Frank: Welcome to A Closer Look Podcast. I'm Frank, your host, and the admin for the Myopia Control and Care in Children Facebook group. Before we begin, I'd like to highlight that this podcast is not funded by industry and is not a sponsored program. Alicia, the co-admin of the group, and I are doing this out of our passion for eye care and our love for children.Â
Our goal here is to help increase public awareness and provide evidence-based insights into myopia, a disease area that we see has room for improvement in educational content. Additionally, our viewpoints are personal and do not represent the organizations we work for during our day jobs.Â
This is an awareness and educational event, so please consult your eye doctor or medical practitioner for professional advice. Today's program will be conducted in an interview format. Feel free to type in your questions in the chat, and we'll be happy to take them. Without further ado, let's jump in.Â
Today, we have a very special guest, Dr. Tina Douroudian, a U.S.-based board certified optometrist specializing in pediatric and myopia control. She's highly regarded in the field and has made significant contributions to pediatric optometry. Welcome, Dr. Douroudian!
Dr. Tina Douroudian: Thank you, Frank. I'm so happy to be here. First, thanks for allowing me to join your parent group. For the first few weeks, I was just observing, and I was very impressed by the huge knowledge base that all of you parents have already. I thought I was going to be walking into a minefield, but I was pleasantly surprised by the very science-based, clinically-based conversations happening. It's really great to see. So, thanks for having me.
Frank: Thank you! It's definitely our pleasure, and we are thrilled to have you on the program. To start, can you tell us a little more about yourself and where you are practicing right now?
Dr. Tina Douroudian: Sure. I was raised in Northern Virginia. I went to SUNY College of Optometry in New York for optometry school, where I met my husband. We got married, had kids, and eventually moved back to Virginia a few years ago. I practice in Sterling, Virginia, at a pediatric ophthalmology practice. I've been doing pediatric optometry for 11 years and specifically myopia control for that long, even before there was a term for it. When I first started, the term "myopia control" didn't exist. It was just, "Hey, let's try to manage this." My interest in myopia control stems from my own experience; I'm very myopic myself, over minus 8. I had always wondered how this happened since my dad has no prescription, and my mom doesn’t not have a very high prescription. My brother has an even worse prescription than me. So, I've been very interested in this from the start of my career, and I'm happy to constantly learn more and do more. I'm happy to answer any questions you all might have.
1. Myopia and Its Impact on Vision
Frank: Fantastic. Let's start with some basics. Could you explain to our listeners what myopia is and how it affects vision and eye care?
Dr. Tina Douroudian: Sure. Myopia is essentially two things: the blur that we see because the eye is stretching out too long, and as the eye stretches longer, that's where the problem lies. The inside back of the eye is called the retina, a very thin, vulnerable tissue. You can think of it when slicing an onion; the slimy layer between the layers is the consistency of your retina. As it stretches and grows longer, this very thin, vulnerable tissue is being stretched to its limit. That's why we care about making sure that the eye doesn't grow too long. This isn't just a problem of needing stronger lenses; the pathology is not the same as other conditions where we just provide stronger lenses.
2. The Rise of Myopia in Children: Causes and Contributing Factors
Frank: I see. Lately, it seems more and more kids have myopia. From your perspective and what you see in the clinics, what are the main factors contributing to the rise in cases in recent years?
Dr. Tina Douroudian: This generation of children has the highest rates of myopia, the youngest age of onset, the fastest progression, and the highest final prescriptions compared to any prior generation in history. The factors contributing to this include genetics, excessive amounts of near work (including screens), and a lack of time spent outside. During the pandemic, we saw a massive rise in myopia due to home isolation, more near work from increased screen time, and less time spent outside. While genetics play a role, they cannot account for the rapid rise we've seen.
Frank: Do you think there's a link between the increased use of devices like iPhones and iPads and the rise in myopia cases?
Dr. Tina Douroudian: I try not to vilify screens; they are part of life now. There is no concrete study that shows screens specifically cause myopia more than reading a book would. However, screens are designed to keep us engaged, and kids take fewer breaks when using them. They get bored less frequently, look away less often, and are completely locked in. So, while there's no study directly linking screens to myopia, common sense tells us that excessive screen use isn't good.
Frank: Yes, definitely. You mentioned near work and vision. Can you explain how near work affects myopia progression and development?
Dr. Tina Douroudian: Near work, especially at arm's distance or closer, can increase the risk of myopia progression. We often advocate for the 20-20-20 rule: every 20 minutes of near work, take a 20-second break and look at something 20 feet away. This helps reduce eye strain and gives the eyes a chance to relax.
Frank: My son finds it boring to look at something 20 feet away frequently. Do you have any tips for making this more engaging for kids?
Dr. Tina Douroudian: Instead of looking at something 20 feet away, it also works if your child closes their eyes and takes five deep breaths. This helps reset their mood and relax their eyes.Â
3. Effective Myopia Control in Children: Treatment Options and Recommendations
Frank: Moving on to treatment options, what are the current treatment options for myopia available in the U.S.?
Dr. Tina Douroudian: In the U.S., we have three main treatment options for myopia control in children: atropine eye drops, soft daytime contact lenses with a multifocal design, and orthokeratology (ortho-k). Atropine eye drops are used every night and come in different concentrations. Soft daytime contact lenses, like MiSight, are FDA-approved for myopia control. Ortho-k lenses are worn at night and reshape the cornea, allowing the child to see clearly without glasses or contacts during the day. Each option has its pros and cons, and the best choice depends on the individual child's needs and circumstances.
Frank: What about children with high astigmatism? Are there treatment options for them?
Dr. Tina Douroudian: Atropine is an option for all prescription ranges. For contact lenses, there are custom lenses available that can accommodate high astigmatism. Custom lenses are designed specifically for each patient, so even those with significant astigmatism can be fitted with soft multifocal lenses. If a child cannot tolerate contact lenses, atropine will be their best option.
Frank: Why do some doctors refuse to use off-label treatments for myopia control?
Dr. Tina Douroudian: Most of what I know about myopia control, I learned after graduating. If a doctor hasn't kept up with the latest research or isn't interested in myopia control, they might be hesitant to use off-label treatments. Atropine, for example, has been FDA approved since the 1960s and has been specifically used for myopia control for over two decades. Its safety and efficacy are well-established. However, some doctors are not comfortable with atropine because they are not aware or educated in the subject matter.
Frank: What about eye exercises or vision therapy? Can they help with myopia control in children?
Dr. Tina Douroudian: Eye exercises or vision therapy are generally not effective for true myopia control. They can be helpful for other conditions, but not for reducing true myopia. When myopia is appropriately diagnosed, the likelihood of success with eye exercises is low. Vision therapy does have some clinical applications, but it's not useful for myopia control.
4. Myopia Management: Axial Length Monitoring and Risks of High Myopia
Frank: Why is monitoring axial length important in myopia control in children?
Dr. Tina Douroudian: Monitoring axial length helps us objectively see how fast myopia is progressing. We have strong data on how much a person's eye should be growing at various ages. If a child's axial length is increasing faster than expected, it indicates that their myopia is progressing rapidly, and we need to take action. Axial length is a more objective measure compared to subjective refraction, which can be influenced by various factors.
Frank: What are the risks associated with high myopia?
Dr. Tina Douroudian: High myopia increases the risk of several eye conditions, including retinal detachment, glaucoma, and macular degeneration. These conditions can affect vision and overall eye health. The longer the eye grows, the more stretched and vulnerable the retina becomes, increasing the risk of these complications.
Frank: What about progressive lenses for kids? Are they effective for myopia control?
Dr. Tina Douroudian: Progressive lenses are not very effective for myopia control. They can be useful for other conditions, such as helping children who are on atropine and experience near blur. However, for myopia control, progressive lenses have not shown strong efficacy.
Frank: What is the average age at which myopia progression usually stops?
Dr. Tina Douroudian: Myopia progression generally slows down between the ages of 15 and the mid-20s. However, this can vary widely depending on the individual. Factors such as the age of onset, the child's lifestyle, and genetic factors all play a role in when myopia progression slows down.
Frank: Thank you so much for all this valuable information, Dr. Douroudian. It's been a pleasure having you on the program.
Dr. Tina Douroudian: Thank you, Frank. It's been great being here and sharing insights with your audience. Remember, your child's eye health is critical, so stay informed and consult your eye doctor for professional advice.
Frank: Thank you to our audience for joining us today. If you have any further questions, feel free to add them to the chat or start another discussion within the group. Most importantly, reach out to your eye doctor or medical practitioner for personalized advice. Until next time, take care and stay informed.
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