Tuesday, July 07, 2020

Are you doing all that you can to reduce or eliminate your degree of nearsightedness?

Some call it nearsightedness, some myopia and still others use the British term, short-sightedness. In any case, it all means the same thing. Vision at far distance is blurred, while vision at near distance is clear.

All this is common knowledge; however, what is not commonly known is that some children who have been diagnosed as nearsighted are not nearsighted, and others don’t have to go through increases in prescription every few months, making their lenses increasingly thicker.

Children who have frequent increases in their eyeglass prescription are most often diagnosed as “functionally nearsighted” by Behavioral or Developmental Optometrists. Typically, functional nearsightedness may begin as early as 5 to 7 years of age and usually starts with a low prescription. It is common to initially associate it with eyestrain and frontal headaches related to sustained reading, computer and/or writing tasks. Copying from the blackboard may especially cause inaccuracy and fatigue. The first symptom that usually occurs is reduced distance vision, only after sustained near vision tasks. Typically, vision gradually improves when sustained near visual activities are suspended. Over time, however, the blurred distance vision remains and eventually worsens with length and demand of the near visual task.

Functional nearsightedness is different from genetic myopia in that genetic myopia is passed on from one generation to the next, regardless of how one uses one’s eyes. The genetic form of nearsightedness usually starts earlier in life, with children 2 to 5 years of age; has an initial moderate to high prescription and is typically unrelated to eyestrain associated with near vision tasks.

For you, the parent, to understand the process of functional nearsightedness, you must understand the association or linkage between your child’s inside (ciliary) muscle for focusing and outside (extra-ocular) muscles for coordination. There are six outside muscles surrounding each eye and one muscle inside the eye controlling focus. This process occurs because the internal and external eye muscle systems are linked, allowing one system to support and compensate for the other. Typically, extra effort to focus is needed when there is a lack of ability to coordinate and turn the two eyes inward, and that extra effort will translate into an increased ability to turn the two eyes inward. However, over time, the increased focusing leads to an internal muscle spasm and ultimately becomes what some call “structured in” myopia. At this time we don’t understand how that occurs, but we do know when it does occur. The functional focusing spasm becomes myopia.

In other words, if I can’t coordinate my two eyes together, enabling them to look at the same point in space at the same time, I can elect to over focus, increasing my ability to coordinate these 12 external muscles (6 for each eye), assisting the two eyes to turn inward together preventing double vision and associated symptoms and creating eyestrain. Eyestrain, often associated with functional myopia, ultimately becomes translated into “true structural myopia” through this process.

Treatment of functional nearsightedness is different from that for the genetic type. Whereas treatment for genetic myopia typically involves a nearsighted spectacle lens, treatment for functional nearsightedness is through remediation of the eye-muscle inefficiency and imbalance.

Treatment for functional myopia may include a therapeutic eyeglass prescription (which may be in the form of a bifocal), vision therapy (training), proper visual hygiene and diet, designed to reduce stress and strain of the visual system. Therapeutic lenses are designed to reduce the need to over focus, while vision therapy potentially eliminates the need to compensate for one system with another and can resolve the eye coordination difficulty. Proper visual hygiene may include diffuse uniform lighting and proper posture. In addition, some recent research suggests a properly balanced diet rich in chromium may reduce myopic effects. Personality may also play a role in a child’s ultimate visual development.

There is a lot that is not known about myopia and its development; however, there are programs and procedures that have been proven to reduce and/or eliminate myopia. Join me in reducing myopia in children today.

Joel H. Warshowsky is a Behavioral and Developmental Optometrist. He is Associate Clinical Professor Emeritus and founding Chief of Pediatrics at SUNY State College of Optometry, where he taught for 37 years. He has served as Optometric Consultant to numerous schools throughout New York and New Jersey. Dr. Warshowsky has lectured nationally and internationally and is published widely in the field of optometry. He is a Fellow of the American Academy of Optometry and College of Optometrists in Vision Development. He maintains three pediatric practices in Roslyn, New York; Ringwood, New Jersey and Riverdale, New York.

By Joel H. Warshowsky

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