Asia, the rate has risen as high as 80 per cent in some areas. Eye specialists aren’t sure why myopia is soaring in some regions but say too much indoor screen and study time could be disturbing normal eye development.

There has never been a way to stop myopia, but now, some eye doctors are experimenting with using a diluted form of a medication that is already on the market.

The drug is called atropine and is currently used to dilate the pupil to treat specific eye conditions. Neither Health Canada nor the FDA in the U.S. have approved atropine for managing myopia in children, but some doctors have begun using it for that use anyway.

They include London, Ont.-based optometrist Dr. Michael Fenn. He says the problem with myopia that begins in childhood and progresses into the teen years is that it causes the eye to actually grow into an oval. That then increases the risk of sight-threatening conditions such as myopic macular degeneration, retinal detachment and glaucoma.

“So if you can do something to slow the progression of myopia at this stage, you could potentially reduce the risk of potential ocular complications later on in life,” he told CTV News.

Fenn says he was struck by recent research from Singapore that found atropine can slow myopia progression by 50 per cent over five years.

In the study, children were given atropine at a dosage of 0.01 per cent -- which is one-hundredth of the usual dose -- for two years. The dose causes minimal pupil dilation (less than 1 mm), but helped slow myopia progression by about 50 per cent compared to children not treated with the medication.

Fenn has been using the low-dose drops on patients such as Juliana Szucs, 11, for a year. Szucs’ distance vision was once worsening so quickly, she needed to get stronger glasses every six months.

“I was honestly afraid she would be blind, her eyes were changing so quickly,” said her mom Wendy Szucs, who is also nearsighted.

But since Juliana has been using the drops, her prescription hasn't changed.

Fenn says the treatment is effective, inexpensive, and simple, with patients using the drops just once a day at night.

The Singapore study found that of 84 patients treated with .01 per cent atropine for 24 months, only one experienced significant side effects, which included a burning sensation in the eyes. The study also found that about six per cent of patients needed to wear sunglasses because the dilation of the pupil allowed in too much light.

Fenn says there have been “very minimal side effects” among the patients he’s treated, but he notes there have no studies on the drug’s effects over the long term. Scientists also still don't understand how exactly atropine works to arrest myopia, or what happens after its usage ends.

Still, the results of the Singapore study are intriguing enough that scientists have their eye on larger studies planned in the U.K. and Japan next year.

With a report from CTV medical specialist Avis Favaro and producer Elizabeth St. Philip

Video of interview can be seen by clicking here.

Researchers present findings on five-year clinical trial of low-dose atropine for myopia at AAO 2015, the American Academy of Ophthalmology's annual meeting


LAS VEGAS - Nov. 16, 2015 - Researchers say medicated eye drops may be the key to fighting rapidly worsening eyesight in children with myopia. Results from a five-year clinical trial show that drops of low-dose atropine significantly slowed the progression of nearsightedness in children with fewer side effects than higher dosages. The research is being presented today at AAO 2015, the 119th annual meeting of the American Academy of Ophthalmology. The findings suggest that this medication could potentially be an effective treatment in the fight against the global surge in nearsightedness.
 
Nearsightedness, or myopia, has increased dramatically worldwide over the last few decades and remains a leading cause of visual impairment globally. In the United States, an estimated 42 percent of the population is myopic, up from 25 percent in the 1970s. Developed Asian countries report myopia rates of 80 to 90 percent among young adults. While vision can be corrected by glasses or contacts, severe nearsightedness has ramifications that include greater risk of retinal detachment, macular degeneration, premature cataracts and glaucoma.
 
To help combat this public health issue, investigators in Singapore turned to atropine, a treatment commonly used to treat lazy eye. In this study, which began in 2006, 400 children age 6 to 12 were randomly assigned a daily dose of atropine. Three different groups took drops nightly at concentrations of 0.5, 0.1, or .01 percent for two years. Doctors then stopped the medication for 12 months. For children whose eyes became more myopic during that year off (-0.5 D or more), researchers started another round at 0.01 percent for another two years. The researchers discovered the following key findings:
 
• After five years of usage, children using the low-dose 0.01 percent atropine drops were the least myopic when compared to patients treated with higher doses.
 
• Atropine eye drops at 0.01 percent slowed myopia progression by an estimated 50 percent compared to children not treated with the medication in an earlier study.
 
• Atropine at .01 percent appears to be safe enough to use in children age 6 to 12 for up to five years, though more study is needed. The lower dose caused minimal pupil dilation (less than 1 mm), which minimized light sensitivity experienced at higher concentrations. Patients also experienced minimal near-vision loss with the low-dose drops.
 
 
Atropine inhibits axial growth of the eye associated with nearsightedness. But, the way the medication works remains largely unknown. In addition, the medication has several side effects when given at higher concentrations. For instance, at the concentration used for lazy eye, atropine dilates the pupils. This results in light sensitivity and blurry vision when looking at objects up close. Children taking higher concentrations often need to wear bifocals and sunglasses. In addition, higher concentrations have also caused allergic conjunctivitis and dermatitis. These drawbacks explain why atropine use for myopia to date remains fairly uncommon in the United States.
 
This trend could change now that much lower doses of atropine appear to offer the similar benefit in reducing nearsightedness progression, without the side effects. The researchers say this latest five-year follow-up study shows the long-term benefits outweigh the risks. However, they emphasize more information will be needed to establish which children are good candidates, as about 9 percent of children in the low-dose group did not respond to the drops in the first two years. More research is also needed to determine when treatment can safely begin and how long the drops should be used. Additional studies on atropine for myopia progression to be conducted in Europe and Japan may help find those answers.
 
"For a long time we've known that atropine drops can help keep myopia from getting worse to some degree," said Dr. Donald T. Tan, FRCS, FRCOphth, lead investigator and professor of ophthalmology at the Singapore Eye Research Institute and the National Singapore Eye Centre. "We now have data showing that it is not only effective, but also safe. Combined with other interventions, this treatment could become a great ally in preventing myopia from causing serious visual impairment in children worldwide."

The full research study can be viewed by clicking here.

So here is the clinical take home:

  • Daily dose of atropine 0.01% is an effective first-line treatment in children 6-12 years with documented myopia progression of greater than or equal to 0.5 D in the preceding year with few side effects. 
  • Because atropine appeared more effective in the second year than in the first, treatment should be continued for at least 2 years
  • If there is good response to atropine 0.01% (less than 0.25D progression in the second year), especially in older children >13 years, then atropine 0.01% could be stopped.  If an increase in myopia myopia then occurs, then children should be restarted on atropine
  • If the initial response to atropine was more moderate (e.g. progression of 0.25-0.75D in the second year), then one would consider using atropine 0.01% for a longer period until progression slows to <0.25D per year, as it may in the mid to late teens
  • Some children are poor responders to atropine which appears to be dose dependent.  During phase 1 of the study, 9.3% of the children in the 0.01% group, 6.4% of the children in the 0.1% group, and 4.3% of the children in the 0.5% group had myopia progression.  Thus in children who respond poorly to atropine 0.01% (e.g. progress >0.75D per year in the second year), it may be possible than they would not respond to higher doses and that atropine should be stopped.  


 

London Ontario Optometrist Provides Hope for Children with Progressive Myopia

London Ontario Optometrist Dr. Michael J. Fenn came upon treatments to stem the growing epidemic of nearsightedness, properly known as myopia, out of concern for his patients after over 15 years of seeing desperate patients and their parents looking for options to help stop the sometimes visually devastating effects of myopic progression.  "I have a family member who has had two retinal detachments due to very high myopia.  “I've also had a gentleman in my practice become blind as a result of his myopia and found it frustrating not being able to offer my patients options to help them."  "I felt I had to do something to help these patients and as a result I began studying the growing science behind myopia control."   

Myopia is a common condition due to a progressive lengthening of the eye that causes blurry vision when viewing objects that are far away.  Its prevalence appears to be increasing and varies throughout the world.1-5It is much more prevalent in industrialized countries and in cities compared to rural areas.6-10,5  In the United States, the prevalence rate has increased from 25% between 1971-1972 to 41.6% between 1999-2004.11,12,5Some countries in Asia are seeing prevalence rates as high as 80% or more.13,14,5This rapid increase in prevalence raises some public health concerns.5For many people, low levels of myopia are a nuisance and just may mean you are dependent on glasses or contact lenses to see things at distance.  However, with high levels of myopia the consequences can be sight threatening due to induced anatomical changes that involve a progressive lengthening of the eye.  Persons with higher degrees of myopia have a greater risk of visual impairment or blindness from myopic macular degeneration, cataract, glaucoma, retinal holes and tears, and retinal detachments.13,14,15,16,5  Thus, finding ways to slow the progression of myopia is important in decreasing the associated ocular consequences and increasing peoples quality of life.

“I came to dread the conversation with patients and their parents when a child’s myopia would progressively increase without being able to offer them any options other than hope things don’t change at the next appointment.”  This often is never the case as most myopia progresses approximately -0.50D per year until a persons 21st birthday, however some patients can progress well into their 20’s.17“Imagine any other medical condition that we would watch get worse and not do anything to help prevent or slow its course. “  

The biggest risk factor for children developing myopia unfortunately is one they can’t change: their parents.  Children of parents who are myopic are at higher risk of developing myopia.19 However increasingly studies have found environment may play an important role.  Primarily, the amount of time spent outside in the development and progression of myopia.18,20-22“The first thing I recommend to parents, especially to those who are myopic themselves and worry about their children is to ensure their children have lots of play time outdoors.”  “Studies have shown that children are less likely to become myopic if they spend close to 14 hours a week playing outside and progress at a slower rate if they already are myopic.”18-21 This appears to be independent of the amount of time spent reading.18-21

Once the child becomes myopic, interventions may include orthokeratology, which involves the use of a specially designed rigid gas permeable lens which moulds the cornea while the patient sleeps so when they wake up and remove the lens they don’t require contact lenses or glasses to see for the day.  Children and adults like the procedure as it frees them from daytime visual correction, plus studies show that it has the added benefit of slowing the growth of the eye by 30-57% in children. 23-27    

Another option is the use of a soft contact lens multifocal lens that is usually prescribed to older patients who want to wear contact lenses and have age related problems with reading that is used off label in children to slow the progression of myopia.  Studies show it appears to slow the progression of myopia similar to that of orthokeratology.28-30  

The last treatment Dr. Fenn has available is atropine eye drops.  Atropine is normally used when treating inflammation of the eye.  However, it does appear to also decrease the progression of myopia.  When used at its pharmacologically available dosage it appears to decrease myopia progression by 77% over a two year period.31The drop at this concentration can be difficult to tolerate for children as their pupils are constantly dilated and they can’t focus for near tasks and are very light sensitive. Much more tolerable for a patient is having the drug diluted to one 100th of its dosage by a compounding pharmacy.  “I have yet to prescribe the 1% concentration of atropine because of the risks of adverse events and side effects even though it appears quite effective.” The 0.01% concentration does not require any special lenses, studies show it slows the progression of myopia by 50% over a two year period, and the minimal concentration and dosage makes the likelihood of any adverse events very low.32In my experience patients tolerate it very well.   My major concern which I communicate to patients and parents is the lack of long-term studies on the effects of atropine especially in children, and as a result, it is not the first line of treatment I recommend.  Other treatments that have been tried include bifocal and multifocal glasses but have proven to be less effective and only work on children with specific ocular characteristics.33,34

For more information please feel free to visit Dr Fenn’s website at: www.orthoklondon.ca

 

References

1. Fotouhi A, Hashemi H, Khabazkhoob M, Mohammad K. The prevalence of refractive errors among schoolchildren in Dezful, Iran. Br J Ophthalmol 2007;91(3):287-92.

2. Rudnicka AR, Owen CG, Nightingale CM, Cook DG, Whincup PH. Ethnic differences in the prevalence of myopia and ocular biometry in 10- and 11-year-old children: the Child Heart and Health Study in England (CHASE). Invest Ophthalmol Vis Sci 2010;51(12):6270-6.

3. Naidoo KS, Raghunandan A, Mashige KP, Govender P, Holden BA, Pokharel GP, et al. Refractive error and visual impairment in African children in South Africa. Invest Ophthalmol Vis Sci 2003;44(9):3764-70.

4. Saw SM, Goh PP, Cheng A, Shankar A, Tan DT, Ellwein LB. Ethnicityspecific prevalences of refractive errors vary in Asian children in neighbouring Malaysia and Singapore. Br J Ophthalmol 2006;90(10):1230-5.

5. Cooper J, Schulman E, Jamal N. Current status on the development and treatment of myopia. American Optometric Association.  2012 May 31;83(5):179-99.

6. Uzma N, Kumar BS, Khaja Mohinuddin Salar BM, Zafar MA, Reddy VD. A comparative clinical survey of the prevalence of refractive errors and eye diseases in urban and rural school children. Can J Ophthalmol 2009;44(3):328-33.

7. Saw SM, Hong RZ, Zhang MZ, Fu ZF, Ye M, Tan D, et al. Near-work activity and myopia in rural and urban schoolchildren in China. J Pediatr Ophthalmol Strabismus 2001;38(3):149-55.

8. Garner LF, Owens H, Kinnear RF, Frith MJ. Prevalence of myopia in Sherpa and Tibetan children in Nepal. Optom Vis Sci 1999;76(5): 282-5.

9. Sapkota YD, Adhikari BN, Pokharel GP, Poudyal BK, Ellwein LB. The prevalence of visual impairment in school children of upper-middle socioeconomic status in Kathmandu. Ophthalmic Epidemiol 2008;15(1):17-23.

10. Nangia V, Jonas JB, Sinha A, Matin A, Kulkarni M. Refractive error in central India: the Central India Eye and Medical Study. Ophthalmology 2010;117(4):693-9.

11.Vitale S, Sperduto RD, Ferris FL, 3rd. Increased prevalence of myopia in the United States between 1971-1972 and 1999-2004. Arch Ophthalmol 2009;127(12):1632-9.

12. Saw SM, Katz J, Schein OD, Chew SJ, Chan TK. Epidemiology of myopia. Epidemiol Rev 1996;18(2):175-87.

13. Lin LL, Shih YF, Hsiao CK, Chen CJ, Lee LA, Hung PT. Epidemiologic study of the prevalence and severity of myopia among schoolchildren in Taiwan in 2000. J Formos Med Assoc 2001;100(10):684-91.

14. Saw SM, Carkeet A, Chia KS, Stone RA, Tan DT. Component dependent risk factors for ocular parameters in Singapore, Chinese children. Ophthalmology 2002;109(11):2065-71.

15. Fong DS, Epstein DL, Allingham RR. Glaucoma and myopia: Are they related? Int Ophthalmol Clin 1990;30(3):215-8.

 

16. Haug SJ, Bhisitkul RB. Risk factors for retinal detachment following cataract surgery. Curr Opin Ophthalmol 2012;23(1):7-11.

17. Chua WHBalakrishnan VChan YHTong LLing YQuah BLTan D. Atropine for the treatment of childhood myopia.  Ophthalmology. 2006 Dec;113(12):2285-91

18. Wu Pei-Chang, Tsai Chia-Ling, Wu Hsiang-Lin, Yang Yi-Hsin, Kuo His-Kung, Outdoor activity during class recess reduces myopia onset and progression in school children, Ophthalmology, 2013May;120(5):1080-1085

19. Mutti DO, Mitchell GL, Moeschberger ML, Jones LA, Zadnik K, Parental Myopia, Near Work, School Achievement, and Children’s Refractive Error, Investigative Ophthalmology & Vision Science;.December 2002 vol. 43 no. 12 3633-3640

20. Cui D, Trier K, Ribel-Madsen SM, Effect of Day Length on Eye Growth, Myopia Progression, and Change of Corneal Power in Myopic Children, Ophthalmology 2013 May;120(5)1074-1079

21. Rose KA, Morgan IG, Smith W, Burlutsky G, Mitchell P, Saw S-M, Myopia, Lifestyle, and Schooling in Students of Chinese Ethnicity in Singapore and Sydney, Arch Ophthalmol. 2008;126(4):527-530.

22. Jones-Jordan LA, Sinnott LT, Manny R, Cotter SA, Kleinstein RN, Mutti DO, Twelker D, Zadnik and the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study Group, Early Childhood Refractive Error and Parental History of Myopia as Predictors of Myopia, Investigative Ophthalmology & Vision Science; January 2010; Volume 51(1):115-121

23. Cho P1Cheung SWEdwards M, The longitudinal orthokeratology research in children (LORIC) in Hong Kong: a pilot study on refractive changes and myopic control; 2005 Jan;30(1):71-80.

24. Walline JJ, Jones LA, Sinnott LT, Corneal Reshaping and Yearly Observation of Nearsightedness (CRAYON), British Journal of Ophthalmology; 2009-82:1181-1185

25. Santodomingo-Rubido J , Villa-Colla C, Gilmartin B, Gutiérrez-Ortega R, Myopia Control with Orthokeratology Contact Lenses in Spain (MCOS): Study Design and General Baseline Characteristics, Journal Of Optometry 2009;Vol 02 Num 04:215-22

26. Richdale K, Troilo D, Contact Lens Treatments for Myopia Control: Emerging Evidence Based Practices, American Academy of Optometry Continuing Education Denver, Colorado, November 2014

27. Cho P, Cheung SW, Retardation of myopia in Orthokeratology (ROMIO) study: a 2-year randomized clinical trial, Investigative Ophthalmology & Vision Science, 2012 Oct 11;53(11):7077-85

28.  Sankaridurg  P , Holden B, Smith III, Naduvilath T, Chen X, Lazon de la Jara P, Martinez A, Kwan J, Ho A, Frick K, Ge J, Decrease in rate of myopia progression with a contact lens designed to reduce relative peripheral hyperopia: one-year results, Investigative Ophthalmology & Vision Science, 2011 Dec 9;52(13):9362-7

29. Antice NS, Phillips JR, Effect of Dual-Focus Soft Contact Lens Wear on Axial Myopia Progression in Children, Ophthalmology June 2011, Volume 118(6):1152-1161

30. Walline JJ, McVey L, Myopia Control With a Soft Bifocal Contact Lens, Optometry and Vision Science 2011 VOL 88 - Issue 3 pp 395-403

31. Chua W, Balakrishnan V, Tan D, Chan Y and ATOM Study Group, Efficacy Results from the Atropine in the Treatment of Myopia (ATOM) Study Invest Ophthalmol Vis Sci 2003;44

32. Chia A, Chua W-H, Cheung Y-B, Wong W-L, Lingham A, Fong A, Tan D, Atropine for the Treatment of Childhood Myopia: Safety and Efficacy of 0.5%, 0.1%, and 0.01% Doses (Atropine for the Treatment of Myopia 2),February 2012 Vol. 119, Issue 2, Pages 347-354

33. Fulk GW, Cyert LA, Parker DE. A randomized trial of the effect of single-vision vs. bifocal lenses on myopia progression in children with esophoria. Optom Vis Sci 2000;77(8):395-401.

34. Cooper J, Schulman E, Jamal N, Current Status on the Development and Treatment of Myopia, Optometry. 2012 May 31;83(5):179-99.

 

Increasing Prevalence of Myopia in Europe and the Impact of Education

A recent study published in the American Academy of Ophthalmology has reported an increase in the prevalence of myopia in more recent birth decades in Europe.  The prevalence of myopia has increased from 17.8% in those born between 1910 and 1939 to 23.5% in those born between 1940 and 1979.  Education was significantly associated with myopia.  Those who completed primary, secondary and higher education, the age-standardized prevalences were 25.4%, 29.1% and 36.6% respectively. 

The study determined like in the rest of the industrialized world myopia is becoming more prevalent in Europe.  The study authors felt that higher education had an additive effect on myopia but could not explain the increased rates of myopia.  Myopia although a mere nuisance for some, increasing levels of myopia carries significant clinical and economic implications, with elevated risk of sight-threatening complications and associated healthcare costs.  

Study Forecasts Future Myopia in Children

One test before first grade predicts myopia by eighth grade.

 

Results from a 20 year study by researchers for  the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) suggest that myopia (nearsightedness) can be predicted for children as early as age six just with a simple eye exam.  The researchers initially set out to see “what measures could we have done in first grade to predict who was going to need glasses by the eighth grade?” said lead author Karla Zadnik, OD, PhD, professor and dean of the College of Optometry at The Ohio State University.  They found that children who have no or very little hyperopia (farsightedness) were more likely to be myopic when they were older.  The study also contradicts the notion that near work—such as frequent reading, playing electronic devices or sitting too close to the TV—can bring on myopia.

“At an eye examination as early as first grade, an optometrist can provide parents with an idea of how likely their child is to develop myopia by eighth grade,” Dr. Zadnik says. “This might be of particular interest to parents who are themselves myopic and worried about their child in that regard, and the information could be used to guide the eye exam schedule for a given child.”  This emphasizes the importance of early and regular eye examinations in children.  For the complete article click here.  

Shedding light on the blurry world of myopia and its meteoric global growth

WENCY LEUNG                                     

The Globe and Mail

Published Sunday, Apr. 19 2015, 12:00 PM EDT

Last updated Sunday, Apr. 19 2015, 12:00 PM EDT

 

The world is looking a whole lot blurrier to a growing number of people. Rates of myopia, or the inability to see objects at a distance, are rising at a staggering pace, provoking widespread discussion about what’s causing this deterioration. Its rapid increase and marked prevalence in developed areas – particularly in places with high incomes and high levels of academic achievement – have experts believing there’s more than genetics to blame.

The focus is now shifting to environmental factors. Children today are glued to electronic devices, unwilling to pry their eyes away from the latest game of Fruit Ninja. Meanwhile in East Asia, many kids are stuck indoors with their noses buried in textbooks.

As researchers investigate what’s behind our failing vision, some people are turning to scientifically untested vision-training techniques. Others are examining the potential of neuroplasticity, or the brain’s ability to rewire itself, to improve visual processing. But when it comes to myopia, more evidence is pointing to the power of the sun. Could the solution to better vision be as simple as taking ourselves – and our devices, if we can’t let go of them – outside?

Myopia, or nearsightedness, is a refractive error that occurs when the eye grows too long from front to back, causing the image to land on the retina past the focal point, appearing blurry. That means when an image is projected onto the retina at the back of the eye, where it can be processed, it has surpassed the focal point and is blurry. While researchers have yet to pinpoint the exact cause of the rise in myopia, many agree there may be a cheap and easy way to curb the trend: Encourage children to spend more time outdoors while their eyes are still developing.

As many as 80 to 90 per cent of people in parts of East Asia are now believed to have myopia. In the United States, data collected between 1999 and 2004 showed nearly 42 per cent of individuals from the ages of 12 to 54 were nearsighted, up from 25 per cent in 1971 to 1972. In Canada, the prevalence of myopia is lower – here, it affects about 30 per cent of the population, according to the Canadian Association of Optometrists and provincial optometry associations.

“We’ve always known that myopia has a genetic and environmental component,” says Dr. Setareh Ziai, an ophthalmologist in Ottawa. “But … the speed at which it has increased is much more rapid than any genetic changes can occur.”

The consequences of this condition go beyond a bespectacled norm. Along with its general rise, the rates of severe cases, also known as high myopia, are increasing too, carrying with them an increased risk of retinal complications that can lead to irreversible vision loss, says Dr. Maria Liu, head of the Myopia Control Clinic at the University of California, Berkeley.

As well, people are now beginning to experience blurred vision at a much earlier age, she adds, noting that while glasses, contact lenses and laser surgery can correct nearsightedness, there is no cure. A decade or two ago, it was common for people to become nearsighted around the age of 14 to 16. Today, Liu is seeing it in children as young as 4.

“That really concerns me because kids, once they become nearsighted, unless they start wearing contact lenses or something, it really changes their lifestyle,” she says. She worries they may participate in fewer sports and activities outdoors in favour of indoor pursuits that require a more limited depth of vision. “This is a really bad cycle.”

Liu suggests the introduction of electronic devices at earlier ages may play a role. One prevailing hypothesis is that children’s growing eyeballs may develop in a way that adapts to close-up activities, such as reading and using tablets, smartphones and computers. Liu believes electronic devices can be particularly harmful to eye development, since people tend to hold them up close to their eyes and digital activities, such as games, can keep them engaged for long periods.

However, a growing body of research suggests that too little exposure to daylight may be the real culprit. A 2008 study of Australian school children found high levels of outdoor activity were associated with lower prevalence of myopia among 12-year-old students. Furthermore, the researchers noted that the amount of time students spent on “near work” or close-up activities such as reading, appeared to have little, if any, impact. A follow-up study published in 2013 provided further evidence to support the initial findings.

Sunlight boosts the level of dopamine, a growth inhibitor, in the retina, which restricts eye growth and prevents it from becoming too long, explains Prof. Kathryn Rose, head of orthoptics at the University of Technology, Sydney. She was involved in both studies. “It’s acting like a brake or regulator on growth,” she said in an e-mail.

Adding to this idea, Ziai notes some research suggests that in winter months in parts of the world where daylight hours are shorter, developing eyes have higher rates of growth than in summer months.

It’s still unknown whether myopia is preventable, or whether outdoor activity merely limits its severity or stalls its development. But it appears that the more time children spend outdoors, the greater the protective effect may be. Researchers of the 2013 Australian study said their findings indicated children under 6 should spend at least 10 hours a week outdoors.

Sunglasses, which block UV radiation, do not appear to negate the benefits of being out in the sunshine.

“The intensity of light outdoors is generally so high that the tint in sunglasses is insufficient to block light levels to a point where being outside would not still afford protection from myopia,” Rose says. “So basically, wear sunglasses to protect from UV radiation, but still get outside.”

(If you’re hoping to stave off age-related vision loss, sunning yourself isn’t going to help. Sunlight has no effect on presbyopia, the common inability to focus on objects up-close that begins in middle age.)

Because myopia stems from the physical structure of the eye, it can’t be reversed. Nevertheless, eye exercises and vision-training techniques are having a resurgence in popularity lately, promoted by controversial television personality Dr. Oz, and explored in best-selling author Dr. Norman Doidge’s latest book, The Brain’s Way of Healing: Remarkable Discoveries and Recoveries from the Frontiers of Neuroplasticity.

Doidge, a psychiatrist and psychoanalyst on the faculty of the University of Toronto’s department of psychiatry, re-examines the disputed theories of New York doctor William Bates, who lived from 1860 to 1931. Doidge’s book documents the story of Canadian-born David Webber, a computer-networks expert whose vision was damaged by an autoimmune disease called uveitis. Webber regained his sight using alternative techniques akin to the Bates Method, such as palming, or covering the eyes with one’s palms, to block light and allow the optic nerve and visual circuits of the brain to relax.

As Doidge writes, Bates believed myopia is the result of tense muscles around the eye, which elongate the shape of the eyeball. Doidge attributes this to “neuroplastic changes to the brain, based on the new ways people are using their eyes.” He suggests Bates’s ideas were prematurely debunked by his peers, noting that his techniques were in fact early exercises in neuroplasticity.

But eye doctors and vision researchers note the Bates Method, and its many variations, are not scientifically proven. And while there’s some evidence to suggest our brains may be able to adapt to better interpret blurry images, the effects of neuroplastic adaptation are limited as they can only compensate so much for mechanical and physical issues of the eye itself – which is the case with myopia.

“It is possible for our brain to sort of reinterpret a blurry image, and thus we ‘see better,’” says Dr. Elizabeth Irving, a professor of optometry at the University of Waterloo. “But it doesn’t actually make the refractive error change or the myopia go away.”

The power of neuroplasticity

U.S. researchers have found it’s possible to train your brain to see more clearly.

In a recent study by researchers from the University of California, Riverside, and Brown University, participants showed improved vision after as little as five days of training for 1 1/2-hours a day.

The study, led by graduate student Denton DeLoss, had a group of 16 young adults, with the average age of 22, and 16 older adults, with the average age of 71, look at patterns of stripes on a computer screen. They were asked to pick out the images when embedded in visual “noise,” similar to television snow, and to determine whether they were turned clockwise or counterclockwise in relation to a fixed pattern. With each session, the difficulty of the task was modified according to each participant’s performance from the previous day.

A common occurrence among older adults is the decline in their ability to see objects at low-contrast declines significantly with age, says UC Riverside psychology professor John Andersen, who supervised the study. Yet by the end of the training, the older group could perform the task as well as the 20-year-olds before training. Surprisingly, their near acuity, or ability to see objects at a reading distance, also improved.

“Even in advanced age, the brain has, in the sensory cortex, an enormous capacity for plasticity. In other words, it’s not just that as we age, things decline and there’s no possibility for improvement,” Andersen says. “This is actually showing that the brain, when presented with the right kind of training conditions, can improve function.”

While the findings offer promise for vision problems that arise from issues of visual processing (the brain’s interpretation of images), Andersen says brain-training may also help compensate, to some degree, for physical problems in the eye and optic nerve, such as cataracts or glaucoma.

“To what extent it can compensate is unclear,” Andersen says. “But at least it shows that there is a degree of plasticity in the brain that allows for some improvement.”

Rapid rise of Myopia in Asia due to kids not playing outside enough

March 30, 2015

The Current, CBC Radio's morning current affairs program did a segment on the growing epidemic of myopia in industrialized countries.  One interesting finding was the decreased prevalence of myopia in children who spend more time outside.  

A British campaign designed to encourage kids to spend more time outside launched last year after research showed most kids were spending less than an hour a day outside - the lowest of any generation. Their parents spent an average of more than two-and-a-half hours in the fresh air each day when they were kids. 

\And of course, getting kids outside is about more than just fun and exercise. There's been much talk in recent years about the benefits of unstructured play time, for example.

\Now, a new and unexpected benefit is coming to light... one that's right under your nose... or rather, right above your nose... It turns out that getting outside, may be crucial for the health of our eyes. It's a relationship that some researchers have been looking into to help explain a dramatic increase in myopia — or near-sightedness. It's been especially prevalent in Asia, and among children there.

And it's something Kathryn Rose has been looking into. She's the head of orthoptics at the University of Technology, in Sydney, Australia. 

For a Canadian perspective on myopia and its rate of incidence here, we were joined by Setareh Ziai. She's an Assistant Professor of Opthalmology at the University of Ottawa Eye Institute.

This segment was produced by The Current's Liz Hoath. 

Press Release

                   Nearsighted Patients Can Now Achieve Vision Correction Without the Need for Laser Surgery, Daytime Contact Lenses or Glasses

Dr. Michael Fenn is Providing Orthokeratology to Correct Nearsightedness and Slow its Progression in Children.

London, Ontario –March 24, 2015 – Dr. Michael Fenn has been providing his patients with nearsightedness, properly known as myopia, options to help correct their vision without the need for surgery, daytime contact lenses or glasses.  The revolutionary procedure known as orthokeratology uses a custom made specially designed contact lens a patient wears at night to mould the eye much like braces do for your teeth.  When removed in the morning the eye retains the shape of the mould providing clear vision all day.  As an added benefit, orthokeratology appears to significantly slow down the progression of myopia in children. 

“Many patients would love to free themselves of the burden of wearing glasses or contact lenses during the day”, says Dr. Michael Fenn, an optometrist in London Ontario.  “In many activities like swimming and other sports it is unsafe, not practical or there are issues with contact lenses either drying or falling out that make orthokeratology a viable option for vision correction.”  “Also, studies show that not only is it a safe way to correct someone’s vision, it also slows down myopia progression in children which is reaching epidemic levels in many industrialized countries including Canada.”

The London-based Optometrist is committed to improving his patient’s vision and quality of life by providing exceptional care with the latest technology and research in the field of orthokeratology and myopia control.  The process starts with a thorough eye exam which includes a painless, non-invasive procedure known as corneal topography in which Dr. Fenn takes a precise computerized measurement of the shape of the cornea (the outside covering of the eye).  This is used to create a retainer contact lens that is custom designed to reshape the cornea in precisely the right way to correct the vision problem.  The lens is worn nightly, removing it in the morning with the effect of clear vision lasting for the whole day or longer.  The patient is followed very closely by Dr. Fenn to ensure that optimal eye health and vision correction is achieved and maintained.

“In the past the only option for daytime freedom from contact lenses and glasses was laser surgery,” adds Dr. Fenn   “Some patients may be weary of surgery and are looking for an alternative that gives them vision correction but isn’t permanent and avoids some of the risks.”  “Patients who are not eligible for laser surgery because they are not yet 18 years old or their prescription has not stopped changing are also great candidates for the procedure. “  As an added bonus numerous studies have found that orthokeratology significantly decreases the progression of myopia in children.  “I now feel better when I have a young patient with progressive myopia that I can offer them and their concerned parents an option to help slow down this progression.”  “In the past all we could do is wait and hope that it would stop on its own.”  “This happens eventually but often not until a serious degradation in vision.”  “In addition, patients with higher levels of myopia have a greater risk of visually devastating diseases later on in life, many that can result in blindness that include glaucoma, early cataracts, retinal detachment and myopic macular degeneration.”

For more information, please visit orthoklondon.ca or Dr. Fenn at (519) 673-0210.

About Dr. Michael Fenn

Dr. Fenn has practiced optometry in London Ontario since he graduated from the University of Waterloo School Of Optometry and Vision Science in 1997.  He is a member of the Ontario Association of Optometrists and the Orthokeratology and Myopia Control Academy of America.  He shares his enthusiasm and compassion for providing utmost patient care with his wife Dr. Nadia Mercante, a family physician in Hamilton Ontario.  Dr. Fenn carries this enthusiasm and compassion to many aspects of his life.  From mountain biking in which he participates in the yearly Paris to Ancaster bike race, to donating blood, in which he has donated over 75 times.  He has provided free eye care to many medically underserviced people in the South American Bolivian Andes mountain region with Remote Area Medical Volunteers Canada.  Both he and his wife were happy to welcome the birth of their son, Matthew, on August 7th 2014.