The Reading Glasses Thing

Very often I have the following conversation with patients:

ME: So tell me about those glasses you have. What do you use them for?

PATIENT: Oh these are just drug store reading glasses. I use them for tiny print but I try not to use them too much.

ME: Why's that?

PATIENT: I don't want to get dependent on these. I want to make my eyes do the reading sometimes. You know, so they don't get lazy.

I've said this before and I'll say it again: That's not a thing.

But I can see why you would think that. After all, if I stopped using my left arm entirely the muscles would atrophy and pretty soon I wouldn't be able to use my left arm. If I stop doing yoga, one day I'll wake up and be 55 and unable to touch my toes. Exercise your body, we've been told. Work your body regularly to keep everything functioning to its full potential. But this logic does not apply to presbyopia, or that near vision blur we get when hit our 40's, 50's, and so on.

A better analogy is this: When I was 15 I used to listen to my headphones loudly. Like really loudly. And my dad said, "Ali, turn that down you are going to ruin your ears." To which I'd (freshly) reply, "No, Dad, I'm making my ears work harder so they can be strong." Flawed logic. Same goes for your resistance to reading glasses.

Presbyopia occurs due to changes in the crystalline lens inside our eyes as we age. A young person is able to physically change the shape of the lens inside the eye. When the lens shape changes, it acts like a different power- almost like "dialing-in" the reading glasses prescription internally. This ability is best around age 10, and gradually decreases until around age 70. So in theory, a 10 year old kid could hold something riiiight up to his face and with some effort make it look perfect. I, on the other hand, can only hold it about 6-8 inches away before it looks blurry (I'm 31). And as we age, this distance that things look clear becomes further and further away. Because that internal lens loses its ability to change shape. Becomes less flexible, or less elastic, so to speak. This happens at a rate that is very predictable and has been repeated in studies time and time again. There is no evidence that the rate is different in those who wear reading glasses compared to those that don't.

But wait, I know what you're thinking. You have a friend/parent/aunt/co-worker who is like 60 and STILL DOESN'T NEED READING GLASSES. She has not escaped presbyopia. There are a few reasons for this:

1. She is in denial.

2. She is, in fact, blurry up close but doesn't mind.

3. She is naturally nearsighted. Nearsighted people see blurry far away but are naturally in focus up close (hence the word near-sighted). So a nearsighted person a lot of times can remove her glasses and see perfectly for reading.

4. She wears multifocal contact lenses. I can hook you up.

My advice is this: Embrace the reading glasses. Be reassured that your vision may continue to change whether you wear the glasses or don't wear the glasses. So instead of suffering through blurry vision, tired eyes, headaches, pushing things back as far as your arms go, and pulling out your flashlight at restaurants because you're afraid your glasses are doing you harm- don't. Don't struggle unnecessarily. Don't make things harder for yourself.

How to Choose a LASIK Center

So you've decided you're ready to go for it and get LASIK. The next big decision is, WHERE? It's not a bad idea to get a consultation at more than one place so you can be sure you are choosing a LASIK center you are comfortable with. I would recommend you do careful research, ask lots of questions, and think about the following attributes of each one:

1. Cleanliness, Appearance and Staff: What is your first impression of the office? Are the staff members accommodating, friendly, and kind? Staff appearance and demeanor speak volumes. If it's obvious that the staff members take pride in their jobs, you can feel confident you are in good hands. Every time I go to a doctors office, I wonder how clean everything actually is. I can't help but wonder... when was the last time everything got disinfected? I judge by the general tidiness of the office and the personal cleanliness of staff.

2. Technology and Equipment: Ask what type of equipment is used. Is it the newest technology? Educate yourself on some of the buzzwords that describe LASIK. Here are a few short video-linked descriptions of words to know.

• CUSTOM LASIK

• MICROKERATOME VS. BLADELESS

• WAVEFRONT

3. Relationship With Your Eye Doctor: Will the surgeon work with your current eye doctor? Many surgical centers have affiliations with optometry offices, meaning you can do all of your pre-op and post-op at your local optometrist. As you continue your annual exams with your regular eye doctor after your surgery, he or she keeps lines of communication open with the surgeon. Your optometrist can advocate for you in the unlikely event that you are unsatisfied with your LASIK results in the future.

4. Risk of Side Effects and Complications: Ask about the rates of complications and the rates of side effects at that particular surgical center. Know the industry averages and compare. On large scale studies, complications during surgery are very rare- less than 1%. As far as side effects go, about 30% of patients report dry eyes, glare, halos, or night vision difficulty. These side effects are usually part of the healing process and in most cases are completely resolved or significantly improved after 6 to 12 months.

5. Guarantee of Results and Patient Satisfaction: Most importantly, what are the vision center’s success rates for achieving visual acuity of 20/20 or better? What are the chances of needing an enhancement? Again, compare their answers to those of the recent literature: In a 2016 study, 99% of LASIK patients achieved vision of 20/40 or better and 90% achieved vision of 20/20 or better. The likelihood of needing an enhancement is less than 2 percent over the first 12 months and increases by 1% each year after that. Just in case you happen to be one of those in need of an enhancement, be sure to ask: Does the provider offer a lifetime commitment on the results, including enhancements at no additional cost?

6. Candidate Selection: Don't forget to ask: How many patients get turned down? A center that is overly eager to perform a surgery is always a red flag. A reputable surgeon will turn down around 20% of patients simply because that is about how many people are bad candidates. You should never get the feeling you are being pressured. A surgical consultation should NOT feel like a sales pitch.

LASIK is a wonderful thing and I encourage you and support you if you've made the decision to go through with it. But don't make a hasty decision. Your eyes are a big deal.

How I Hope to Prevent Nearsightedness in my Daughter

I have a young daughter and two young nieces. These three little girls are some of the biggest joys of my life. I want to do everything I can to make sure they have a great life and that includes good eye health.

My husband and I are both nearsighted. So is my sister and her husband. So the kids are pretty much doomed right? Not necessarily. Thankfully, research has shown that genes are not the whole story. In the words of Dr. Neil Barnard, some genes are like dictators. You WILL have blue eyes. Others are more like committees. Meaning, there will be some "discussion" on the matter. You MAY get myopia (nearsightedness) or maybe not. Turns out many factors influence why a person becomes myopic. This is an area of hot debate right now because nearsightedness has increased at striking rates. So can these girls escape the family trend of nearsightedness? I'm going to do everything I can to try. I've been extensively researching the topic and I've come up with a few strategies I'll share.

1. Minimize activities that are close-up

Yes, reading is important. Every pediatrician would agree. But too much close-work is one of the biggest risk factors for myopia. In China, almost 90 percent of teenagers and young adults are nearsighted. It’s no coincidence that the average 15 year old in Shanghai spends 14 hours per week doing homework. Additionally, students who attended more years in school had a much higher rate of myopia than did their less academic peers. Which careers have the highest population of nearsighted folks? Engineers. Doctors. Lawyers. Also, a study was done on workers at a textile factory in Norway. The workers were given the task of finding weaving errors in slowly moving textiles and repair them. Every single one of the workers became nearsighted, even the ones who had been farsighted prior to starting the job. So on one hand, reading is important, but on the other hand too much close-work is detrimental to vision. Therefore, it goes without saying that near-work that is NOT reading (I'm talking about phones, tablets, and other screens), should be minimized, if not eliminated completely.

2. Spend 3 hours per day outdoors

Admittedly, the reason behind this is not well understood. But the trend is undeniable. Those who spend at least three hours per day in daylight are MUCH less likely to become nearsighted than those who don't. Take in this graph for a minute:

This study controlled for both parental myopia and ethnicity. So what's going on? It seems to have to do with the amount of natural light we get. Natural light is a lot brighter than indoor light (measured in a unit called lux). To give you some perspective, natural outdoor light can be as bright as 100,000 lux. With sunglasses on, its more like 10,000 lux. A well lit indoor classroom is no more than 500 lux. What is the amount needed to effectively prevent myopia? Around 10,000. So DO wear the sunglasses.

A glass classroom in Yangxi City, China was constructed in an effort to prevent nearsightedness among students.

Keep in mind this important distinction: Outdoor time doesn't seem to SLOW myopia once it's already started. But it does PREVENT a child from becoming myopic in the first place. So this is most important for a child who isn't showing signs of myopia yet.

3. Delay the age it starts

One of the biggest risk factors for myopia progressing quickly is the age that it starts. If myopia starts at age 9 or earlier, it is more likely to get bad quickly. If it starts at age 10 or later, it is less likely to get bad quickly. So maybe my kid will get nearsighted despite all my efforts. But if I can delay the inevitable, her prognosis will be much better. Needless to say, implementing these strategies as young as possible is key.

4. Make annual exams a priority

Here's why: It's important to know exactly how quickly the nearsightedness developed. I'll give you two scenarios.

1- Julie is in fifth grade and comes home one day and says the board looks blurry. So her parents take her for an eye exam. Julie has had eye exams every single year and the doctor notices a pattern: When she was in second grade, there was -0.25 dioptors of nearsightedness (that's practically nothing) and glasses weren't prescribed. When she was in third grade there was -0.50 dioptors. Fourth grade -0.75. Finally in fifth grade, -1.00 dioptor of nearsightedness is enough to cause difficulty in school so glasses are prescribed. Since she's had annual exams, we know exactly the rate at which this came on: -0.25 dioptors per year. This is pretty slow. Since the progression has been slow overall, we know that it is likely to continue moving slowly. The concern level here is low.

2-Olivia is in fifth grade and comes home one day and says the board looks blurry. At her annual eye exam, the doctor finds there is -1.00 dioptor of nearsightedness. At her exam just a year ago, there was NO nearsightedness at all. It progressed a whole dioptor in just a year. At this rate, she's likely to continue progressing quickly. In this case, the optometrist and the parents will want to consider different forms of myopia control- alternatives to glasses which may slow things down (SEE: Orthokeratology).

Both scenarios happen all the time. A huge risk factor for figuring out whether myopia will progress quickly is how fast its already been progressing. But if the first time the student gets an eye exam is during fifth grade when the blurriness became significant, how do we know if she is a Julie or an Olivia? Bottom line is take your child in for eye exams even if she isn't complaining yet. Even if the myopia is so low that action won't be taken, it's still important to know if it's starting.

Make it a new year's resolution to start protecting your children against myopia now. A few small action steps now can have a huge payoff later.