The Puzzling Rise in Nearsighted Children

The Puzzling Rise in Nearsighted Children

angjiang, China

Children in this small southern Chinese city sit and recite their vocabulary words in an experimental cube of a classroom built with translucent walls and ceilings. Sunlight lights up the room from all directions.

The goal of this unusual learning space: to test whether natural, bright light can help prevent nearsightedness, a problem for growing numbers of children, especially in Asia.

With nearsightedness, the eye grows longer, so light doesn’t focus the retina as it should, making more distant objects appear blurry.

In the U.S., the rate of nearsightedness in people 12 to 54 years old increased by nearly two-thirds between studies nearly three decades apart ending in 2004, to an estimated 41.6%, according to a National Eye Institute study.

In several Asian countries, myopia rates in young people are far higher. A full 80% of 4,798 Beijing teenagers tested as nearsighted in a study published in the journal PLOS One in March. Similar numbers plague teens in Singapore and Taiwan. In one 2012 survey in Seoul, nearly all of the 24,000 teenage males surveyed were nearsighted.
Students in the classroom do eye exercises to help combat myopia. Photo: THEODORE KAYE FOR THE WALL STREET JOURNAL

Wei Wang, a professor of public health at Edith Cowan University near Perth, Australia, and one of the authors on the recent Beijing study, says genes combine with one’s behavior and environment to cause myopia. However, the fast increase must be due to environmental influences, since genes don’t change that quickly, he says.

The World Health Organization helped convened a group of international experts early this year that will review evidence and data on prevention and control of severe myopia. It will release recommendations as soon as this summer, says Silvio Mariotti, senior medical officer and an ophthalmologist at the WHO’s Prevention of Blindness program.

The greatest health concern is the increase in severe myopia, which increases the risk of serious eye problems like retinal detachment, glaucoma and macular degeneration, experts say.

Treatment is a major problem, too. Though glasses can correct vision in most myopic children, many aren’t getting them. Sometimes this is because parents don’t know their children need glasses or don’t understand how important they are for education. Other times, cultural beliefs lead parents to discourage their children from wearing them, according to Nathan Congdon, professor at Queen’s University Belfast and senior adviser to Orbis International, a nonprofit focused on preventing blindness. Many parents believe glasses weaken the eyes—they don’t.
Students play in front of their experimental classroom. Researchers think more outdoor time might help prevent myopia in children. ENLARGE
Students play in front of their experimental classroom. Researchers think more outdoor time might help prevent myopia in children. Photo: THEODORE KAYE FOR THE WALL STREET JOURNAL

Across Asia, doctors, parents and public-health officials are trying to prevent nearsightedness or keep it from worsening. Some methods are widely used but show little or no evidence of influencing nearsightedness. Those include acupressure-type eye massage based on traditional Chinese principles performed daily by many schoolchildren in China.

Other prevention efforts hold more promise. One main strategy being tested is to spend more time outdoors. The other involves a common drug named atropine.

Why myopia rates have soared isn’t entirely clear, but one factor that keeps cropping up in research is how much time children spend outdoors. The longer they’re outside, the less likely they are to become nearsighted, according to more than a dozen studies in various countries world-wide.

One preliminary study of 2,000 children under review for publication showed a 23% reduction in myopia in the group of Chinese children who spent an additional 40 minutes more outside each day, according to Ian Morgan, one of the researchers involved in the study and a retired professor at Australian National University in Canberra. (He still conducts research with Sun Yat-sen University in the Chinese city of Guangzhou.)

Outside the context of the study, it can be a challenge to get children to spend more time outdoors because of the heavy school workload and cultural beliefs about napping after lunch and tanning, Dr. Morgan says.

Not all studies looking at outdoor time have shown a difference in myopia rates. Some eye experts say that other factors, like extensive time spent doing what’s called near work, like homework and reading, also likely contribute to the growth in nearsightedness.
Ian Morgan, an Australian researcher, talks with students outside the classroom. Photo: THEODORE KAYE FOR THE WALL STREET JOURNAL

Dr. Morgan’s theory, which is supported by some animal research, is that light in the eye hits a neurotransmitter called dopamine, which releases chemicals that prevent the growth of the eye that can lead to myopia.

Dr. Morgan, Dr. Congdon and a team from Sun Yat-sen are now testing, as reported recently in the science magazine Nature, a so-called bright-light classroom made of translucent plastic walls in Yangjiang to see if the children can focus and sit comfortably in the classroom. So far it appears the answer is yes.

Sui Weixuan, 12, says the room at Yanxi Experimental Primary School, which seats about 50 students, is hotter than their traditional classroom. But she likes it better because it has better light. Many classmates echoed those sentiments.

Weixuan believes her eyesight deteriorated because she was watching TV and using the computer too much. “My parents told me, but I couldn’t control it,” says the petite girl with a wide smile and oval, black frames. Since she got glasses, she’s afraid of going blind one day and has curbed her TV-watching to one hour a week from three to four hours.

The research team hopes to start rotating children into the classroom for several hours each day starting this fall, Dr. Morgan says.

Eye doctors in parts of Asia already commonly recommend that children get outside more. But it can be surprisingly hard to get families to cooperate, some say.
A chart shows eye exercises, a common fixture in classrooms all over China. Photo: THEODORE KAYE FOR THE WALL STREET JOURNAL

Jason Yam, an ophthalmologist and professor at the Chinese University of Hong Kong, says it’s the first piece of advice he gives parents who bring in their nearsighted children. “The parents say yes, but they don’t do it,” he says.

Usually they come back and say their children didn’t have time to go outside because of homework. However, when he brings up another prevention strategy—using daily atropine eye drops—parents are very committed, Dr. Yam says.

Atropine, a drug used for decades to dilate the pupils, appears to slow the progression of myopia once it has started, according to several randomized, controlled trials. But used daily at the typical concentration of 1%, there are side effects, most notably sensitivity to light, as well as difficulty focusing on up-close images.

In recent years, studies in Singapore and Taiwan found that a lower dose of atropine reduces myopia progression by 50% to 60% in children without those side effects, says Donald Tan, professor of ophthalmology at the Singapore National Eye Centre. He has spearheaded many of the studies. Large-scale trials on low-dose atropine are expected to start soon in Japan and in Europe, he says.

Researchers are unsure how long children should use the eye drops for maximum effect. So far, the longest study has followed children for five years. In Singapore, children typically receive drops for three to six months at the first sign they’re becoming nearsighted. If their myopia continues to progress, they typically continue the drops for up to a year, Dr. Tan says.
Students at work in an experimental “bright classroom,” built to increase the students’ exposure to sunlight, in Yangxi city, Guangdong, China. Photo: Theodore Kaye for The Wall Street Journal

Other doctors say that because the side effects are minimal, children should continue using low-dose atropine drops until major eye growth is over, usually around the time of puberty. Dr. Tan says that exposure to the drops should be limited, as with any medication, to as short a period as possible.

Spending time outdoors is a low-risk solution, so the strategy can be applied broadly to children, says Karla Zadnik, dean of the Ohio State University College of Optometry. “Because more light is almost like fluoride in the water, it’s being applied to children without regard for their individual risk of myopia,” Dr. Zadnik, who has been studying myopia for 25 years, wrote in an email.

But more invasive or expensive treatments mean that children should first be assessed for their risk for developing nearsightedness before trying them, she says.

Prescriptions and Pride: VisionSpring’s Journey to One Million

Prescriptions and Pride: VisionSpring’s Journey to One Million

The woman I met in Choco, Colombia, arrived by canoe. She had made the trip down the river to the village where I was working as a young optometry student with a team of visiting eye doctors from Boston. She had travelled an entire day to get her eyes examined. Most of us complain about having to commute 30 minutes to work. She spoke little Spanish but it didn’t take me long to examine her eyes and determine her problem — she was legally blind. Considering the strength of her prescription, I was worried we might not be able to help her. Fortunately, I was able to locate a pair of glasses for her in the pile of used glasses we had brought down to distribute. While not a perfect match, the glasses were close enough to her prescription to restore her vision — never mind that they had 1950s cat-eye-style frames. I was feeling satisfied that we had done good work that day. But two days later the same woman showed up again. Back in her village, her cat eye glasses had been the source of ridicule. It was enough for her to make the arduous journey again to see if we could offer her a different pair of glasses. Sadly, we could not. The used cat eye glasses were the only pair that even came close to her prescription. I could never have predicted what happened next: the woman thanked us for trying to help, returned the glasses, then paddled back up the river, virtually blind. This was a defining moment in my life, when I first  realized that there are prescriptions, and then there is pride.

The New York Times recently published an article highlighting a new study that documents the inefficiencies associated with the distribution of used eyeglasses in
the developing world. The study gives evidentiary support to what I witnessed firsthand as that optometry student 25 years ago. I learned two things from that experience:

First, the problem is immense. Estimates for those who can have their vision restored with a pair of eyeglasses range from 500 million to 1 billion. The vast  majority of those individuals simply do not have access to affordable glasses. Second, the preoccupation with personal appearance is a human characteristic shared
the world over, or put another way, vanity is not monopolized by the rich. Having seen the depth and persistence of the market failure to deliver this simple tool, I decided to do something about it. I founded VisionSpring in 2001 so I could be an advocate for people like the woman in Choco, not by providing them with free glasses, but by treating them like customers. I built a commercially viable, scalable business model that activated consumers traditionally ignored by the  eyeglasses market: the Base of the Pyramid (BoP) consumer.

From the beginning, I understood that our success as an organization was contingent on our ability to be responsive to the needs and preferences of the BoP consumer. Pioneering a new business model, it is easy to get distracted by the business of the business. Forging new distribution channels, streamlining supply chains and determining appropriate price points are all critical elements of any product-based business. But it was only when VisionSpring started developing aspirational products specifically designed for the BoP consumer that market forces were unleashed and we began to see a path to sustainability. That was
a critical moment in our history.

Now is another, VisionSpring has just sold its 1,000,000th pair of glasses through our distribution channels in El Salvador and India and through partnerships with organizations like BRAC. A University of Michigan study determined that reading glasses have the potential to increase our customer’s productivity by 35%. For the hundreds of thousands of tailors, mechanics and rug makers whose work suffers as their eyesight begins to fail, this increase in productivity translates into tangible economic gain. Additional analysis of the data from the study indicates that increased productivity can translate into a 20% increase in the average  monthly income of VisionSpring’s target customer. Based on this data, we have created more than $216,000,000 in economic impact.

And this is only the beginning of our story; we are on course to sell 10 million more over the next 10 years. Even though we have yet to receive a single request for cat eye frames, if that were to change, we are prepared to give our customers what they want.

Netflix Begins Audio Description for Visually Impaired

Netflix Begins Audio Description for Visually Impaired

At Netflix, we work hard to continually improve the experience for our members when viewing movies and shows on our service, including providing accessibility across devices. Now we’re expanding our accessibility options by adding audio description on select titles, beginning today with our new critically acclaimed series, Marvel’s Daredevil.

Audio description is a narration track that describes what is happening on-screen, including physical actions, facial expressions, costumes, settings and scene changes. Customers can choose audio narration just like choosing the soundtrack in a different language.

In coming weeks, we’ll add more titles, including current and previous seasons of the Golden Globe and Emmy award-winning political thriller House of Cards, Emmy award-winning comedy-drama series Orange is the New Black, as well as Tina Fey’s Unbreakable Kimmy Schmidt and the epic adventure series Marco Polo.

Netflix is actively committed to increasing the number of audio-visual translations for movies and shows in our English-language catalogues. We are also exploring adding audio description into other languages in the future.

Over time, we expect audio description to be available for major Netflix original series, as well as select other shows and movies. We are working with studios and other content owners to increase the amount of audio description across a range of devices including smart TVs, tablets and smartphones.

Stay tuned.

Tracy Wright is the director of content operations at Netflix.

A Spice for the Eyes

A Spice for the Eyes

EyeCure-tumeric-3Turmeric, also known as “the golden spice,” has been around for more than 4,000 years. In India, where Radha Ayyagari, Ph.D., grew up, it’s used widely as both a food spice and an herbal medicine for treating a variety of diseases, including cancer, arthritis, urinary-tract infections and digestive disorders. It has been scientifically established that curcumin, the active ingredient in turmeric, is a potent antioxidant. So it’s perhaps no surprise that Dr. Ayyagari, a professor of ophthalmology at the University of California, San Diego, is developing an extract from turmeric that may be useful in slowing retinal degeneration.

Years ago, while reviewing scientific literature, Dr. Ayyagari discovered that curcumin is a catalyst for producing heat shock proteins, or HSPs, which play an important role in ensuring proper cell function. As so-called cellular chaperones, HSPs help prevent the misfolding of other proteins that occurs in the photoreceptors of people with autosomal dominant retinitis pigmentosa (adRP).

Photoreceptors, or rods and cones, are the retinal cells that enable us to see properly. With adRP, usually one parent is affected and has a mutated gene that causes the disease. In turn, his or her child has a 50 percent chance of inheriting the mutated gene. Dr. Ayyagari, an FFB-funded researcher who’s also a member of the Foundation’s Scientific Advisory Board, believes that curcumin may be able to help slow the vision loss associated with adRP.

Not long ago, she tested her hypothesis in a lab by adding curcumin to cultured cells that have the P23H mutation of the rhodopsin gene. Also known as RHO, it’s the gene that provides instructions for making a protein called rhodopsin, which is needed for normal vision. The P23H dominant mutation is one of the most common causes of adRP. Dr. Ayyagari also administered curcumin to a rodent model of the disease, and results from both studies were positive, showing that curcumin helps stall vision loss.

I recently asked Dr. Ayyagari a few questions about her curcumin studies. Here’s some of what she had to say:

Dr. Radha Ayyagari

How did you get the idea to test curcumin for the treatment of RP?
In India, herbs and spices are commonly used to treat a variety of diseases. Because of its widespread use in treating multiple diseases, I decided to investigate the use of curcumin for RP. Today, many of the drugs that are commonly prescribed are derived from plants. Aspirin, taxol and digitalis are all examples of drugs derived from plants. I think there are a lot more herbs and spices that may help slow disease progression, but they have just not been evaluated yet.

You’re also working on another project, one that’s developing a curcumin-like compound?
Yes. I’ve teamed up with medicinal chemists in synthesizing a curcumin-like compound with 10 times the activity of natural curcumin. In order to avoid systemic side effects, we are planning to deliver the drug directly into the eye. I and my colleagues are currently searching for additional financial support that will help move these studies into human clinical trials.

What else is needed to do that?
Additional research, to further validate the safety and efficacy of the drug in multiple animal models of RP. At high concentrations, curcumin becomes toxic to the body. This is why we developed the drug to directly deliver to the eye. We are currently seeking financial support from non-profit groups and venture capitalists to move this research forward. Research is expensive, and without additional support, we will not be able to move forward.

In addition to her research on curcumin, Dr. Ayyagari is actively involved in trying to identify gene mutations in people affected by retinal diseases. As one of the specific aims in her FFB-supported grant, she is comparing the DNA of individuals affected by RP with the DNA of their unaffected siblings.

In the past, it has been difficult to identify new gene mutations in people with autosomal recessive RP—in which both parents carry one copy of the mutated gene but have no symptoms themselves—because it shows up in one generation, then disappears. By using this novel “DNA comparison” technology, Dr. Ayyagari has identified dozens of new gene mutations in multiple individuals with recessive RP.

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