Myopia - The Search for Help
[!info] This is the fifth in a series of posts about the epidemic of myopia (nearsightedness), my personal experience with it, and what people are doing about it. The fourth part is *"Myopia - Taking it Seriously"
Last time in the series, I covered a little about my own experience with myopia and moderate-high myopia, and my recognition that it can still be a problem in adults, not just kids. There was someone who acknowledged that the problem was real. Since then more sources have emerged, as well as studies demonstrating this.
finding someone who acknowledges the problem can be tough
So I started emailing some optometry school professors or names I'd seen while trying to research the topic, and contacted via zoom a professor who was an expert in this subject. She had obtained an ophthalmology degree and gone on to further obtain degrees in optometry and epidemiology. This optometrist and researcher suggested to me that if my eyes were indeed continuing to get longer in my 30s that this was a serious issue, and that she had seen such cases. She generously volunteered to help me find someone more familiar with the issue in my region and even co-manage. She had a few suggestions for treatments, which would be likely speculative given that existing treatments are almost entirely based on clinical trials done exclusively with children. She also suggested OCT with 5-line raster for macula (ocular coherence tomography, a type of scan of retinal tissue), and said i needed to have axial length measured (ideally by a non-contact biometer, more on that later).
Some OCT images that eyecare professionals will be able to interpret; in this case researchers are training machine learning models to assist in recognizing retinal pathologies source
observing for ongoing issues
I live in a midsized city that's somewhat isolated and, based on previous experiences seems to be generally behind on adoption of new medical technologies. And everything else. It took 3-5 years for escape rooms and frozen yogurt to trend here and die out after they did in major cities.
the AAOMC's Doctor Finder can be a good start for finding a knowledgeable professional
I started driving a few hours to a provider who was known for these things, recommended to me by a colleague of the researcher. We'll call this provider Dr. Adams (not a real name). Dr. Adams noted that it was possible for adults to get worse, and that there might be treatments to try if that were the case for me. Thankfully I was told the back of my eye looked relatively healthy. At that time no treatment was suggested, only monitoring.
This provider also gave lifestyle suggestions:
- Close-up work may make things worse, but taking frequent breaks may mitigate this. Sometimes the suggestion was 20 feet after 20 minutes, sometimes more like gaze at something over 20 feet away for at least 5 minutes every hour. 20 feet is "optical infinity", where the eye has to do less acommodation (altering its shape for changing focus).
- Indoor time and the varieties of light there may make things worse, but this effect is likely more pronounced in children
- Blue light from screens may have an impact, but blue light is also part of the spectrum of light outdoors, and intensity of the light may be more important than color/wavelength.
Environment suggestions for children (source)
The OD began monitoring me at 3 month intervals, and if there was no change we'd increase the time between follow-ups.
Dr. Adams also observed that I had "tesselated fundus", which you may have noticed in the IMI infographic referenced elsewhere in this series is indicated as step one of pathology associated with high myopia. However, Adams also said "I see tesselated fundus all day", and suggested that it may not be as tightly associated with pathology in caucasians with light pigmentation. I am of course hopeful that it is more coincidental in my case.
an aside on optometrists, ophthalmologists, opticians, and others
A note - if you're reading this, you're probably already aware of the differences between optometrists and ophthalmologists, though it can be confusing due to the similarity of the names of the professions. Just in case, I'll try to summarize my take on the differences.
optometrists
In North America, an optometrist is an eye care professional who completes additional study beyond an undergraduate degree to obtain a Doctor of Optometry degree. They can then add "OD" to their names. Optometry's scope of practice includes mainly nonsurgical interventions, measurements, monitoring, and some pharmaceutical interventions. Their scope of practice may be expanding in some areas, to include prescribing of oral medications and even some laser procedures. In addition, there are various specialties which can include their own certification boards. These include the Fellowship of the Scleral Lens Society for fitting complex contact lenses, among others like the Optometric Vision Development and Rehabilitation Association (OVDRA). There are also emerging specialties such as retina optometrists.
source
ophthalmologists
An ophthalmologist is a medical doctor (MD or DO) who specializes in the eye. They receive the same training as any other MD or DO, with additional residency focusing on the eye. They will handle both surgical and non-surgical eyecare, and their scope of practice can include most or all of the items done by an optometrist. In some cases they will delegate work to an ophthalmological nurse. In other cases, they work in a practice that employs optometrists as well, leaving the ophthalmologists to only take on work outside of the optometrists' scope of practice. It's been my experience that ophthalmologists are in general behind on adoption of myopia control and take it less seriously than optometrists (at least in North America).
source
opticians
A dispensing optician is the person who fits eyeglasses or can dispense and demonstrate commercial non-custom contact lenses. There is a certification board in the USA, but opticians are not required to be licensed. This may become important for you! Especially when it comes to fitting some of the specialty eye glasses that will be discussed later, which rely on a high degree of precision measurements and to be situated correctly on the face. In this case an ABO optician may be desirable.
Opticians may work inside of an optometry practice, or optometrists may work inside of an optical shop.
One confusing note - in the UK, the office of an opthalmologist may be called "an opticians", even though the primary focus of the office not dispensing opticianry!
One way to think about optometrists and ophthalmologists and opticians - optometrists seem to be a first point of care. If they find something very complex or requiring surgery, they'll refer to an ophthalmologist. If they find that you need correction during their exam, they'll have you follow up with an optician.
high-precision specialty instruments for eye length
I mentioned before that I was "monitored" for axial elongation - continued growth of the eye. Monitoring involves high-precision measurements on what is called a "non-contact biometer". This means a device that can measure eye length without actually touching the eye. I had tried a more local provider who used an ultrasound-based biometer, but these are now considered less accurate, and that was my experience visiting that provider. Some providers will use the term "A-Scan" when referring to ultrasound biometry. Confusingly, some office staff may also say "A-Scan" to refer generally to any type of biometer, so it may not hurt to ask which instrument(s) the practitioner uses.
My understanding is that the high standard for this type of biometer can be met by instruments including: Haag-Streit Lenstar, Oculus Pentacam, Oculus Myopia Master, Zeiss IOLMaster, and sometimes the Topcon Aladdin though that may be less preferable than the others. I believe most of these work by interferometry. It's kind of astounding. They have precision to hundredths of a millimeter. Practitioners note that the important thing is to get multiple readings over time on the same instrument as readings can differ between manufacturers.
A lenstar instrument
For a period of about 1 to 1.5 years, it looked like there was no change for me. However at my 2-year appointment it started to appear that there may have been a slight worsening. After a few more follow-ups, this was confirmed. Again, this was something that felt terrible. Perhaps the psychological impacts of this disease are for another time.
But I thought I should try to seek help and attempt to do something. Assuming that the rate of change I had over about 2 years continued (let's call it around .7mm/yr ). Then by age 60, that would be an additional 1.4 mm of elongation. By the cumulative risk graphs referenced earlier, that's a lot! It would raise me from a near normal risk of serious visual impairment to around 15% or more. By age 80, it would move me from around a 1/4 chance of serious impairment to near certain visual impairment.
I often think of a line from a Dylan Thomas poem I was assigned in high school, and featured in the film Interstellar: "Rage, rage against the dying of the light."
In the next part, I'll talk about some of the emerging treatments and preventatives that are available in children, and the ones practitioners suggested I might be able to try as an adult patient.