I?m sure my fellow opticians would agree with me that, as opticians, we do not just sell products. A big part of what we do is counsel people about their eyes and appropriate life enhancing vision products. How many times a week, depending on your clientele demographic, are you asked questions about impending cataract surgery, what to do between surgery and the post cataract refraction, and finally options for a client that may not need much of a distance Rx, but would be lost without the multiple working distances of progressives? And the doctor has told them they only need readers. In my practice I seem to be seeing these scenarios sometimes multiple times a week. This motivates me to keep my knowledge of cataract surgery up to date. In the last few years Blue Light has been a topic of interest with clients and within our industry. Another education opportunity.

After all, most stakeholders and the public regard us as front line healthcare workers who are very accessible.

Another current topic of interest for us to educate our clients about is eye strain and myopia. The press has been publishing reports that claim there is a myopia epidemic on this planet and it will continue with 50% of the world suffering vision loss due to myopia by 2050. ?This topic has intrigued me this past year and has motivated me to use it for my self-directed learning this year.

Myopia is becoming so prevalent, nearly 50% of the world will have it by 2050, according to new?research?published in the journal Ophthalmology

There seems to be consensus that lack of natural light and too much close work put people at risk for myopia. Rates of myopia are growing at a rapid pace in the last 50 years or so. Google certainly isn?t short sighted when it comes to myopia. My Google Alerts bring information on the subject on pretty much a daily basis.

Some say that myopia is determined by genetics.

It is an inherited condition usually detected in children between the ages of eight and twelve. Few factors outside of heredity affect this condition. Using dim light, reading too much or nutritional deficiencies do not seem to impact it one way or the other. ? ? ? ? ?Copyright Canadian Ophthalmological Society

Some say that it caused by environmental factors like too much reading.

Children now spend much of their time focusing on close objects, such as books and computers.To compensate, the eyeball is thought to grow longer. That way less effort is needed to focus up close, but the elongated eye can no longer focus on distant objects.

New Scientist “Lifestyle causes myopia, not genes.”

?High rates of myopia in Shanghai teens.

A report last year from the Organization for Economic Co-operation and Development showed that the average 15-year-old in Shanghai now spends 14 hours per week on homework, compared with 5 hours in the United Kingdom and 6 hours in the United States.

?Others say it?s due to both close work combined with genetics forming the perfect storm.

The past decade has seen a greater understanding of the molecular biological mechanisms that determine refractive error, giving further support to the belief that myopia is the result of a complex interaction between genetic predisposition and environmental exposures.?

Eye, The Scientific Journal of The Royal College of Ophthalmologists

And lack of natural light seems to be a culprit too.

A comparative study of children ages six to seven with Chinese ancestry in Sydney and Singapore found kids in Sydney had a 3% prevalence of myopia while the same age group and ethnicity in Singapore had a 29% prevalence rate?almost ten times higher.

The study identified the most significant factor associated with the differences: time spent outdoors.?

The kids in Sydney spent 13.75 hours a week outdoors on average compared to just 3.05 hours for the Singapore kids.

(Rose et al. 2008

I could go on quoting studies and challenges of studies. Two things seem to be a common thread throughout the majority of the information; lack of natural light and too much accommodation. The eye is evolving from its anatomy created to utilize natural light and distance viewing as our main activity. Lack of natural light lessens the production of dopamine, which helps keep the eye from elongating, and excessive accommodation increases the intra-ocular pressure of the eye among other things that cause elongation.

So where does this intersect with the daily practice of opticianry?

Having information to address your patient?s concerns and interests helps build your brand. Knowing the theories and conclusions of studies shows your patients that you are up to date not only with the latest in lens designs and frame styles, but the workings of the eye and the epidemiology of their vision disorder.

Clients like clinical information and information embedded in stories and short anecdotes. When talking about the lack of natural light and extensive reading most patients will relate because their parents told them that reading in the dark would ruin their eyes. For years we responded that this claim was an ?Old wives? tale?. The last few decades of research are proving that it wasn?t an old tale at all. I came across a that study controlled the amount of light chickens were exposed to and the result was the group receiving an inadequate amount of light became myopic chickens. A group that was injected with a dopamine production inhibitor, to stop the protecting effects of Dopamine in eyeball elongation, also became myopic.

What do you tell parents of a myopic child when you are asked if they should wear their glasses all the time? Years ago I would have said that with their glasses on they are a corrected eye just like an emmetropic eye and they would accommodate as needed. Now when asked I talk about the current line of thinking and suggest that the glasses are removed when reading but they should consult their prescriber.

In a study entitled “Bifocal Control of Myopia,” Kenneth H. Oakley and Francis A. Young described how they used bifocals with plus lenses on children to reduce their rate of myopia progression to a fraction of what it would have otherwise been. (American Journal of Optometry and Physiological Optics, 52, no. 11, November, 1975).

?How are you addressing patient?s concerns with fatigue from today?s lifestyle of extensive near work? Are you recommending Near Boost lenses for pre-presbyopes? Are you educating them about the effects of Blue Light?

The message I want to convey in this post is that your patients will see your passion and commitment to their needs when you are well educated on the topics that affect their vision.

I?m sure you?ve heard this before:

?An educated consumer is our best customer?

I truly believe that this is paramount in our profession.

?- Lorne Kashin, RO

Executive Director

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