Short-sightedness in children. Why is slowing its progression so important? Episode 24

Monika Rachtan
Did you know that myopia is the most commonly diagnosed visual defect in children? Did you know that your child should spend 14 hours a week outdoors? Only then does his/her eyeball have a chance to regenerate. Did you know that there are effective methods available on the market to slow down myopia? We will talk about all this in the next episode of the programme "Patient First". I will be talking to Sylwia Kijewska, optometrist. I invite you to watch my programme.

Monika Rachtan
Good afternoon, Monika Rachtan and welcome to another episode of the programme "Patient First". Sight problems also affect children, and increasingly younger ones at that. Short-sightedness is the most frequently diagnosed eye disorder in children. Short-sightedness causes children to see distant images and objects that are far away from them blurrily. Today, I will talk to my guest, Sylwia Kijewska, about effective methods of stopping myopia. A very warm welcome to you, Sylwia is an optometrist.

Sylwia Kijewska
Yes, maybe I'll start by asking what an optometrist does, because I think our audience might not have a clue. I think the majority do.

Monika Rachtan
And where to find an optometrist?

Sylwia Kijewska
Usually, these offices are next to opticians' salons, but also in an increasing number of clinics or clinics with content are and then work in tandem with a team with ophthalmologists.

Monika Rachtan
OK, then those organisational matters are cleared up. I hope our viewers know with whom I have the pleasure today, but also you my dear ones. Today we have met to talk about myopia in children. Well, just what was the youngest child? How old was he or she in whom you encountered the problem of myopia?

Sylwia Kijewska
The one I examined was a seven-year-old child. On the other hand, I know that there are specialists, my friends, who have even children of 2 or 3 years old who already have myopia.

Monika Rachtan
So they are actually very young children, very young.

Sylwia Kijewska
Very. Some children have congenital myopia and here it is in these younger ones, at a younger age this defect is diagnosed later at school age. This is often referred to as school myopia. As the name suggests, this is how school starts, school myopia. On the other hand, there are also kids, unfortunately, burdened with problems related to genetics and this visual defect.

Monika Rachtan
You said myopia of schooling. I immediately wonder about that because we had Pandemic covid-19 recently, and the kids were spending a lot of time in front of computers and actually learning was in front of the computer, in front of the monitor, then free time. Well let's not kid ourselves, they couldn't hang out in the backyard, they couldn't go play football together, so they were spending in front of computers as well. Has this situation that we all faced also contributed to this myopia detecting us more and more?

Sylwia Kijewska
Yes, definitely changing lifestyles, because here this trend was observed even before the pandemic restrictions. Even then, it was suggested that due to the decreasing number of hours outdoors, we are all spending more and more, not just children. More time indoors, looking close. It is because of this that myopia is being diagnosed more often by just being obstructed. There was a time when we couldn't go into the woods, where it was a natural, natural place to go somewhere without extra people, but to relax. This has nevertheless contributed a great deal to the fact that children are being diagnosed more and more frequently, and this is growing at an exponential rate.

Monika Rachtan
Tell me, this problem is only seen in Poland or...

Sylwia Kijewska
All over the world? It is visible all over the world and here these restrictions. They were present everywhere. Yes, because they have been present everywhere. Even Africa is not free of it either, with more people with myopia being diagnosed.

Monika Rachtan
Amazing. And tell me, how is the image formed in a person who doesn't have a visual impairment, and how in a person who does? Who has myopia?

Sylwia Kijewska
As for people who do not have a visual impairment, they look far away, see clearly, look close, see clearly there is no problem. Generally when they change the direction of their gaze everything is fine too. A person who has myopia close up like I don't know what they need to read something, whether it's on their phone or a book or seeing something on the computer doesn't have much of a problem. The further away the object is that he is looking at, the worse he sees. It's like, for example, taking a camera and putting it into macro mode. You look at something close up, you want to take a picture of something close up and then, without changing the mode, you look at it far away and it's all blurry there. That's more or less what it looks like. So yes, everything is just blurred. The bigger the defect, the bigger, bigger the problem.

Monika Rachtan
I took the glass because I wanted you to tell me how such a child would see such a glass. You already said with another example, so I won't go back to that. But tell me, is the child able to identify the symptoms themselves? Maybe we'll talk about them soon, but. First I will ask you if the child is able to identify the symptoms themselves and report to the parent that something worrying is happening?

Sylwia Kijewska
Very rarely. Mostly children, because they don't know what it is like to see well. If they see poorly for a long time, they don't have that reference point. It's not like with a toothache, that it was fine, suddenly it hurts and we have to do something. Yes, absolutely that doesn't happen. Short-sightedness. It comes on very slowly, very gradually. It's the worse vision that appears in a child, so kids are mostly not able to notice by themselves that something is wrong here. Especially if this problem started, for example, at the beginning of primary school, where they were functioning more before. They would be drawing at the table, gluing something with plasticine and suddenly later they come to school and they have to rewrite something from the blackboard. So here, if this process started earlier, they don't know that something can be different, looking far away. Obvious.
Monika Rachtan
Tell me this. If the answer doesn't lie on the shoulders of the children, it probably lies on the shoulders of the parents. So what symptoms should parents look out for if a child squints when looking at something further away?

Sylwia Kijewska
If, for example, we go to a bus or tram stop with a child and the child is unable to recognise what the bus or tram number is, this could already be a signal that something may be wrong with their vision. When we watch something on TV, we move closer to the screen. Sometimes you may notice that children sit at a distance at first, but then move closer and closer to the computer screen. This can be a symptom that something is wrong with the vision. Sometimes there can also be symptoms that are not directly related to vision, such as headaches. A child with poorer vision may experience headaches because they have to strain more to see. Concentration problems may also be more apparent. Teachers may notice that the child cannot see well and has difficulty concentrating, especially when transcribing content from the board. Although the child is trying to pay attention, he or she may be spinning around in the chair, which may also suggest vision problems.

Monika Rachtan
That is, we appeal to the teachers who listen to us to look out for such signs. However, I think it is important for parents to take this advice seriously, because sometimes they may think the teacher is exaggerating.

Sylwia Kijewska
No, overdoing it by putting the child on the first benches is not a good solution. This can make it impossible to notice if something is changing in the vision, and the defect can progress. Therefore, it is a good idea to take into account suggestions from teachers that something may be wrong with your child's vision. If a teacher suggests that something is wrong with your child's vision, it is worth verifying this and going for an examination to rule out possible problems. Schools also carry out screening tests, which include an eye test. This too can help detect vision problems. However, the interval between such screening tests is several years, so problems can develop in the meantime. It is therefore worth having your child's eyes checked regularly by an ophthalmologist, even if your child does not complain of any problems.

Monika Rachtan
Do you need a referral to a paediatric ophthalmologist?

Sylwia Kijewska
As far as I am aware, a referral to a paediatric ophthalmologist is not required. However, it is worth making sure what this looks like by consulting your paediatrician. Procedures can change, so it's worth asking about current policies.

Monika Rachtan
Thank you for the clarification. It is also worth discussing your child's eyesight with your paediatrician.

Sylwia Kijewska
Yes, it is definitely worth talking to your paediatrician, as paediatricians also do eye examinations and are trained in this area. If there are any concerns about your child's eyesight, your paediatrician can provide appropriate advice and guidance.

Monika Rachtan
Once we have worrying symptoms, who should we go to in the first instance?

Sylwia Kijewska
If worrying symptoms appear, it is worth taking the first step to an ophthalmologist. The ophthalmologist will not only check the general health of your eyes, but will also assess your vision and the accuracy of your visual impairment. This visit will determine if there are vision problems and what the sources are. If necessary, the ophthalmologist may recommend further tests or treatment.
Monika Rachtan
And can it happen that a child is afraid of a visit to the ophthalmologist? Should we, as parents, prepare for such a situation, which may be unpleasant for the child?

Sylwia Kijewska
As far as the examination itself is concerned, there are unlikely to be situations that are unpleasant or painful for the child, unless we are presenting with a problem, such as an eye injury or illness. In that case, the situation may be different. However, when it comes to a routine check-up to check the state of the eyes, it is a good idea to talk to your child and prepare them for the visit. Exercising with eye drops is the most important thing here, as this is the biggest challenge. Therefore, it is worth visiting the ophthalmologist regularly from a young age, just like the dentist. Follow-up visits help your child get used to the eye surgery and eliminate stress. It also provides an opportunity to practice with saline drops, which are safe. Mastering this skill can help avoid stress for both child and parents.

Monika Rachtan
Of course, as parents, we often also feel the stress of going to the doctor ourselves, especially when we have a lot to say. Stress can make us forget things, so it is important to be prepared for the visit. It is also worth noting that detecting myopia in a child at an early stage is crucial. Why is this so important?

Sylwia Kijewska
As for myopia, it develops gradually and asymptomatically. Detecting it at an early stage allows appropriate methods to be used to both correct and slow down the progression of the visual defect. Correction is important so that the child can see clearly and not have problems at school. However, slowing the progression of myopia is equally important so that it does not become significantly worse in the future.

Monika Rachtan
What can be the consequences if myopia is neglected?

Sylwia Kijewska
The consequences of neglected myopia can be severe. There can be problems with the retina, which can lead to disruption of the neurosensory part of the eye, resulting in the loss of part of the visual field. There may also be problems with the macula, which is responsible for acute and colour vision. High myopia increases the risk of so-called macular degeneration or other damage to the eye. Unfortunately, irreversible changes to the eye are difficult to treat, so early action and prevention is important.

Sylwia Kijewska
Therefore, by investing in regular visits to the ophthalmologist and proper correction, we are investing in our children's future.

Monika Rachtan
That is, well-fitting glasses or contact lenses not only help to improve vision, but can also prevent serious vision problems in the future?

Sylwia Kijewska
Precisely, well-fitting glasses or contact lenses not only improve vision, but also help to control the progression of myopia. This is an investment in the healthy visual development of our children.
Monika Rachtan
Sylvia, you said about how we fortunately have effective methods of slowing down myopia. What do they consist of?

Sylwia Kijewska
When it comes to these methods, we have two types: pharmacological and optical. Both aim to slow down the growth of the visual defect. It is worth pointing out that although parents often think that if something can slow down the progression of the defect, the defect will not grow at all, this is not true. This slowing down means that the defect is growing, but more slowly.

Monika Rachtan
I understand. And what kind of slowdown can be achieved?

Sylwia Kijewska
Effective methods, which are recognised in research, allow the growth of the defect to be slowed down by around 50-70%. These are truly significant values. As for pharmacological methods, such as atropine in low concentrations, these achieve efficacy of between 60 and 70%, depending on the concentration.

Monika Rachtan
Are they drops or tablets?

Sylwia Kijewska
These are drops, but with a low concentration, of the order of one hundredth to five hundred per cent. They are applied every evening before bedtime, dropping in both eyes of the child.

Monika Rachtan
However, there is a problem with regularity, isn't there? In Poland, we often have a problem with regular medication. What if your child is at camp, for example?

Sylwia Kijewska
Yes, that's right. It is a prescription, so you have to go to the doctor every time.

Monika Rachtan
I see. And there are still optical methods?

Sylwia Kijewska
Yes, there are also optical methods that can help. We have colour lenses with a special design available. These are not ordinary contact lenses. These are lenses that have extra elements to focus on the periphery of the retina. In the centre, the child sees well, and in the periphery they have this special focusing. This helps to slow down the growth of the defect. This is one solution. Another option is contact lenses for myopia control, which work on a similar principle, creating a focus in the periphery and achieving high efficiency.

Monika Rachtan
So it's not just colour lenses or contact lenses that we use every day?

Sylwia Kijewska
Exactly, these are special lenses with a different design. Don't confuse them with regular contact lenses or glasses with regular lenses. These lenses are designed to slow down the growth of visual impairment.
Monika Rachtan
That is, when the doctor informs us that our child suffers from myopia, as parents we should pay attention to choosing the right lenses. Now tell me, do we find specific lens recommendations on the prescription, or is it up to us? When we visit the optical salon, how do we choose the best lenses for our child?

Sylwia Kijewska
There should be a specific recommendation for lens selection in the specialist's office, whether it is an ophthalmologist or another specialist who examines the child. Every case is different, so the specialist will be able to assess whether a particular lens will be best for your child. It is a good idea to make sure that you receive these recommendations from the specialist. If the specialist doesn't mention it, it's worth asking what we can do to both halt the progression of the defect and avoid making it bigger, especially if it's the first correction. Is there anything we can do about this? Sometimes there can be confusion or lack of time at a specialist appointment, which means that these recommendations can be missed. It is important to make sure we have clear recommendations from the specialist.

Monika Rachtan
Earlier you talked about different methods of combating myopia. I wanted to ask you about the characteristics of these methods.

Sylwia Kijewska
When it comes to lenses with DMS technology, they are non-invasive solutions because they do not require anything to be inserted into the eye. They are safe and effective, which is common to all methods. Contact lenses, on the other hand, are also safe but more invasive, and not every child is ready to wear them. As for drops, they are invasive and relatively inexpensive, but long-term costs are similar to other methods. It is worth remembering that regular visits to a specialist are required to obtain prescriptions, which is an additional burden. Nevertheless, all of these methods are effective and applicable.

Monika Rachtan
How do you convince parents of the effectiveness of these methods when myopia is difficult to see? We judge the results on the health of our children, not on our own eyesight. How can we be sure that these methods work?

Sylwia Kijewska
Without regular follow-up visits to a specialist, be it an ophthalmologist or optometrist, we are unable to verify the effectiveness of these methods. However, if a child starts to squint while wearing glasses, this may suggest that something has changed. An increase in eye defects and the need to replace lenses or glasses at the next visit are indicators of the effectiveness of these methods. Six-monthly check-ups allow you to assess whether the defect is progressing. This means that the lenses used are effective and frequent changes of lenses or glasses are avoided. This is both a financial saving and a long-term benefit to your child's health. It is worth remembering, however, that without regular check-ups we are unable to confirm the effectiveness of these methods.
Monika Rachtan
I have a specialist in front of me, so on behalf of inquisitive parents, I would like to know if we are able to find these studies on the internet? Where should we look for them?

Sylwia Kijewska
I most often use PubMed, which is available for English speakers. However, there are also many Polish sites where you can find translated abstracts of these scientific studies. It is worth noting that all the methods we discuss have research evidence and are available online. We can read entire scientific articles and better understand how these methods work.

Monika Rachtan
This is great information. I'll admit that in preparing for this talk, I read some recommendations and guidelines where the term 'full correction' came up. Can you explain to us what this means?

Sylwia Kijewska
Of course, 'full correction' is a very important concept, especially in the case of myopia. It means that the visual defect is corrected as fully as possible, i.e. the child sees as well as possible in these glasses or lenses. We should not use a weaker correction than the test indicates, as this can accelerate the progression of the visual defect. It is worth understanding that a child needs to see as well as possible to maintain eye health.

Monika Rachtan
I think this is again very difficult for the parents because when the child is at the eye doctor's examination, it is difficult to determine if the child has received full correction because we cannot see with the child's eyes. Tell me, how do you talk to your child and how do you prepare them for such an examination so that they actually achieve full correction and come out of the eye doctor's office and then out of the optician's shop with it?

Sylwia Kijewska
When it comes to talking to your child, it is useful to prepare them for the fact that the examination at the optician or ophthalmologist is not about checking if they have errors in reading letters, but about how your child sees. For us, this is information that helps to determine whether the child sees fully or at what level of vision they are at.

Monika Rachtan
I understand. And how do you convey this to your child?

Sylwia Kijewska
It is useful to talk to your child that the test is to see how he or she sees and that it is not an exam or test to test knowledge. The child does not have to learn the letters on the board, but rather answer questions based on what he or she sees. If the child does not see something, this is not a problem, but an indication to us that something may be wrong with the vision.

Monika Rachtan
When we talk about various health problems, including eye problems, prevention is very important. What can we do if a child does not have any worrying symptoms and has already been to the ophthalmologist and everything is fine?

Sylwia Kijewska
Prevention plays a huge role. First and foremost, it is worth encouraging children to be outdoors, where natural sunlight has a beneficial effect on vision and the release of dopamine, which helps slow the development of myopia. It is important that children spend at least two hours a day or 14 hours a week outside. In addition to this, limiting the time spent on close activity, reading, phone or tablet use can help with prevention. TV is safer, in terms of eyesight, than reading or using mobile devices.

Monika Rachtan
Can reading books be problematic?

Sylwia Kijewska
We can encourage children to listen to podcasts, which is a safer alternative. When it comes to reading books, it's a good idea to introduce short breaks every 20 minutes, during which the child can look out of a window into the distance or at something green to help relax their eyes. This is a good way of prevention.
Monika Rachtan
I would like to come back to the issue of teachers and how they inform children about the need to take care of their eyesight. I am trying to find ways for children to develop good habits. How do teachers implement this?

Sylwia Kijewska
It depends, different teachers use different methods. They often do it in the form of play, especially with younger children. Children are then more willing to engage in these activities. It is also worth looking at health-oriented initiatives in schools, such as healthy eating education, which can complement this sight education.

Monika Rachtan
It is very important that children are aware of the importance of taking care of their eyesight. Parents and teachers are encouraged to do so.

Sylwia Kijewska
Exactly, education through play can help children better understand why it is important to take care of their eyesight and how to do it.

Monika Rachtan
Now, please tell me what are the three most important messages from our conversation today that our viewers and listeners should remember?

Sylwia Kijewska
First and foremost, regular eye examinations for children are essential, whether or not your child reports vision problems. It is worth visiting an ophthalmologist to check that everything is in order. Secondly, if a visual impairment is diagnosed, it is worth asking about methods that can help slow down its progression. And thirdly, encourage people to spend time outdoors, which has a positive effect on vision and overall health.

Monika Rachtan
Thank you for these valuable tips. I, for one, will definitely make use of them. Now, let's wrap up this conversation because we are working with the Institute for Patients' Rights and Health Education, which promotes the humanisation of medicine. How do you see the humanisation of medicine?

Sylwia Kijewska
In terms of humanising medicine, I think it is important to take a holistic approach to the patient. This means that we should take into account not only the obvious health condition, i.e. the eyesight, but also other aspects of the patient's life, such as eating habits, lifestyle, stress and other diseases. All of these can affect eye health. Therefore, it is worth looking at the patient as a whole.

Monika Rachtan
This is a very wise approach. It is important not to focus only on one aspect of health, but to examine the patient comprehensively, taking into account various factors. Thank you for this interview. I hope that our viewers now understand the importance of taking care of children's eyesight and regular eye examinations.

Sylwia Kijewska
It is never too late to take care of your eye health. We encourage everyone to visit ophthalmologists and take care of their eyes