Raconteur

Eye Health 2019

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R A C O N T E U R . N E T 5 Myopia is an eye condition that causes distant objects to appear blurred, while close objects can be seen clearly. Other symptoms include squinting, eye strain and headaches. Feeling fatigued when driving or playing sports can also be a sign of uncorrected short-sightedness. The condition occurs when the eyeball is too long, relative to the focusing power of the cornea and lens of the eye. This causes light rays to focus at a point in front of the retina, rather than directly on its surface. Short-sightedness can also be caused by the cornea being too curved for the length of the eyeball. In some cases, myopia occurs due to a combination of these factors. Myopia typically begins in childhood and you may have a higher risk if your parents are short-sighted. In most cases, it stabilises in early adulthood, but sometimes continues to progress with age. What is myopia? Battling blue light obsession With half the world expected to be myopic within the next three decades, screen time habits may need to change before it's too late f you are reading this article online, you might want to look away now. The curse of the digital age is our relentless focus on screens and a pandemic of myopia is unfolding before our very eyes. Myopia, commonly known as short-sight- edness, is estimated to affect one in three people in the UK and it is becoming even more common. Research, jointly funded by the College of Optometrists and Ulster University, has shown myopia is more than twice as prevalent among children in the UK now than in the 1960s. "To avert tomorrow's explosion of blind- ness, we have to defuse this time bomb today," says Bhavin Shah, myopia control consultant. This is a global phenomenon, which is being felt across the world with varia- tions between regions and ethnic groups. In South Korea, for example, an extraordi- nary 96.5 per cent of 19-year-old males are myopic. But, in varying degrees, myopia is becoming the new normal and more than half the world's population will be myopic by 2050, based on current trends. So, why it is happening now? Scientists believe modern lifestyles play a key role, including the fact that we spend more time indoors, away from natural light, and we are not getting enough sleep. Increasingly, researchers are coalescing around one significant factor: screen time. There is no clear evidence that screen time alone is a direct cause of myopia. But there is evidence that spending more time out - doors reduces the risk of short-sightedness. Scientists are studying the long-term effect of exposure to blue light, a high- energy visible light with shorter wave- lengths, which we see from screens such as TVs, computers, smartphones and tablets. There is currently no scientific evidence that blue light damages your eyesight, but studies are ongoing. We do know that car- rying out near tasks, involving looking at something close up, such as mobile devices and computers, can increase eye strain for those who do this for long periods. But while it does not cause permanent damage to your eyes, it can be uncomfortable. One of the main symptoms is temporary blurred vision, but other signs, such as sore and tired eyes, dry eyes and headaches, are also associated with digital eye strain. Although mild myopia typically does not increase the risk of eye health problems, moderate and high myopia can be associ - ated with serious side effects that can put a person's eyesight at risk. Studies have shown that cataracts develop sooner in highly myopic eyes. They also have found that eyes with high myopia have a higher prevalence of co- existing disease and complications, such as retinal detachment. Meanwhile, myopia, even mild and mod- erate kinds, has been associated with an increased risk of glaucoma. An Australian study found that people with short-sight- edness had a two to three times greater risk of glaucoma than those with no myopia. Retinal detachment is another risk asso- ciated with myopia. A study published in American Journal of Epidemiology showed eyes with mild myopia had a four- fold increased risk of retinal detachment compared with non-myopic eyes. Among eyes with moderate and high myopia, the risk increased ten-fold. The study authors also concluded that almost 55 per cent of retinal detachments not caused by trauma are attributable to myopia. Short-sightedness can usually be cor - rected effectively with a number of treat- ments. Corrective lenses, such as glasses or contact lenses, help the eyes focus on dis- tant objects. Increasingly, people are turn- ing to laser eye surgery to alter the shape of the eye, while artificial lens implants are also becoming more widely available, using a man-made lens inserted into the eyes to help them focus. Although an outright cure for myopia has not been discovered, treatments are emerg - ing to raise hope that we may be able to slow its progression. Studies of atropine eye drops to control myopia progression have been impressive, at least for the first year of treatment. More research is needed to understand how atropine can best be used for the longer term. Orthokeratology involves the use of gas-permeable contact lenses that are worn during sleep at night to correct short-sight - edness temporarily, so glasses and contact lenses are not needed during the day. Evi- dence suggests children who undergo ortho- keratology do better than children who wear glasses or regular contact lenses during the peak years for myopia progression. Myopia often begins in childhood or ado- lescence, so parents are advised to sched- ule regular eye tests. It is also important to encourage children and young people to spend more time outdoors in regular play or exercise. Studies show two hours of outdoor activity every day is ideal. Best practice for safe mobile use includes night settings on devices to help children sleep by reducing the amount of blue light given off by the mobile phone, for exam - ple. It is also recommended that digital devices be switched off at least one hour before bedtime. More research is needed to help us under- stand the impact of smartphone eye strain and the best strategy for mobile usage. In the meantime, the message is slowly get- ting through that less is best when it comes to screen time. M Y O P I A I Martin Barrow ASIAN COUNTRIES PRO JEC TED TO BE MOS T AFFEC TED BY J U VENILE MYOPIA Countries with the highest prevalence of myopia among school children Breakthrough tech in the fight against sight loss Profiling three pioneering technology projects that could help those suffering from severe eye conditions T E C H N O L O G Y Retinal pigment patch An engineered patch derived from stem cells is used to treat people with severe sight loss from wet age-related macu- lar degeneration (AMD), a chronic con- dition with swift onset. Diseased cells at the back of the patients' affected eye are replenished with a stem cell-based patch, which is inserted under the retina with a special surgical tool in an operation last- ing one to two hours. Two patients mon- itored on a 12-month trial went from not being able to read even with glasses, to reading 60-80 words a minute with nor- mal reading glasses. The study by the London Project to Cure Blindness, a part- nership between London's Moorfields Eye Hospital NHS Foundation Trust, University College London Institute of Ophthalmology and National Institute for Health Research, could lead to off-the- shelf treatments being available on the NHS in the next five years. Danny Buckland Implantable miniature telescope A pea-sized optical lens magnifies and transmits images missed in blindspots and vision loss caused by age-related macular degeneration (AMD), which prin- cipally attacks the central vision. The device, developed by California-based VisionCare Ophthalmic Technologies, deploys two micro-lenses in a small glass tube that generates images that are picked up by healthy retinal tissue outside the central damaged areas. The eye's natural lens is removed and the tel- escope implanted in its capsule enabling light to be enlarged by three times which, although it does not cure AMD, allows patients to recognise people and objects that would have appeared dark prior to the operation. The device is implanted in one eye, which experiences a loss of peripheral vision, and the brain learns to balance the information from both eyes to create fuller images. Bionic eye Patients in London and Manchester made history by receiving the world's first bionic eye implants. The Argus II system, devel- oped by US company Second Sight Medical Products, restores a degree of functional sight in patients with retina pigmentosa, an inherited condition. An implant, contain- ing a micro-electronics pack, an antenna and an electrode, is positioned in the retina and links to a video processing unit pack and pair of sunglasses worn by the patient. The Argus II bypasses damaged areas of the eye by using a small video camera built into the sunglasses to generate images which are translated into electrical impulses that stimulate the remaining healthy cells in the eye to transmit visual images from the optic nerve to the brain. Hundreds of patients have successfully recovered some sight with the device. UI Diagnostics, the brainchild of two university medical stu- dents, could hold the key to improving eyecare inefficiencies and patient diagnosis. A simple plug-and-play tool could rev- olutionise eye-screening to save sight and streamline the NHS clogged clini- cal pathway. An innovative device, created by two final-year medical students at Imperial College London, could create a dynamic shift to preserve sight for patients and provide an economic boost across a strained health pathway. Simon Rabinowicz and Uddhav Vaghela, both 23, got their idea after being on GP placements where they noticed the standard hand-held oph - thalmoscope diagnostic tool was either feared or not used because of its poor functionality and results. "This device had barely changed since the 1870s and we discovered that many doctors did not feel comfortable using it," says Simon, who runs V UI Diagnos- tics with Uddhav in spare time around their studies. "GPs are fearful of making a false diagnosis and, if you are not confident, then the likelihood is you will refer the patient on and so our clinics are packed with people who could have been diag- nosed earlier." The pair combined their backgrounds in bio-engineering and software design to create the portable, box-shaped device which takes less than a minute to diagnose both eyes compared with the ophthalmo- scope's tortuous ten-minute process. "The ophthalmoscope involves the doctor getting very close to the patient and shining a light that gives a pin-hole image. They then have to move the light around and stitch every image together in their mind before making a diagno- sis. It is uncomfortable and inaccurate," adds Simon, who comes from London. "Our system just involves the patient looking at the box while the camera takes an image and transmits it to a computer screen where a doctor can make a detailed assessment of a full image rather than trying to remember scores of tiny images." T he s t udent s' i ngen iou s appl ic at ion of te ch nolog y won t he £ 4 0,0 0 0 Ven - t u re Cat a ly s t Cha l lenge 2 019 top pr i z e ea rl ier t h i s yea r a nd ha s at t rac te d supp or t f rom ex p er t s at t he We s ter n E ye Ho spit a l a nd Roya l Fre e Ho spit a l i n L ondon. The device, which features proprie- tar y technolog y to acquire and trans- mit images, is easy to operate and could be used by hea lthcare professiona ls or even patients at home. It is moving into clinica l tria ls with the aim of launch- ing in mid-2021. " This is a simple, affordable solu- tion that addresses a big problem," says Uddhav, from Teeside. "We have spoken to patients who were put down for a non-urgent referra l and seen months later by which time they had lost quite a lot of vision from macular degeneration. "Our device removes doubt so GPs can ma ke much clearer management plans and, if you think that ever y refer - ra l costs £1 20, just saving a fraction of these will save millions of pounds for the NHS." The students believe the device will have a huge impact in developing coun- tries where avoidable blindness affects up to 800 million people, according to the World Hea lth Organization. It can be used remotely to generate early and accurate diagnosis, so patients can be treated before their eyesight deterio- rates or disappears. V Our device removes doubt so GPs can make much clearer management plans and just saving a fraction of these will save millions of pounds for the NHS 2 China India United States Mexico Indonesia Nigeria Pakistan Bangladesh Brazil Japan 66% 62% 59% 31% 28% 23% 22% 22% 22% 12% 47% 50% 37% 15% 20% 11% 11% 11% 12% 4% 2020 2050 Clearly 2019 Danny Buckland The device shining a light on old-fashioned care C A S E S T U D Y Simon Rabinowicz and Uddhav Vaghela, founders of VUI Diagnostics 3 K.D.P. on Shutterstock Tim Mainiero on Shutterstock 1 Second Sight Medical Products h-a-m-a-n-n on Shutterstock VUI Diagnostics

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