Dual therapy against myopia progression: MIYOSMART + Low Dose Atropine

by Patrick Ng
Optometrist
Msc Clinical Optometry
28th April 2023

This article is targeted at readers who already have read about myopia control options such as atropine, DIMS lenses (Miyosmart) or myopia control lenses. If you have yet to read about those, it may be better to read about those lenses in the same blog first, before reading this article.

In the last 2 years, it has been our observation that Miyosmart lenses ( DIMS technology) when used in combination with low dose atropine has better results than atropine or Miyosmart standalone. However, we did not take the effort to do a statistical review of records. But the improvement in slowing down myopia progression is noticeable. The ophthalmologists are also noticing that too.

A European myopia control study consisting of 146 kids was concluded in Feb 2023. The study aimed to compare the efficacy of low dose atropine vs DIMS lens vs dual therapy (low dose atropine+ DIMS lens) vs control ( no therapy). The study concluded that dual therapy is the most effective at slowing myopia progression. Both Atropine and DIMS has also slowed myopia progression significantly compared to no treatment. This study confirmed what the industry have noticed with monotherapy vs no therapy and in cases of rapidly progressing myopia, with dual therapy against single therapy.

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0281816

With the findings from this study, we will be more confident to recommend children who have the potential to be highly myopic to start with dual therapy from the onset. Prior to this study, we have erred on the side of caution and start them on monotherapy ( either atropine or DIMS).

It does not mean that every child will need to go through dual therapy. Children with a later onset of myopia or a slower myopia progression will do well enough with a mono therapy. The challenges of dual therapy is that with atropine, even on a lower dose, may result in photophobia due to a slight dilation of the pupils. We had to make do with caps/hats or even clips on sunglasses. But these methods require the child to remember putting them on whilst outdoors.

Miyosmart has now launched Miyosmart SUN. The same DIMS technology, now with photochromatic technology. This means that under the sun, these lenses will change to a darker shade to reduce glare. This makes dual therapy a lot easier for parents and a lot more comfortable for the children. During this launch, HOYA has also announced that regardless the type of lens, Miyosmart or Miyosmart Sun, there will be no price difference! This is quite surprising, as traditionally, photochromatic lenses cost at least 100-200 dollars more than their non photochromatic version. The reason given by the management was that they realized that their lenses was helping a lot of children globally with myopia control, hence for kids for needed dual therapy, they do not want cost to be the deterrent. Sweet!

Speak to your pediatric ophthalmologists or optometrists about your child suitability for dual therapy myopia control. Alternatively, speak to us over WhatsApp @ +6587256911 or email precisionoptics2013@gmail.com

Slow Down Myopia Progression- Abiliti 1 Day by Acuvue

by Patrick Ng,
Optometrist
Msc Clinc Optom (USA)

Covid19 brought about a rapid change in the work and educational landscape. It accelerated digital learning. Although physical lessons have resumed, e-learning has become a part of the education journey. Due to the change from looking at white boards (usually viewed @ more than 3metres, to looking at computer screens ( 80cm or closer), the accommodative load on the eyes has increased by almost 4 times.

Compared to pre Covid19, the primary eye care industry has been witnessing a more rapid progression in myopia. Kids are starting to become myopic at an earlier age and the rate of myopia progression is faster. High myopia is associated with increased risk of eye problems such as retina detachment, glaucoma and maculopathies at an older age. These problems can result in irreversible vision loss. Hence, there is a need to slow down myopia progression in our kids. Spending time outdoor seems to have a protective effect against myopia for those pre-myopes. However, once myopia sets in, outdoor time seems to have little effect in slowing down myopia.

Currently, there are 3 proven methods to slow down myopia.
1) Atropine (prescribed by eye Dr)
2) Myopia control spectacle lenses (Hoya Miyosmart aka DIMS and Essilor Stellest)
3) Contact lenses (Overnight reshaping Ortho k hard lenses and day wear daily disposables, Misight and Abiliti 1 day)

I have written about Atropine, Miyosmart and MiSight before. I will discuss more about Abiliti 1 Day in this article. It is a myth that children are too young to wear contact lenses. We have fitted children from 6 years old onwards as long as their eyes have been assessed to be healthy and the child is able to demonstrate the ability to handle the contact lenses by themselves. Since the myopia control soft contact lenses are daily disposables, the child gets a new clean lens every day, so hygiene is not going to be an issue here.

Previous myopia control contact lens uses a dual focus technology to create a myopic defocus effect on the fovea. This resulted in a slower elongation of the axial length of the eyeball, thus a slower increase in myopia. ( Axial length increases, myopia increases). It is theorized that a larger myopic defocus effect on the fovea has a better effect on myopia control. However, with the dual focus lens, a larger myopic defocus will also significantly decrease the sharpness of images. Hence most of the myopic defocus is around the +2.00D range.

Abiliti 1 day is a daily disposable contact lens developed by Acuvue. It utilizes a RingBoost technology (+7D defocus) for myopia control. It is made with a silicon hydrogel material and smaller diameter for high oxygen permeability, increased wearing comfort as well as easier handling and insertion for young children. The revolutionary RingBoost technology is designed to break the interdependence between vision quality and treatment effect. When light hits the lens, it splits. A portion of this light focuses on the retina to correct vision, allowing your child to see clearly while the rest of light focuses in front of the retina to slow down myopia. Abiliti 1-Day lenses can provide strong myopia treatment while maintaining visual quality. In fact, in as little as 6 months, Abiliti 1-Day reduced axial elongation by 0.105mm on average. Generally speaking, 0.18mm corresponds to approximately 0.5D of myopia.

From our experiences, the lens is easier to insert compared to traditional soft lens. Once the child has adapted to the lenses (as fast as the first few hours and up to 5 days), the visual acuity is much like the usual contact lenses. For children with high astigmatism, a pair of top up glasses will be required. We are excited about this new technology. As much as it is new and in its early days, the first few fits have been excellent. We look forward to share more data once we have reviewed our existing clients who are on this program. It is an option for those who have not responded well/keen on the other options of myopia control. For parents looking for combination therapy with low dose atropine, Abiliti 1 Day lens is an excellent option as it comes with UV protection.

We will update this page whenever there are more new data and findings as well as our own experiences with the lens. Feel free to reach out to us @ 87256911 if you have more questions.

Caring for your eyes during WFM or HBL

Covid19 changed how the world is working and learning. Starting from the circuit breaker in Singapore last year, we experienced new waves of eye-related issues, discomfort pertaining to pro-longed screen time, wearing of mask etc. This article will talk about the common problems that is caused by WFM or HBL.

1. Mask-related eye discomfort
   
   Reason
   Prolonged wearing of ill-fitting face mask results in a constant stream of hot air from our breaths venting upwards, resulting in evaporative dry eyes, causing irritation and decreased vision.
   
   Solution
   Reduce the stream of air by either using a mask with a pliable nose wire or taping up the top of the mask to the bridge. Use of artificial lubricants will help to reduce irritation.
   
2. Digital eye strain
   
   Reason
   Prolonged near work ( not necessary digital devices, can be books or documents) resulting in wide ranging symptoms like headaches, eye-aches, blurred vision, double vision, nausea, dry eyes etc. When one is looking at a near object, your medial rectus contracts to move both your eyes inward to converge and your ciliary muscles contract to focus on the object that you are looking at. Like any other muscles, overuse results in muscle fatigue and cramps. Your brain may also have to cope with an inconsistently sharp image resulting in nausea. Staring at a screen also reduces blink rate, resulting in dry eyes.
   
   Solution
   Take short vision breaks( even looking in the distance for a few seconds is useful) every 20-30 mins.
   Increase your screen working distance to reduce the convergence and accommodation required.
   Lubricate your eyes before, during and after use of the digital device
   Rotate your eyes to stretch your different extra-ocular muscles
   See your optometrist for special computer glasses ( not just blue-ray blockers) to help relax the accommodation
   
   
3. Myopia Progression
   
   Reason
   We have noticed a increase in the rate of myopia progression in children especially those below the age of 12. Extensive near work, limited outdoor time has been linked to myopia progression. With home based learning and circuit breaker, most children have been spending their time at home and using digital devices for both education and leisure. This increases the amount of neat work that they usually do when they are attending school. With parents preoccupied with work at home, the children may also be given more time with the digital devices.
   
   Solution
   We will encourage besides setting breaks for them, parents will also want to consider using the TV instead of near digital devices to entertain the kids. The increase in the viewing distance will help to reduce accommodation, thus reduce the risk of myopia progression. A walk around the estate in the mornings or evenings will also increase dopamine that may help to slow myopia progression.
   
   For children that myopia has already set in or progressing rapidly (more than -1.00D in a year), parents should consider myopia control. There are currently 3 types of myopia control that is proven to slow the rate of myopia progression, atropine eyedrops, special spectacle lenses(Miyosmart) and special contact lenses (Misight & Ortho-k). Reach out to your ophthalmologist or optometrist to see which is best suited for your child.

MIYOSMART – Probably the most effective optical myopia control product

1st published 2019, updated April 2022

MIYOSMART is an optical product invented and designed by Hong Kong Polytechnic University, manufactured by HOYA. It works based on DIMS technology ( Defocus integrated multiple segments). This will create a slight blur at the peripheral view of the lenses (hyperopic defocus, we call it). Hyperopic defocus and has been proven in many clinical research to prevent axial elongation which results in progressing myopia.

Well established products such as Myovision by Zeiss (spectacle lens) , MiSight by Coopervision (contact lenses) works on the same theory. MIYOSMART hyperopic defocus is different from the products mentioned above. It utilizes a honeycomb defocus treatment zone around a 9.1mm clear zone.

Clear viewing zone in the center. Honeycomb like defocus zone at the peripheral

When viewing through the lens, the user will feel a slight blur at the edges of your vision. This blur is slight more noticeable than Myovision. However, in a clinical trial, almost of the children adapted to it within 2 weeks. In the same double masked clinical trial, the results are very good. It slowed down myopia progression by 59% and in 21% of the cases, myopia did not increase in the 2 years clinical trial.* Third year results are currently being collected and analysed and will be out soon.

It has been 3 years since we have started prescribing these lenses and as a simple non invasive method, it has done very well. For the treatment to be most effective, the frame selection is very important. The frame has to be well adjusted and fitted to the face. The glasses serves dual function (treatment as well as corrective) and has to be worn full time. We will also recommend a 6 monthly review so that we can stack on low dose atropine to improve the efficacy if required. Miyosmart and atropine are not mutually exclusive and can be used together in a combination therapy if the child does not have extreme photophobia or sluggish accommodation ( rare in low dose atropine, more common in high dose atropine)

We also frequently have request to have blue filter added onto Miyosmart. However, it is currently not available. (to ensure that the lenses used in the research is identical to what is being prescribed). To date, there is no strong evidence that blue light can increase or decrease the rate of myopia.

In summary, Miyosmart is effective in slowing down myopia progression. It can also be used in tandem with low dose atropine for better efficacy if required. Speak to your optometrist.

Link below for full scientific article

https://bjo.bmj.com/content/early/2019/05/29/bjophthalmol-2018-313739

*

MiSight – myopia control contact lenses

 

MiSight is a new daily disposable contact lens that has been proven to slow down the progression of myopia in children by 59% in a 4 year study done in a few countries. As a non-pharmaceutical option to control myopia, it is a very appealing tool for optometrist.

Currently, to control myopia progression, we have special spectacle lenses (progressives, bifocals, prismatic bifocals, myopic defocus), atropine as well as Ortho-K. The myopia control spectacle lenses will work for certain children who exhibit certain binocular vision anomalies such as convergence excess and accommodative lag. The effectiveness is also contingent on the glasses being well aligned and the child using it correctly.

Atropine treatment seems to work quite well for children especially in higher concentration but parents may be concerned with potential long-term side effects (not established as yet). It also may increase glare as the pupils will be dilated. There is also an associated rebound myopia upon sudden cessation of the drops.

Ortho-k works very well to control myopia but there is always a small but real risk of a bacterial infection. During the treatment period, the lenses must be worn regularly to maintain good vision and myopia control. In the event the child has to stop wearing these lenses, the myopia will creep back resulting in reduced vision during this period. The child has to wear glasses in the interim until lens wear is resumed. The prescription will fluctuate during this period.

MiSight presents another option for us to control myopia progression. It creates a retinal myopic defocus to prevent the eyeball from elongating by using alternating rings of corrective and treatment zone on the contact lens. In a multi-center, double masked 3 year study, kids wearing MiSight lenses shown a 59% reduction in the progression of myopia versus those on regular daily disposable lenses. At the end of the 3 year study, the control group was switched over to the MiSight lenses. At the end of the 4th year, they too exhibited a slow down in the progression of myopia.

This contact lens is only available in a daily disposable to reduce the risk of allergies and infection. MiSight disposable lens uses PC Technology. Phosphorylcholine (PC) molecules attract and bind water to the surface, creating a shield that keeps the lenses clean and functioning properly. The PC molecules also help the lenses remain hydrated, which in turn, help them feel moist and comfortable all day long.

Due to the unique rings of corrective and treatment zone, it will take a few days to get used to it. I have personally tried it on myself to test the vision and comfort, under room lighting images are clear with no physical nor visual discomfort. However, when I enter a dim room, I do notice a slight halo around light sources. The lens stayed comfortable in my eye till I finish work and reach back home.

For children with astigmatism, they will have to make a pair of glasses to correct the residual astigmatism as these lenses do not correct astigmatism. The children can then choose to do wear these glasses in class so that while the treatment is taking place, it does not disrupt their vision in school. As it is a treatment administered through contact lenses, the child has to wear the lenses for 6 days per week to have a good effect on the myopia progression.

This is indeed a very promising lens. It is a safe, comfortable and effective way to slow myopia progression in children. It can also be used in tandem with 0.01% atropine if the 0.01% atropine is not working well enough.  The only drawback that foresee is the cost. A month supply costs $150. We look forward to offering this as another option alongside with the existing ones in the fight against myopia. Call or visit us now to understand more.

 

Patrick Ng Yao Min

Optometrist

Msc Clinical Optometry

Red Eye – Common causes

By Mr Gregory See Toh

Red-eye is the enlargement of the blood vessels in the conjunctiva making your appear redder than it usually does. In this article, we try to summarize  the common causes for red eyes and how it can be treated/prevented

What are common causes of a red eye?

1. Allergies
2. Bacteria Infections
3. Viral Infections
4. Poor contact lens fitting
5. Dry eyes
6. Glaucoma

1) Allergies

Extracted from: https://hickeysoluhttps://hickeysolution.com/allergic-conjunctivitis/tion.com/allergic-conjunctivitis/ on 16 Jun 2018

Allergic conjunctivitis can be caused by dust, pollen, pet fur/hair or foreign objects. It can be both acute and chronic. In both instances, it is important to identify the causative agent. The treatments are symptomatic relief.

Patients would have the following signs & symptoms

• Red eye
• Swelling
• Itchiness
• Slight burning sensation
• May also accompanied by a runny nose

Treatments

Your optometrist will be able to pick up allergic conjunctivitis and recommend you OTC eye drops. In more severe cases, a visit to the ophthalmologist may be in order for stronger anti-inflammatory/ steroid eye drops.

Intervention

• Close windows during allergy season

• Keep your home/workplace dust-free

• Use an indoor HEPA air purifier

• Be aware of your allergies and try to avoid them. Should contact with allergens be inevitable, your doctor might be able to prescribe you mast cell stabilizer to reduce the severity of the symptoms. 

2) Bacteria Infections

It can happen to both contact and non-contact lens wearers. This condition can cause visual impairment if treatment is delayed, hence it is important to have it treated as soon as possible. In most bacterial infection, the discharge is often yellowish/greenish and sticky.

Extracted from: https://www.emedicinehealth.com/image-gallery/bacterial_conjunctivitis_pink_eye_picture/images.htm on 16 June 2018

Signs and symptoms

• Red eye
• Sticky discharge
• Photophobia
• Tearing
• Gritty feeling
• Intolerance to Contact lens
• Pain

Treatment

Your optometrist should be able to discern a bacterial infection vs allergic reaction. In a bacterial infection, a visit to the eye specialist will be required. Besides antibiotic eye-drops, your eyes will be checked thoroughly to make sure that the infection did not spread to the back of the eye. For contact lens users ill-fitting contact lenses or extended hours of lens wear can make you more pre-disposed to opportunistic infections. 

Interventions

• Good hygiene
• Avoid sharing of towels etc
• For contact lens users, have your eyes check at least once a year by your optometrist.

3) Viral infections

Viral infection can be extremely contagious. Viral eye infections can be accompanied with common cold, measles, chicken pox and other systemic viral infections.

Signs and symptoms

• Redness
• Swollen Lymph Nodes
• Itching
• Clear watery Discharge
• Gritty feeling
• Pain
• Swelling or clouding of the cornea
• Photophobia

Treatments

Viral eye infections are usually self-limiting, lasting about a week for mild cases or up to 3 weeks for severe cases. In mild cases, your optometrist will be able to diagnose and prescribe you ocular lubricants for comfort. Should it not resolve in a week, an ophthalmologist or doctor would prescribe antiviral and/or steroids.

Interventions

Viral infections are very contagious thus patients should take note of the following:

• Use hand sanitizer or practice proper hand hygiene before touching your eye
• Avoid touching infected patient
• Avoid sharing body contact items such as towels or pillows

4) Poor Contact lens fitting

It is important to have your contact lens properly fitted. Prolong usage of the wrong material and parameter of the contact lens can result in damage to the sensitive cornea tissue. Getting your contact lens from an online store with no physical store (which is not legal in Singapore) may be cheaper, but there is no telling if the lens is counterfeit or not. Very often, counterfeit lenses are produced in poorly equipped facilities that increases the risk of an eye infection or damage. 

Signs and Symptoms

• Limbal injection (red-eye)
• Lid redness
• Discomfort
• Tearing
• Photophobia
• Lens intolerance

Treatments

Before new lens are being fitted your optometrist may recommend a lay off period. He/she will re-examine your eyes to fit a you with the appropriate lens and it’s recommended to come back for an annual review to ensure that the contact lens is still a good fit.

5) Dry eyes

Dry eyes is can be due to lack of tears or rapid evaporation of the tear film, resulting in damage to the cornea surface. It can also be due to over wearing of contact lenses

Signs and symptoms

• Red eyes
• Gritty feeling
• Stinging
• Excess tear production
• May experience blurring of vision

Treatments

• Ocular lubricants
• Omega 3 supplement
• Lid scrubs
• Short course of steroid eye drops in severe cases
• Punctal plugs to retain the tears in your eyes

Extracted from: https://www.medicalnewstoday.com/articles/315681.php on 16 June 2018

Interventions

• Try to avoid air-conditioned rooms or anywhere with a dehumidifying effect. A room humidifier may help
• For contact lens wearer, ask your optometrist for options of higher oxygen permeability contact lenses and the right lubricants to go along with it

6) Glaucoma

Acute angle closure glaucoma is caused by a rapid or sudden increase in intraocular pressure (IOP), the pressure within the eye. It can happen due to genetic pre-disposition or due to eye injuries. 

Extracted from: http://paulwashburn2.typepad.com/blog/2012/07/topamax-closed-angle-glaucoma.html on 16 June 2018

Signs and symptoms

• Ciliary flush (red eye)
• Pain
• Blurring of vision
• Seeing halos
• Nausea
• Severe Headache

Treatments

This is an ocular emergency that needs to be attended to urgently. The doctors will use either laser treatment and/or medication to reduce your eye pressure to prevent irreversible vision loss.

 

In Summary, most cases of red eyes may have similar signs and symptoms. Hence it is important not to self diagnose and self treat. Do not use OTC eye whitening eye drops as such drops mask the symptoms and can make the original condition worse. Visit your optometrist or ophthalmologist for an eye exam.

Diabetic Retinopathy

 

Image extracted from : medicalsecrets.com/wp-content/uploads/2017/04/dest-prediabetes.jpg

 

What Is Diabetes?
Our body requires a hormone known as insulin to control the sugar level. Without the presence of insulin, the cells are unable to breakdown the glucose in the body. Diabetes is a disease in which the body is unable to produce or produce enough insulin to breakdown the glucose. Another possible cause would be the cells in the body do not respond normally to the insulin produced. Therefore, it is unable to breakdown the glucose causing increase in sugar level. Prolong high blood sugar level will lead to diabetes.

What Is Diabetic Retinopathy?
Diabetic Retinopathy affects the small blood vessels in the retina. Occlusion and leakage will occur in those blood vessels.

What Are The Different Types Of Diabetic Retinopathy?

1. Non-Proliferative Diabetic Retinopathy (NPDR)
Retinal blood vessels become weakened. Development of tiny red dots can cause leakage of fluid leading to macula oedema. Patient will experience poor vision. In very mild cases, tiny red dots can be seen on the retina. As the condition progress, signs like bleeding, white fluffy spots, yellow patches and vascular abnormalities will develop.

2. Proliferative Diabetic Retinopathy (PDR)
Abnormal new vessels will start to develop due to the blockage of the blood vessels. Those vessels are very weak. They can burst and lead to bleeding in the eye. In advanced cases, retinal detachment will develop causing blindness. Abnormal blood vessel growth can also be seen on the iris. This will lead to glaucoma.

 

Image extracted from : http://www.newhealthguide.org/images/10448676/image001.jpg

What Are The Symptoms Of Diabetic Retinopathy?

• Blur Vision
• Black spots
• Floaters
• Poor night vision
• Diplopia
• Loss of Vision

What Are The Risk Factors?

• Poor control of blood sugar level
• High blood pressure

What Are The Ways To Prevent Diabetic Retinopathy?

• Maintain good sugar level
• Go for annual blood test and health check
• Go for annual eye check

What Are The Treatment Methods?
1. Laser treatment to decrease the swelling
2. Intra-vitreal anti-VEGF injections to prevent growth of new vessels
3. Laser Pan-retinal Photocoagulation to reduce VEGF release
4. Vitrectomy
5. Macular grid laser to limit vision loss

Click here to watch a video about Diabetic Retinopathy : https://www.youtube.com/watch?v=X17Q_RPUlYo

References
https://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/diabetic-retinopathy?sso=y
www.diabetes.co.uk/diabetes-complications/diabetic-retinopathy.html

By Re’ane Chua Rou Yan

 

Cataract

by Ms Tricia Lee

What are Cataracts?

The crystalline lens is mostly made up of water and protein. Cataract is a condition whereby the proteins starts to clump together, causing the clear crystalline lens to turn cloudy. This prevents light rays from entering the eye, limiting us from a clear vision. This affects about 70-80 % of the elderly in Singapore.

Signs and Symptoms

Pic extracted from http://thinkaboutyoureyes.com/articles/eye-problems-diseases/cataracts

Cataract slowly develops over the years. The first complaint you would notice is the blurring of vision. In the early stages, cataract may cause short-sightedness. Hence, you may need a new pair of glasses. However, as the cataract further develops, you may experience other symptoms such as:

• glare
• halos around lights
• double vision
• poor colour and contrast sensitivity

Cataracts can be easily diagnosed with the use of a slit lamp microscope or an ophthalmoscope. Signs such as yellowing of lens, opacities and other abnormalities are indications of cataract. There are different types of cataracts and these are classified according to the location and shape of the cataract. The progress and management will then be different.

Causes

Cataract usually occurs due to aging however it may also be present at birth. Other risk factors may include the following:

• Chronic exposure to ultraviolet light
• Trauma/ injury/ surgery
• Smoking
• Certain drugs e.g. steroids
• Certain conditions e.g. diabetes
• Inflammation to the eye

Prevention

There is no proven methods in preventing the formation of cataract. However, there are several strategies which may slow down its growth such as:

• Wearing sunglasses to protect yourself from ultraviolet rays from the sun
• Quit smoking
• Have a health and balanced diet
• Have a good control of diabetes (if present)

Treatment

In the early stages, bright lighting and the use of higher powered corrective lenses may help to compensate for the visual disturbances. However, as it advances and start to hinder you daily activities such as reading and driving, surgery is the only option. Cataract surgery is one of the most performed ophthalmic surgery. The process includes removing the old crystalline lens and implanting a new artificial lens called the intraocular lens (IOL).

pic extracted from http://www.seebetterbrevard.com/centers/cataract/lens-options

There are several types of IOL that you can choose from to meet you vision needs

Single focal

If you require a clear precise vision for distance or near, this would be the most preferred option. This would correct your vision for far or near. However, you would require reading glasses or distance glasses for the other uncorrected vision post surgery

Multifocal lenses

These types of lenses are built with two to three different optical power for distance and near vision. Hence the brain receives more than one image. This is where neuro-adaptation is required for the brain to ‘filter out’ the blurred image and have a clear image.

Monovision

Monovision means the dominant eye is used for seeing far, and the non-dominant for reading. As it is compromised to allow you to see far and near without the need for glasses to go about your day-to-day activities. To improve the quality of vision for distance or near, glasses can be used.

Optometrists in Singapore are able to detect cataracts and assist to improve the quality of vision in certain cases.  Ophthalmologists will be able to perform a day surgery to remove the cataract in more severe cases to improve the vision.

 

Dry Eye

By Ms Leong Jing Ying

Many people always wondered what is dry eye and what causes it. In simple terms, dry eyes occur when the eyes does not produce enough tears, or when the tears are not of the right consistency, thus evaporating too quickly.

So what is the importance of a tear film? 

1. Tears help to protect our eyes from foreign bodies which may cause inflammation and even infection.
2. Tears can also help to keep our cornea well-lubricated.
3. Tears help to provide nutrients to the eye.
4. Tears refract light, without it, images we see will not be crisp and clear.  

Symptoms 

• Burning sensation 
• Itchy eyes
• Heavy eyes 
• Sensitive to light 
• Blurred vision 
• Gritty sensation

Diagnosis

In addition to your symptoms, Your optometrist or ophthalmologist can conduct these tests to better classify your dry eyes,

A) Tear Break Up Time

A non invasive measurement of how fast your tears evaporate with the aid of a yellow dye

B) Schirmer’s / Phenol red thread test/Tear Prism

A test of the volume of tears in your eyes.

C) Meibomian gland assessment

A visual assessment of the meibomian glands along your lid margins using a slit lamp biomicroscope.

Mechanism of dry eyes

There are many causes of dry eyes. The common ones are our lacrimal glands being unable to produce enough of “water” and/or  inflammation of the meibomian glands can cause our tears to become oily therefore fasten the evaporation of our tears. 

Our Tear Film

Our tear film has three layers – Lipid, aqueous, mucin. 

Lipid Layer

• Lipid layer of the tear film is being produced by the Meibomian glands.
• A lipid layer is oily stuff that sits on top of your watery tears so as to keep it from evaporating. 
• Without the lipid layer, the tears would evaporate and eyes will feel dry.
• Many dry eye sufferers have glands that are clogged up, this complication is known as Evaporative Dry Eye

Aqueous Layer 

• It is being secreted by the lacrimal glands. 
• It makes up the watery layer commonly known as tears – contains water and proteins. 

Mucus Layer 

• It works as an anchor to hold the tear film to the eye as it coats the cornea and allow an even distribution

Factors that exacerbate dry eyes

• Computer usage
• Contact lens wear 
• Aging 
• Places with high humidity, or even being under windy or air-conditioned areas
• Frequent flying as cabins of airplanes can be extremely dry
• Smoking 
• Certain medications can increase risk of dry eyes
• Incomplete and infrequent blinking 
• Incomplete closure of eyes whilst sleeping

Treatment:

Non-medical 

1. Using of eye lubricants. Many different formulations exist. Ask your optometrist for recommendations. What has worked for your friend may not work for you.
2. Maintaining good lid hygiene by using lid scrubs and/or warm compresses
3. If  due to contact lens wear, reduce lens wearing time or by changing to a better lens material.
4. Increasing your dietary intake of Omega 3
5. Taping of the eyelids shut with surgical tapes when sleeping at night
6. Using of air humidifier

Medical (Requires visit to an ophthalmologist)

1. Using of cyclosporine (eg Restasis) is thought to calm down inflammation in dry eyes, hence increasing the eye’s ability to produce tears
2. Plug drainage holes at the inner corners of the eyelids to allow the tears to stay in the eye for a longer period of time.

If you are suffering from dry eyes, check with your optometrist and he/she will be able to help you.

 

Myopia progression in certain binocular vision anomalies

Myopia progression is a hot topic in Singapore. Most people are aware of the almost epidemic proportions of myopia in children here. There are many treatments available ranging from special spectacle lenses to cornea reshaping, more popularly known as OK lenses to atropine eyedrops. However when asked about the reason behind the myopia progression, the finger is usually pointed towards genetics or extensive close up work. In this article, we will try to explain myopia progression caused by 2 binocular vision anomalies. We believe that if the conditions are diagnosed and managed, then myopia progression can be slowed. The signs and symptoms may include, but not limited to the following points

 1) Divergence Excess

Divergence excess is a condition where the eyes tend to drift out when viewing objects in the distance.  In order to correct this drift, the focusing muscle (ciliary muscle) of the eye has to tense up to activate the steering muscle (medial rectus) of the eye to correct the drift. The constant focusing of the ciliary alters in the pressure in vitreous humour of the eye, over a prolonged period causing the elongation of the eyeball.

Signs & Symptoms
The eyes tend to drift outwards during periods of inattentiveness
Diminishing work productivity/ acccuracy with increased time on task
Headaches, usually frontal
Poor hand eye co-ordination

2) Convergence excess

Convergence occurs when both eyes move inwards to focus on an object close up. When we convergence, the ciliary muscles will tense up getting the eye ready to read.  As it name suggest ,  the eyes over convergences when the child focuses on something near. This causes the ciliary muscles to over contract, causing the muscles to go into spasm over a prolonged period. This will eventually cause the elongation of the eyeball.

Signs & Symptoms

The child complains of headaches and blurred distance vision after a period of near work( could be only after 15-20 mins , which in most people is well tolerated).  The child may complain also of dull ache within the eyeball or above the eye around where the brows are.  In some cases, this results in pseudo-myopia (transient myopia).

 

The above 2 conditions can cause myopia to progress quite rapidly and the approach to resolving it can differ. It ranges from special lenses to visual therapy to sometime eyedrops. Once identified and graded, your optometrist can work out a management plan for your child. Close intervals of follow up is preferred to the “annual” eye exam.

These conditions is unlikely be discovered during a routine refraction. It may also be missed in the ophthalmologist clinic. Hence, it is our opinion that a child should always be checked by an optometrist to ensure that the myopia progression can be better managed. The next time when you bring your child for new glasses, speak to your optometrist for more information regarding the 2 conditions.