What Is Myopia? Important Facts For Every Parent

TRANSCRIPT

0:06 If you've got kids and you pay attention to health and wellness issues, you might have heard that experts are worried about the alarming

0:15

rise in myopia among children. Myopia means that the eyes have difficulty focusing on far away objects,

0:23

but there are more serious implications than just needing a stronger pair of glasses.

0:29

Once Again, I'm talking with Paul Graham about a topic which he regularly discusses with patients in his clinic.

0:35

Paul is a leading Gold Coast optometrist with over 30 years of experience. He's also the owner of Harmony Vision Care in Varsity Lakes.

0:45

In this interview, we're going to be talking about myopia, the causes, and the available treatment strategies.

0:51

But first, who am I? My name is Paul Sallaway. I'm the owner of Optics Digital Marketing. We're an agency that helps independent optometrists to grow their practice.

1:00

So Paul, good to see you again. Likewise. It's been such a long time. I mean, it's at least 10 minutes since we last talked.

1:06

So full disclosure, we're doing back to back interviews today to catch up on some lost time due to some certain

1:14

weather events that happened. Yes. Yes. The old cyclone, Alfred.

1:20

Anyway, so let's talk about myopia. So if my child has early stage myopia, what symptoms would he

1:31

or she be experiencing? Sometimes none.

1:36

I'm sure of myself, and mine was picked up by not being able

1:41

to read a bumper sticker on a car when the rest of the family could. For me, I didn't realize that I was missing out on anything.

1:49

And so in the early stages, that little bit of distance blur might not impact you too much in an obvious way. And if it creeps up on you, you just get used to it.

1:56

And certainly in a modern classroom, you to talk kids and they're using boards and screens a lot less now.

2:03

And a lot of kids are at the front. And if they're at the front of the class, then they're at a distance

2:09

where they can still see things. So it can actually go unnoticed for the initial It's unfortunate.

2:15

Plus, I think it creeps up. So it doesn't just creep up. Sometimes the initial part of myopia occurs so quickly that

2:24

you get caught by surprise. And this is the reason why we say, if there's a family history

2:30

of myopia parents and siblings, then it's a good idea to get your kids checked recently to be trying to catch it as early as possible.

2:40

Yeah, I think anyone who wears prescription glasses has got some kind of story such as yours.

2:47

Like with me, I think I was about maybe 18, 17, 18 with some friends driving,

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and I took a wrong turn heading towards the Gold Coast. My friends in the back saying, Where are you going?

2:59

I just litteraly , I misread the sign because and it was at night as well. So I think maybe your night vision is the first to go.

3:07

I'm not sure. Yeah. And look, it was funny. I remember the TVs when you and I were growing up If you walked up close enough

3:16

to them when they were off, you could actually see the pixels on the screen. And so I always thought the TV screen was meant to look pixelated and fuzzy

3:24

because it was made of pixels. And then after it got corrected, I went, no, I'm meant to be seeing it much more clearly and not realizing that you can actually see the leaves

3:32

on the trees from a distance. And there's little things that you just don't notice because it creeps up on you.

3:38

But, yeah, it can go unnoticed initially, but eventually the kids will start

3:43

to squint or make errors with copying or just not being able to see what they're

3:48

asking the kid next to them or what's on the board. And in your case, they're missing things

3:54

in sport or this just starts to become

4:00

errors in performance and judgment and things like that. So I've got two kids, and one of them, I think he's okay.

4:09

But the other one, I've noticed that she... I noticed that she was sitting closer and closer to the television.

4:17

And I thought, okay, maybe that's a sign. That's a sign that we need to do something here.

4:23

Yeah, look, and some really young kids will do that because they want to get close to the screen and tune out everything else, and they get

4:32

captured by whatever's on the screen. But if they're a primary school child that's becoming a new behavior, then you certainly want to get that checked out.

4:39

I just had a young fellow yesterday who we were concerned about his potential

4:45

for becoming short-sighted because both parents were short-sighted, his sister short-sighted. And one of the behaviors that prompted them to come back in was

4:52

that he was walking up to the TV, which he hadn't done for a while at eight years old, and sure enough, and he wasn't noticing

4:59

problems in the classroom. It was that behavior of walking to the TV. Sure enough, you found that he was short-sided.

5:07

I have a link somewhere to... There's a really interesting page online where you It looks like a classroom.

5:16

You can see a perfect image of a classroom. And by adjusting the slider, you can see how that classroom becomes

5:24

blurred depending on how severe your myopia is. I'm not sure if you're familiar with that one.

5:30

Look, I've seen something like that. And I think we can think of blur like that,

5:36

but there is the ability to still understand what you're looking at, even though it might be blurry. And so sometimes the human brain is fairly incredible.

5:44

It's incredible at adapting to these things. So the amount of blur that you might get

5:50

in that simulator may not be properly what someone's experience is because it's a bit like if you're reading letters

6:00

on a chart, it might be difficult to identify those individual letters. But if we made those letters into a word, you could probably identify the word even

6:07

if a few of the letters were difficult to see. So the brain is able to fill in the gap and make really good

6:14

predictions about things. And I think this is the other reason why sometimes people might not notice it being a problem, because they're not actually making as many mistakes

6:22

as we think they might. And of course, I think this is one

6:27

of the misunderstandings that goes along with myopia, is that maybe some people, they hear about myopia and they think about, okay, well, yeah, sure, you

6:35

have problems, problems like seeing things at a distance, but just get a pair of specs and you're good to go.

6:41

That's problem solved, right? But there's actually longer term implications to this.

6:47

Do you want to talk about that? Yeah. And part of the problem with just getting a pair of glasses is it doesn't

6:53

stop it from getting worse. And so you've got that increasing myopia that you just need to deal with,

6:58

which is inconvenience on its own. But a lot of the research is now indicating that the more short-sided you are,

7:04

the higher the risk you have of developing other eye disease and eye problems as an adult.

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glaucoma, which is one where the pressure goes up in the eye. The problem with glaucoma is that it's a sneaky disease.

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You don't get a lot of symptoms from it until it's upon you. And often it's picked up through routine testing of pressures and other

7:26

aspects of your vision. You've got a higher risk of getting a thing called the retinal detachment. And that's where the retina pulls away from the back of the eye effectively.

7:32

As the eyeball grows, then the retina itself gets stretched.

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And so you can get tears and breaks in that, and then that can actually pull away. That can result in the sight loss and sight distortion.

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You've also got issues around developing a higher incentive of

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macular degeneration, particularly in very, very high amounts of myopia. So part of the overall global goal is that we want to reduce the number

8:02

of people who get to that point of having a very high risk of these extra problems.

8:07

And some of those things, especially macular degeneration, they're irreversible, aren't they?

8:13

So once you've got a severe situation like that, there's not much you can do. Yeah.

8:18

And the type of macular problem you get with myopia may well be different to the regular age related macular issues. Absolutely.

8:27

Okay. All right. So Let's say, in my case, I've noticed that my kid likes to

8:35

sit closer and closer to the TV, and I bring her in to your clinic there.

8:41

What's your process? What questions do you ask? What tests do you run?

8:47

Yeah, so we do a case history. So we might ask them about how easy are they seeing things

8:53

in the classroom, distance and near, what devices they use, how long they use them, what activities that do they participate

9:02

in that takes them outside, so what sport and other things. We want to know parental history because your chances of developing myopia

9:11

increased for every other direct family member who is short-sided. So it's more risk with two parents than one parent as an example.

9:23

That's probably the core questions. We're still short-sided people are notorious that having

9:30

poor near visual skills, even though they don't have visual symptoms at near distances as much as other people do.

9:37

And so we need to be aware of generalized visual dysfunction

9:42

in addition to them maybe starting to have problems with their distance vision.

9:49

And so you'd still do the typical eye chart test?

9:56

Yeah, and that's probably the most obvious one that picks up the problem where they're no longer able to see 20/20 or 6/6 on the chart, and then that matches up

10:04

to then that would then match up to their prescription. And so we do a prescription check and find that they need some minus lenses

10:10

to restore good distance vision. And one of the main phase of myopia control now is also

10:16

looking at axial length. So the axial length is the distance between the front of the eye

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and the back of the eye. So effectively, if we get the old model again, so from the cornea to the back

10:27

of the eye here is the axial length. And so in myopia development, this eyeball grows longer.

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And there's a fairly good correlation between increasing levels of

10:38

myopia degree and your axial length. So I could normally point to it.

10:44

It normally sits about there. But someone in the practice has seen some myopic kids done and has taken the machine

10:50

that we use to measure axial length. So that's a very important part of diagnosing and then

10:56

managing myopia afterwards. That does require special equipment then to measure that actual length.

11:03

Yeah, look, you don't need it to find myopia because just distance blur

11:09

and blur that's corrected by a minus lens is a fairly basic definition. But yes, if you're serious about managing myopia, ideally, you

11:17

are measuring axial length as one of the primary measurements

11:23

that you use for treatment effectiveness. And what is the youngest age

11:30

to really start testing for myopia? If I've got a child who's three or four, is that too soon to really

11:38

be concerned about this? So getting an actual length measurement at that age is difficult, but we would recommend getting a test around six to nine months old, and that's

11:48

just more for general visual development. Same thing around three years old. And the classic thinking is the three-year-old,

11:54

we're really looking at things more like eye turns the night, lazy eyes, those sorts of things. So certainly Certainly by the time you get to preschool, four or five years old,

12:05

you definitely want to be getting some measurements, particularly if there's a family history. There's some suggestion that if you've got...

12:12

Most kids are a little bit long-sided or hyperopic, and if you've got a lower level

12:18

of that hyperopia compared to the normal, that may be considered a predictive factor that you might be heading towards myopia.

12:24

And so it's good to have that as a baseline to get a sense of how much has it changed.

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I even saw my own daughter change within nine months. She was reasonably hyperopic, and then nine months later, she wasn't.

12:35

So these things can change quite rapidly. So having some baseline measurements is particularly good.

12:43

And you touched on some of the root causes here of myopia, which is environmental,

12:49

but also genetics plays a role as well, doesn't it? Absolutely. A combination of the two.

12:54

And so where you look into genetics is that you've got the family background.

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So the classic one, 20 years ago, if we had a child who was developing myopia sitting in our chair, you were almost guaranteed

13:10

that the parents were myopic as well. Fast forward to nowadays, I've got lots of parents who are coming

13:17

in where there is no history of myopia, yet the child is becoming myopic. And so you go, it is absolutely a mixture of that inheritance,

13:24

but also environmental factors. And we've discussed in the past, we know that That there is a higher

13:31

incidence of myopia in East Asian cultures. And is it environmental because of lifestyle, cultural differences,

13:39

large populations in built environments, or is it genetic? But pretty much across cultures, there's been an increase in the prevalence

13:48

of myopia over generations. So absolutely a combination of the two.

13:54

I don't remember the exact statistic, but I think that they So I think that within the next 10, 20 years, maybe half the population of

14:05

the world is going to have myopia. Yeah, 2050 was the market that 50 % will be short-sighted.

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And I think Australia recently has been sitting around that 27, 30 %,

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which is where America was in the '70s. They're now at the over the 50 %.

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So it's certainly changed over time. And outdoors It's interesting when you look

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at relationships in research, we often talk about correlations

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and relationships and associations because it's very difficult to talk about cause.

14:43

Causse needs a very, very high level of scientific proof for a researcher to be

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able to state with confidence that something's a cause. And myopia is one of those areas in vision care where they're pretty confident

15:01

in saying that spending more time outdoors delays short-sight,

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and that the lack of outdoor activity is a cause of early short-sight misdevelopment or myopia development.

15:14

And outdoor time, you were speaking about that.

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But when it comes to UV, like UV light, does that have any in itself?

15:26

Does that have any beneficial effects for myopia? That's a great question.

15:32

Yeah, and that's a great question. What is the benefit of spending time outdoors? Is it the overall volume of light that's available?

15:42

Is it the UV that's protective in some way? is it the, I saw one paper years ago that I think makes

15:50

a lot of sense that when you're in an indoor environment, you have a lot of light reaching you from very close distances, walls and roof

15:59

that you would not get exposed to outside. If your retina is effectively a little bit of brain tissue, that it's

16:06

averaging where that light is coming from across the day as a potential trigger for short-sideness.

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And so you've got all these close distances. And so maybe it's an adaptation to that. And the benefit of outdoor activity is that you have this more natural

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light coming from further away. So lots of theories we still don't know.

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That's that tension as a clinician to say, get outdoors, but still be sun safe. And you're going, well, is the UV increase part of the magic?

16:34

We just don't know. It's a challenge. Interesting. Well, if you're enjoying this conversation and you're getting value out of it,

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16:54

more high value videos such as this one. So Paul, all right. So we We've talked about the symptoms and the causes of myopia.

17:04

Now, let's talk about treatments, because I think there is quite a spectrum

17:09

of options which parents have for their kids if they are diagnosed with myopia.

17:16

So can you tell us what are some of the common strategies that you use in your practice?

17:23

Yeah. Look, and behavior counseling is a broad term where we go, well,

17:29

we know So we know that intense near work, coupled with not enough time outdoors may

17:35

well be part of the trigger of early myopia development. So regardless of your journey, whether you're not yet short-sighted or

17:42

already short-sighted, then maintaining some good visual habits of taking plenty of breaks with near work, getting up and moving

17:51

around, preferably outdoors, spending as much time as you can outside at least 90 minutes a day outdoors

17:58

and trying to your device use under 2 hours per day is a general bit of advice, and certainly a strong one for people

18:07

who are not yet at that myopia development stage. I think we can all confidently now say that just prescribing a distance lens is

18:16

probably not really an appropriate thing to do anymore in someone who's highly likely to progress.

18:22

And so the younger you are, the more parental history that you have,

18:28

and depending on cultural background, these are all increased risk your factors for progression. So if you sit in that medium to high risk of progression, then

18:38

just prescribing glasses to restore distance vision and doing nothing else is probably no longer appropriate, particularly when we've got

18:44

so much choice now, especially in Australia, where a lot of the leading research in myopia for a long time

18:52

has come from Australia. So I'm very fortunate in that regard. Our close proximity to Asia as well means that we have access to a lot

19:01

of myopia control products. And a lot of them are optical devices. So we've got really started out.

19:08

One of the leading ones that probably has one of the most bits of literature and research around it is orthokeratology.

19:15

Which is the lenses that you put on your eye overnight. And I've worn them as an adult to correct my myopia.

19:23

It wasn't for controlling my myopia. It was just certainly just a method of restoring distance vision.

19:29

And so it started out as an adult treatment to have something as an alternative to contact laser surgery because you could wear a lens

19:36

at night, take it out when you wake up. Because it's a stiff lens, it's temporarily

19:41

reshaped the cornea on the front of the eye, and you get this benefit And the seeing clearly. And the accidental discovery that came from that is

19:49

when you fit kids and teenagers with them, their progression in myopia appeared to slow.

19:55

And the research has certainly back that up now, that that's a primary strategy for slowing progression.

20:00

So you get to see clearly without wearing glasses, and also you

20:05

slow the development of your myopia. You can also do that through a contact lens that you wear during the day.

20:12

Now, it's not reshaping your eye, but it's creating a certain type of optical defocus that they have shown slows myopia progression.

20:21

So you've got a number of different soft contact lenses. You can call them dual focus or multifocal.

20:26

There's lots of different names. The main idea is that they're not a single vision sight, correcting only lens.

20:33

And so we've got those available. And they've been around not quite as long as ortho-k, but certainly getting fairly close.

20:38

And things like the MiSight lens, this NaturalVue, this

20:44

SEED lens from Japan. There's a Mylo, I think, from Spain. So there's a number of different lenses available.

20:52

They're all daily disposable, are they? Those are all daily disposable. The Mylo Lens might be a monthly We can use some monthly disposables where if

21:03

someone's got astigmatism, that is too much to be corrected by a normal daily myopia control lens.

21:10

We've got those sorts of things that we can order. And then you've got spectacul lenses. And there's a number of spectacul lenses that come on the market over

21:17

the last couple of years. I can think of at least five or six now available in my practice that we

21:24

are able to choose from based on the individual needs of the patient. I It might be closer to eight now, I think about it.

21:32

So we've got plenty of choices. They all have varying degrees of ability to slow progression on average.

21:38

Right. Yeah. Just on that point, do they all use the same defocusing

21:45

approach to slowing myopia?

21:50

And if so, what is the difference between the lenses? What would prompt you to say, okay, I think you should choose

21:57

MiYOSMART versus Stellest or something else? Yeah, look, some of it might be that you might choose it based on the population

22:07

that that lens was studied on. So if you were dealing with someone where a lot of the data from that particular

22:14

lens came from Asian countries, then you have someone who has an Asian background, then East Asian background, then you might choose that lens versus

22:22

someone who is Caucasian and use a lens where the data comes from more Caucasian studies.

22:28

That can sometimes come into There are some people with myopia who also have different forms of binocular visual dysfunction, and there may be

22:38

varying degrees of weighing up the tension between making sure that you're paying attention to other aspects of how they're functioning

22:46

visually and the myopia. And so you might be leaning into a lens that maybe might not be as effective

22:52

at controlling the myopia, but provides quality of life in other ways. So there are some of the other things that you need to balance and And

23:00

that's probably something that's sometimes overlooked. Everyone gets caught up on the myopia aspect and forgets the person's got two

23:08

eyes and has to have good function of the two eyes working together in terms of binocular function.

23:14

And then, in focusing. They're probably the primary things. You might adjust it based on the risk of progressing more rapidly because

23:24

they're younger versus older. So there's a number of different things that you might use to consider for that

23:30

individual patient that's sitting there. Okay. And are there therapies?

23:37

I mean, are there exercises that you can do to slow down myopia?

23:43

Look, the research into doing vision therapy or exercises for myopia,

23:49

specifically, is not there. It would be an interesting thing to look at because there

23:56

appears to be influences in certain types of binocular dysfunction into myopia

24:01

progression, higher versus lower. And it would be great to have those studies, but trying to get funding for that when the approach to myopia at the moment is

24:09

a global approach to trying to reduce the overall levels. So they're looking at what are the simplest strategy,

24:15

so it tends to be fairly lens-based. If someone's got symptoms from binocular visual

24:20

dysfunction, then certainly vision therapy has got a place there, but we don't go into it as something where you're promising any control over myopia.

24:30

I've certainly seen the odd case where we've been able to reduce the amount of myopia a little bit with the vision therapy, but it's not something that I

24:39

would recommend as a primary strategy, really getting into using lenses.

24:44

It's our primary strategy at this stage. And just in case anyone's thinking about this,

24:52

so LASIK and laser surgery for vision correction, I think that's something

24:58

that they probably don't do on people whose eyes are still developing anyway. Certainly in this country.

25:04

So certainly in Australia, you have to be 20 and you have to be stable.

25:10

And if we take an example of my Ortho-k patients. So we opened the practice over 20 years ago with two things in mind.

25:19

We wanted to provide Ortho-k and myopia control services to the Gold Coast, and we wanted to have a very professional dedicated

25:28

set up for doing vision therapy. And so I've got people who have been wearing Ortho-k for quite some time.

25:34

And so we have that discussion as they are starting to get to an age where they might want to consider doing something other than lenses, glasses, or Ortho-k.

25:43

And the discussion I have is, well, we need to at least wait in your 20s because the surgeons prefer that.

25:50

Part of that is traditionally your progression slows. I think the old data used to be about one in 10 people in their early 20s

25:58

still progress and about one in 20, so about five percent still progress when they're in the mid 20s.

26:04

I think with modern life, the data is potentially more like one in three still progress. So we need to be really cautious around that.

26:11

So my approach with the Ortho-k wearer is to say, okay, let's get to Let's get through your studies. Let's get through high school and stop wearing your off okay for 12 months.

26:19

That does two things. You move into regular contact lens wear or regular spectable wear.

26:25

It allows plenty of time for your eye shape to return to its baseline. And because that's the part that they're going to laser is the corneas,

26:33

we want to make sure that that shape has returned to its baseline shape. And we also want to demonstrate that you're not going to progress when you

26:40

don't have something there trying to stop the progression. To prove that you are now well and truly stable.

26:47

So that's where laser surgery fits in this whole scheme of things.

26:52

You want to be someone who's definitely stable. So just to be clear, so laser surgery, it might fix the refractive problem,

27:01

but it doesn't do anything to stop that eyeball elongated, does it? Yeah. And I haven't seen strong enough evidence.

27:08

And the practicality is that no one in this country is going to do LASIK on someone who's young anyway.

27:15

So that's a big point either way. But yes, it's only about restoring. It's just another way of restoring clarity in the distance again.

27:24

So I've heard that with all of these types of myopia control strategies, the earlier

27:31

you start, the better the results. So you're going to maybe get more...

27:37

You've got more hope of success if you start with a child who's maybe seven or eight than one who's 15, 16. Is that right?

27:45

So it's more important to really

27:51

be careful around getting in early. So this is part of the conversation you have with parents that

27:57

a late starter can still progress, so we still need to manage the progression. So there's still value in managing the progression at any age.

28:06

The concern about the early starters is that they've got a lot longer

28:11

for the progression to be in place. So there's two things that happens when you're young,

28:17

that when you do progress in your myopia, the changes over time are a lot more rapid, and the amount of time that you've got to develop myopia is longer.

28:27

So you've got two things that make it a big and part of this is based on

28:33

in an ideal world, we'd be able to stop myopia in its tracks. The reality is we just slow it down.

28:39

And we're trying to avoid the average level of short-sideness from getting about

28:46

minus 550 and higher. And so younger you start, the quicker you go, the longer you have

28:53

for eventually reaching those levels.

28:58

But that slow down could be, I mean, the cumulative effect of it, it's not nothing, is it?

29:05

I think with some of the studies, they talk about reducing the progression by 50 or 60 %, is that right?

29:11

Yeah, so your ortho-k, your

29:17

higher doses of Atropine, your contact lens where you're sitting in that. So I always say it's around that 50 to 70 % level.

29:26

And the glasses on paper are saying similar levels now.

29:33

We just have a little less time clinically to see if what we're getting in the clinic is matching the data.

29:39

And there are other types of lenses where the progression control is probably around that 30 to 40 %.

29:46

But they're all contributing in a way of actually slowing it down compared to just doing nothing or wearing

29:51

a regular pair of glasses. And well, just to paint the full picture, we should probably talk

29:58

about atropine eye drops. That's been something that's been around for a while as a strategy.

30:04

But I think that some practitioners like yourself have a mixture of views about that.

30:12

Yeah, so I'm not against it. We tend to use it in a situation where the other strategies aren't working well

30:21

enough for a particular patient or for some reason they're just not available. And the thing atropine is that the high dose has certainly slowed down

30:29

the progression more, but you get a high drop out rate because the side effects from the drops start to make the treatment

30:38

something that someone doesn't tolerate. And so once you lower the dosage down to a more tolerable level,

30:44

You are getting similar outcomes from atropine that you get from spectacle lenses,

30:50

contact lens wear, and ortho-k. So you go, well, we're going to have to correct your site anyway.

30:56

Why not use the optical devices first? Because you're going to have to correct your site anyway.

31:01

And that way you don't have this additional drop that you need to be doing at the same time.

31:07

And there's research going into how effective they are as an adjunct therapy. So if you've got someone in ortho-k or myopia control, contact lenses and

31:16

the progression is still more than you would like, is there a benefit in using a

31:22

atropine as an additional one? But the research is still equivalent on that one.

31:28

And there will be There's some people who hear about atropine and that's the approach they want to take.

31:33

And I will refer if that's the way that they would go. Like I said, the vast majority do well in our, let's call it regular

31:41

myopia control strategies. So what I'm hearing you say is that if your child has an obvious refractive

31:50

problem, they're struggling to focus on things, then eye drops maybe are going to slow down myopia, but they're not

31:57

going to help them see better. So that's They probably need glasses or contact lenses anyway.

32:03

Exactly. They're going to have to wear. And there is an argument that not

32:11

wearing glasses or wearing a week prescription may actually increase progression.

32:16

People talk about a lot. My looking at the research is I don't know how much impact an under

32:24

correction or no correction actually has on myopia other than it's not a strategy you choose to use. It's not I'm effective.

32:30

I don't think it's necessarily better or worse than full correction. I just don't think that full correction or no correction works at trying

32:40

to slow down myopia at all. But the reality is, yes, if you're becoming And I'll pick,

32:45

there's just a quality of life issue of not being able to see. And so you need to see, you need to have glasses.

32:50

And then if your option is to slow it down, then so be it. But you still need to be wearing an optical device in order to still get

32:59

this vision And we should probably do some myth busting here, and that is that wearing glasses isn't going to make

33:06

your eyes weaker, is it? Just regular glasses. Yeah, that's right. And I think let's pull apart where that comes from.

33:15

And there are two conditions that progress regardless of whether you're

33:20

wearing glasses or not. And one of them is myopia. So correcting your myopia is not the cause of the progression.

33:28

The cause of the progression is And that's the nature of myopia and perhaps

33:33

your visual habits during the day. And the other one is the presbyopia. It's the age-related loss of flexibility in your lens, so you can't

33:43

see it as well at near. As you used to. And it's a progressive condition. It's like chasing your gray hair and your wrinkles.

33:49

It keeps getting worse. The glasses, your first pair of reading glasses

33:54

were prescribed because you were having problems first. It didn't happen the other way around. We just can't slow down.

34:00

I'm impressed by opium, unfortunately. So it's just natural for your reading prescription to get stronger

34:05

every couple of years. Okay. So I brought my daughter in.

34:12

We've agreed that she's got myopia. Maybe we've prescribed some defocus lens

34:18

glasses for her, whatever it may be. So how often would you like to see

34:26

patients if they do have signs of myopia? What's a normal program for you, or follow-ups?

34:35

Yeah, look, if we've got someone who's definitely now short-sided, then we need to get a handle on what the progression rate is like.

34:43

So part of the discussion is looking at what's your risk of progression. I like to put the power of the decision in the patient's hands.

34:53

And so on the odd occasion, you will get someone who wants to wait for a little bit longer before we employ any treatment.

34:59

And regardless of whether they go for treatment or not, my first strategy is, well, we need to be measuring someone

35:07

every three months initially to get a handle on what the progression is like. So either if you're not getting treatment, how quickly is this traveling?

35:15

If you are getting treatment, how quickly is this traveling? Is that treatment? How effective is it?

35:21

Once we get a handle that the progression is in an acceptable range,

35:26

we might move to six monthly. And then if it's really showing good consistency and stability,

35:35

then we might go every 12 months. And certainly, if you're a contact lens wearer or an Ortho-k wearer, if it's not for myopia control,

35:42

it's just something you're wearing as your method of site correction on a daily basis, then the norm is to see you every 12 months anyway.

35:50

So the short answer is it'll range between three monthly and twelve monthly,

35:56

depending on the individual situation. Right. Okay. Well, it's been excellent, Paul.

36:03

So thanks for sharing that information with us. So if people want to get in touch with you there at Harmony Vision Care

36:11

in Varsity Lakes, what should they do? So www.harmonyvisioncare.com.au

36:17

so we've got some great resources there, the ability to ask questions, and also book an appointment through our online booking system.

36:26

If you want to ring and chat to our team first, if It's 07-5520-5900,

36:36

which, again, you can find that number on the website as well. Okay. And don't forget to follow Paul's Facebook business page and also

36:44

his Instagram account. Let's not forget that one. So he's regularly posting helpful

36:50

content and short videos that cover topics like this one today.

36:57

All right. Well, I think let's wrap up there, Paul. So any last words of wisdom?

37:03

It's just a matter of getting regular checks done. Nine months, three years, preschool, and then a couple of times

37:13

during primary school. So just being on the front foot, particularly if you, as a parent, are short-sighted or one of your other kids has already become

37:20

short-sighted, just regular checks are a good way of picking these things up early.

37:26

All right, Paul. Well, once again, thanks very much. And until next time.

37:33

Bye for now, everyone. Thanks, mate.