Out Of The Old Black Bag
OUT OF THE OLD BLACK BAG
Spend More Time Outside and Ditch the Glasses?
“In the midst of every crisis lies great opportunity.”
— Albert Einstein, widely acknowledged to be one of the most influential physicists of all time, as well as a supreme visionary.
Being both severely near-sighted and too stubborn to wear his glasses made comical cartoon character Mister Magoo a favorite of the author!
I am not sure to this day whether the fourth grade teacher’s “screws were loose” or whether her slap across my face had loosened my eyeballs’ connections to their surrounding boney sockets — or whether both were happening at the same time! The teacher claimed that I, the timid mouse of the class, was purposely rolling my eyes to make fun of her and deserved corporal punishment to learn a lesson. Even at that ripe age, I should have suspected that something was amiss; my younger brother had needed glasses two years before this when (as the story goes) a bolt of lightning flashed in his face, and I can not remember my dear father and my fraternal cousins without their thick “coke-bottle” glasses.
At the vision screening conducted by the school nurse the following semester, I failed miserably with high myopia readings in the drifting right eye. And so, at the age of 9 or 10, I became an eyeglasses-wearing member of the club that now comprises 28% of the world’s population, with a peak prevalence exceeding 70% among the urbanites of East Asia. Sadly, there are projections that the club will balloon to approximately half of the world’s population, or five billion people, by 2050, with the consequent long-term risks of retinal detachment (especially in those with high myopia, a spherical equivalent of -6.00 diopters or more), amblyopia (“lazy eye”), myopic macular degeneration, glaucoma, and early-onset cataract formation. Not to mention the economic burden on families who choose to correct their vision using spectacles, contact lenses, or surgical interventions like LASIK (Laser-Assisted In Situ Keratomileusis), a procedure that permanently changes the shape of the cornea and obviates the need for correction of any kind.
I am greatly indebted to Dr. Marvin Mercer, the kindly optometrist who lived next door. He was always willing to immediately repair my eyeglasses — the pieces broken or bent or shattered playing basketball — and, later, to mail replacements for the hard contact lenses I flushed down the sink during removal when at college, in spite of his gentle reminders not to do that every time I returned home to visit. Unfortunately, by the time I required cataract surgery in my sixties and the new artificial lenses corrected my myopia, I still required spectacles almost full time for the reading problems (presbyopia) universal in old age.
My lifelong prejudice was that the individual was sentenced to myopia at the time of conception; while it is true that first-degree relatives like offspring and siblings of myopes have an increased risk, as evidenced by the Kovatch pedigree, the genetics of the condition are far more complex, involving dozens, if not hundreds, of genes. Furthermore, I recently was astonished to learn that the changes in lifestyle wrought by the COVID-19 pandemic brought to the forefront an “epigenetic” variable with a significant impact on the risk of developing myopia at the most vulnerable ages of 6-8 years: The amount of time spent in outdoor activities!
A large-scale study conducted in Feicheng, China one year after the peak period of home confinement enforced by the COVID-19 pandemic showed a 10% overall increase in the prevalence of myopia in children 6-to-8 years old in 2020 compared to a consistent baseline level from 2015 to 2019, representing a significant -0.3 diopter “myopic shift.” A breakdown of the data by age showed that the increase in prevalence was inversely proportional to age (3 times higher in 6-year-olds, 2 times higher in 7-year-olds, and 1.4 times higher in 8-year-olds), reflecting the plasticity of the developing eye. There was no increase in prevalence in children 9-to-13 years of age. As in my case, the dominant right eye was often more myopic that the left eye in the children studied.
A follow-up study by the same authors in China, just hot off the presses in last month’s edition of JAMA Ophthalmology, corroborated the association. When the Chinese children in Feicheng returned to normal living and learning environments following the end of the pandemic, the post-pandemic screening prevalence returned to the pre-pandemic level, indicating that the apparent exacerbation in the burden of myopia associated with the COVID-19 pandemic was temporary and alleviated by resumption of normal lifestyle.
Although the temporal association is statistically powerful, the cause and effect relationship remains speculative. Seven different facets of spending time outdoors could contribute to the positive beneficial effects on myopia: brighter light than the ambient indoor lighting, reduced peripheral defocus regulating eye growth, higher vitamin D level, differing chromatic spectrum of light, higher physical activity in general with its attendant health advantages, entrained circadian rhythms, and greater high spatial frequency (SF) energies. In the same way that an abundance of social interactions prevents cognitive decline and memory loss in seniors, can an increase in peer-socializing through activities (like team sports or hiking, for example), have a positive effect on the developing visual pathways?
It is very tempting to conclude that the association is strictly a negative one: time outdoor prohibits the excess involvement with near work, like reading, screen time and use of technology so prevalent today among early school-age children. Studies in humans trying to indict excess digital screen time for the development of myopia have produced mixed results, however, it seems prudent for parents to try to enforce the recommendation of limiting screen time in school-age children to 2 hours per day.
We need to put this spinoff of the COVID-19 pandemic in perspective. The burden of illness was mild for most children, with the exception of those who unpredictably developed the multisystem inflammatory syndrome (MIS-C). The greatest effect of the pandemic was COVID-19-associated orphanhood that tragically left an estimated 10.5 million children without their parents and caregivers. The effects on the collective mental health of society far outweighed those on improving the vision of predisposed individuals.
It seems very, very trivial to me these days that I spent most of the waking hours of my life wearing spectacles. In the same sentiment expressed by Einstein above, Winston Churchill is credited with saying, as the world approached the end of World War II, “Never let a good crisis go to waste.” It is incumbent upon our civilization that we analyze what we learn during these times of misfortune lest we unwittingly repeat the same mistakes over and over.
Following my cataract surgery, I no longer needed glasses for distance, so I am now able to enjoy outdoor activities, like running and kayaking, without them. Perhaps with the knowledge we gained during the pandemic, I could have started these outdoor activities when I was 6 years old and saved myself from the slap across the face rendered by the wrongful judgment of a fourth grade teacher!
source https://www.thepediablog.com/2023/03/23/out-of-the-old-black-bag-41/
Comments
Post a Comment